Cervical Cancer - Prevention is in your hands

Today's blog is going to be a little different than my usual ones - focusing on something that I am very passionate about. I came across a news article last week about the rates of cervical cancer screening being at a 20 year low and so I want to take the time to discuss this in a bit more depth as I know first-hand how vital it is for women to attend regular screenings.

Dr Georges Papanicolaou’s screening method (the Pap smear) started in the US in the 1940s and was widely used in the UK a decade later. Papanicoloau's original smear technique obtained cells from the vaginal pool by a glass pipette. The cells were then placed on a glass slide and examined. As the cells examined were from the vagina and were, therefore, few in number, it made the detection and recognition of the abnormal cells a lengthy and laborious process. For many years, efforts were made to develop methods that would enhance the sensitivity and specificity of the Papanicolaou smear test and from this research and development, liquid-based gynecologic specimen collection evolved. Using this method the sample is collected directly from the cervix, normally by a small brush but rather than the smear being transferred directly to a microscope slide, the sample is deposited into a small bottle of preservative liquid. At the laboratory the liquid is treated to remove other elements such as mucus before a layer of cells is placed on a slide. This technique allows much more accurate results compared with its predecessor and is still used all over the world today.

In the UK, a national programme of cervical screening was established in 1988 as prior to this cervical screening was not applied in a systematic fashion in the UK. The programme originally involved every woman between the ages of 20 and 64 years being called and recalled every 3–5 years for a cervical sample test and now offers cervical screening screening at different intervals, depending on a woman’s age. See below:

Age Group Years Frequency of Screening

24.5 First invitation

25-49 Three yearly

50-64 Five yearly

65+ If any prior abnormality detected

The Cervical Screening Programme aims to notify people of their results within 14 days. Results can either be normal, inadequate, or abnormal.

• Normal: A normal test result means no abnormal cell changes have been found. No action is needed and you don't need another cervical screening test until it's routinely due.

• Inadequate: You may be told you need to have a repeat test because the first one couldn't be read properly. This may be because either not enough cells were collected, the cells couldn't be seen clearly enough or there was an infection was present. You'll be asked to go back so another sample of cells can be taken, usually after about 3 months.

• Abnormal: If you have abnormal results, you may be told you have: borderline or low-grade changes (dyskaryosis) moderate or severe (high-grade) dyskaryosis. If your result is low-grade, it means that although there are some abnormal cell changes, they're very close to being normal and may disappear without treatment. Further tests will be conducted to determine this. If more severe changes are found then these can eventually become cancerous if they are not treated - therefore it is vital that you attend further tests and treatment if recommended.

If caught early, cervical cancer is one of the most preventable cancers with a five-year survival rate of up to 91%. If cervical cancer is caught late and the disease has advanced, then the five-year survival rate drops to less than 20%. This shows the importance of having regular cervical cancer screening - however still too many women are not attending. Across the UK, only 72% of those invited will attend their screening - this is now the lowest it has been for 20 years, having fallen across every age and almost all local authorities in England.

Screening is a personal choice and women have the right to choose not to attend, but there is more than 1.2 million women who are making this decision and effectively putting their lives at risk.

Following the diagnosis of Big Brother star Jade Goody with cervical cancer back in 2008 and her subsequent death at the age of just 27, an extra 400,000 women went for their screening. Her openness in fighting the disease which killed her on Mother's Day in March 2009 - leaving behind her young sons Bobby and Freddy - brought home to young women the importance of regularly going for the checks however Robert Music, Chief Executive of Jo’s Cervical Cancer Trust, now states "the Jade Goody effect has long gone".

Statistics show that women aged 25-29 are the least likely to attend for screening of any age group and numbers are falling year on year. A study conducted by Jo's Cervical Cancer Trust shows that embarrassment about body shape is a barrier to attendance for between a third and half of women. It also highlights a lack of understanding about the importance of screening, with a quarter saying they didn't think they needed to go because they were healthy and more than a third believing screening doesn't reduce your cancer risk.

As a result of these findings, several experts have spoken to inform and reassure women about cervical screening. Robert Music, chief executive of Jo's Cervical Cancer Trust, said: "Smear tests prevent 75% of cervical cancers, so it is a big worry that so many young women, those who are most at risk of the disease, are unaware of the importance of attending. It is of further concern that body worries are contributing to non-attendance. Please don't let unhappiness or uncertainty about your body stop you from attending what could be a life-saving test. Nurses are professionals who carry out millions of tests every year – they can play a big part in ensuring women are comfortable". Jilly Goodfellow – senior sister and nurse practitioner at Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust has also said: "Nurses who take smears see hundreds of women but should never forget that the procedure may be embarrassing for some. We know that if a woman does not have an acceptable experience, this may put her off having smears in the future, and the biggest risk of developing cervical cancer is not having a smear. The nurse's focus is to make women feel welcome, comfortable and ensure their dignity is maintained, while obtaining a good sample. We do this by talking to the woman while she is fully dressed so she is aware of what is going to happen, explaining reasons for the smear, when she will receive the result and what it will mean. A chaperone is always offered, and if they would like a friend or partner with them, this is fine too. The majority of sample-takers are female nurses who fully understand what it is like to expose the most intimate part of their body to a complete stranger."

Every day 9 women in the UK are diagnosed with cervical cancer and 3 women will lose their lives to the disease. Cervical cancer is the most common cancer in women under 35 but this is largely preventable thanks to cervical screening programme. We need to start utilising this free service - it is clearly a life or death matter.