Health and cervical screening: emotion vs evidence

I won’t bore readers with all my usual concerns about screening programmes in the UK: the tendency to supply unbalanced information, the overselling of the plus points of screening, and, too often, the quiet hush about the negatives. I’m not against screening per se – I’m just very concerned about the potential of it to do more harm than good, and the need for healthcare professionals to give enough good quality information to allow people to make properly informed and free choices.I was just about to go on holiday a few weeks ago when this press release landed in my email, which I have copied below.

Women in England Remain at Increased Risk of Undiagnosed Cervical Cancer Compared to Rest of UK

- Marie Stopes International Reinstates Call for Uniform Cervical Screening Programme throughout the United Kingdom -

According to news reports, the Department of Health have today announced that women under the age of 25 will not be routinely screened for cervical cancer. Leading sexual health agency Marie Stopes International (MSI) makes the following statement:

“We are extremely disappointed that the Department of Health has today announced the decision not to offer routine cervical screening for under 25s. Cervical screening currently begins at age 20 for women in Scotland, Wales and Northern Ireland, but women in England have to wait until they are 25.

“Since the beginning of this year, Marie Stopes International has been calling for cervical screening to be standardised across the UK, so that all women start testing at the age of 20. We are today reinstating this call to action.

“The sad and high profile case of Jade Goody has shown that cervical cancer, whilst extremely rare among women under 30, does nevertheless represent a potential threat to their lives and wellbeing. In the UK, more than 1,000 women die from cervical cancer each year. However, early detection and treatment can prevent around 75 per cent of cervical cancers developing in women, so an about-turn from the Government to offer screening from a younger age could save lives.

“The recent introduction of a cervical cancer vaccination programme ironically makes screening all the more important. The vaccine is not a bullet-proof shield against cervical cancer, but there is concern that once vaccinated some young girls may think they are ‘safe’. It is therefore vital to encourage girls to start thinking about their own cervical health as early as possible, and to develop a screening culture amongst young women to ensure as many cases of this preventable form of cancer are detected as possible.

“The Department of Health concerns itself with the provision of standardised high-quality care for all, and with promoting a culture of prevention rather than cure. It is therefore nonsensical that English women have to wait for a preventative cancer screening service that is provided five years earlier to women living in the rest of the UK.”

All quotes above are attributable to Liz Davies, Director for UK and Europe, Marie Stopes International Spokesperson.

- Ends -

I think this is very interesting for a number of reasons.

The release doesn’t relate any of their points to clinical evidence. The chances of any women benefiting from cervical smears between 20-24 are minimal, as a study in the BMJ shows: Effectiveness of cervical screening with age: population based case-control study of prospectively recorded data.

In fact, there has been no clear evidence for benefit up till now. Why is this important? Women in this age group are at risk of “false positives”, ie the smear detecting an abnormality when the cellular changes are not dangerous and would not have led to invasive cancer. They might receive treatments for these changes – but treatments they will not benefit from, because these changes would never have led to a life-threatening cancer.

Is cervical cancer “preventable”? The authors analysed the histories of the women who had developed cervical cancer in the 20-24 age group – of these 73, only five had not been screened in the past five years. Neither vaccination nor regular smears can guarantee to prevent cervical cancer. Furthermore, what about the stigma? There is a line being taken that women with cervical cancer have somehow themselves to blame for not having had the necessary “preventative” treatment: utter rot, of course.

It would be far more sensible for the rest of the UK to change their smear progammes to start at age 25, in line with the more evidence-based practice in England. It’s a great pity Marie Stopes does not seem to have considered the lack of evidence for what they favour, and the potential harms of the screening that they advocate.

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