DO SMEAR TESTS NEED REBRANDING?
With so few of us attending our cervical screening appointments, would a name change help? Anne Montague investigates…
Asks Anne Montague
If you’ve had the HPV vaccine, you still need to go for screening
Let’s be honest, no one looks forward to a smear test. Maybe it’s the indignity, the potential discomfort or just the name that puts us off, but the fact is, fewer of us than ever are responding to that cervical screening invitation letter. Screening attendance in the UK has hit a 20-year low, with only 71.4% of women in England attending. In some areas of the country, uptake has dropped below 50%, even though cervical cancer is still a significant threat. Around 3,000 women are diagnosed with cervical cancer every year and more than 99% of cervical cancers are known to be caused by infection from high risk HPVS (human papillomavirus). And, shockingly, at least two women die every day from the disease, which is largely preventable.
What’s particularly worrying is that those who are least likely to attend screening, 25-35 year olds, are also those most at risk from the disease. Research shows that the number of cases is set to rise. Over the next 20 years, the diagnosis of cervical cancer will increase 50% among 50-54 year olds and 54% among 60-64 year olds, according to research by Jo’s Cervical Cancer Trust.
‘Screening can stop cancer before it starts, and estimates show that if everyone attended regularly, 83% of deaths could be prevented,’ says professor Anne Mackie, director of screening at Public Health England (PHE). Cancer prevention experts at King’s College London estimate that smear tests helped prevent 65,000 cancers between 1988 and 2013, and now prevents around 5,000 cancers every year. Yet apart from a brief surge in 2009 after the death of
Big Brother star Jade Goody, the numbers attending screening show a steady downward trend.
WHAT’S STOPPING US? The research carried out by Jo’s Cervical Cancer Trust found many reasons why women don’t attend. ‘Embarrassment, fear of pain, fear of the result, of cancer, of the unknown and lack of understanding of what the test is really for all play a part,’ says Kate Sanger from the charity. She believes that the word ‘smear’ may not help. The Government recently tackled this head-on with its first-ever advertising campaign that dropped the word smear, and urged more women to attend by focusing on the life-saving potential of screening.
Older women may not think cervical cancer really constitutes a health threat to them, especially if they’ve had a run of clear smears and are in a stable relationship. ‘What many women don’t realise is that HPV can be in your body but remain dormant for 20 years before it becomes active,’ says Kate.
Amazingly, there’s also still widespread ignorance about what cervical screening does. Some believe it’s designed to detect cervical cancer rather than abnormal, potentially pre-cancerous cells, or that it can detect other cancers.
Amid all this, there is some good news. All girls born after 1991 are now offered an HPV vaccination, and this is starting to have an impact. Experts originally thought the vaccine would knock out two types of HPV (which caused around 70% of pre-cancerous conditions) but have now found that it also eliminates another three, giving even better protection. Early results from Scotland suggest that the vaccination could eliminate 80% or more cervical pre-cancerous cells. This is positive for
those in their teens and early 20s, but it doesn’t mean they can skip screening, because the vaccine doesn’t protect against all types of HPV that cause cancer. For older women who haven’t had the vaccination, screening still provides vital protection.
BETTER SCREENING TECHNIQUES
Cervical screening is not 100% accurate and cytology, which looks for abnormalities in the cells taken from the surface of the cervix, is only 70-80% reliable. By contrast, HPV testing, where the cell sample is first tested for the presence of high-risk HPV, is 90-95% reliable. It is also the best way of detecting anyone at a higher risk of cell changes or cervical cancer. This type of testing will be rolled out later this year in England, next year in Scotland and is already happening in Wales. Dates for Northern Ireland are still to be confirmed.
HPV self-sampling (also known as DIY smears or home-testing kits) will also be piloted in two areas of London later this year to try to find the best way to offer the test to women who haven’t responded to a screening invitation. The test involves using a swab (like a long cotton bud), or a soft brush, to collect a sample from your vagina and takes just a few minutes. You then send it to the laboratory for testing and, if you have HPV in the sample, you will be asked to have a standard cervical screening test; it’s thought only about 13% of women will have to do the latter.
Australia is already showing what can be achieved. It was one of the first countries to introduce HPV vaccination for girls in 2007, which was later offered to boys. Researchers now say that Australia will become the first country to effectively eliminate cervical cancer if vaccination and screening rates are maintained. It is predicted that by 2022 cervical cancer will be classified as ‘rare’, when the incidence should drop to less than six cases per 100,000 people. Dr Philippa Kaye from Jo’s Cervical Cancer Trust says we have the potential to do the same. ‘There’s a real chance that cervical cancer can be eradicated. The HPV vaccination combined with screening could lead to the cancer becoming a disease of the past. It would not be able to develop.’ So the message to all women is keep your screening appointment. That way, we can beat cervical cancer.
WAITING FOR YOUR RESULTS
The shift to HPV testing later this year and the subsequent restructuring has meant that cytologists are already leaving the NHS. This has meant that, in some areas, laboratories have become overloaded and women are waiting longer than the promised two weeks to get their test results. The recent government campaign encouraging more women to get screened has put even more pressure on the system. Although plans are in place to address delays, waiting for results is an anxious time. When you go for your screening, ask how long it will be before you get the results; remember, cervical cancer takes around 10 years to develop, so it’s unlikely a short delay will affect your health. If you have any concerns, see your GP immediately, or contact the Jo’s Cervical Cancer Trust Helpline on 0808 802 8000.
HPV VACCINATION FOR BOYS
There are around 200 different types of HPV and a small number of these are classified as high risk because they increase the danger of getting some anal, genital, head and neck cancers as well as cervical cancer. Overall, 5% of cancers worldwide are linked to HPV. Now boys as well as girls aged 12-13 are being offered the HPV vaccination in schools. Boys can also get the HPV vaccine free from the GP up to the age of 18.