Health & Wellbeing Service - Manchester


Cervical Cancer

 

Health and Wellbeing Service fully supports the overall goals of NAEDI and works closely with partners to ensure that information, training and advice is provided to encourage health professionals and their patients to address any concerns or worries over cancer as quickly as possible.

Please read more information about the following Cancer area:


Cervical Cancer Translated Factsheets

 

Please select the relevant language below to find details of Cervical cancer symptoms.


Cervical screening for under 25s – statement of position

 

Why are women under 25 not invited for Cervical Screening?

Following the death of Jade Goody in March 2009, we have had a lot of enquiries and questions asking about the reasons why women under 25 are NOT invited or can (in most circumstances) access regular cervical screening which is also known as smear testing

This is because changes in the young cervix are normal. If they were thought to be abnormal this could lead to unnecessary treatment which could have consequences for women's childbearing. Any abnormal changes can be easily picked up and treated from the age of 25. Rarely, younger women experience symptoms such as unexpected bleeding or bleeding after intercourse. In this case they should see their GP for advice.

In June 2009 the Advisory Committee on Cervical Screening reviewed the policy of starting screening at age 25 and agreed unanimously there should be no change in the current policy.


Cervical Screening - Frequently Asked Questions:

 

What is cervical screening?
Cervical screening is not a test for cancer. It is a method of preventing cancer by detecting and treating early abnormalities which, if left untreated, could lead to cancer in a woman's cervix (the neck of the womb). The first stage in cervical screening is taking a sample using liquid based cytology (LBC).

A sample of cells is taken from the cervix for analysis. A doctor or nurse inserts an instrument (a speculum) to open the woman's vagina and uses a spatula to sweep around the cervix. Most women consider the procedure to be only mildly uncomfortable.

Early detection and treatment can prevent 75 per cent of cancers developing but like other screening tests, it is not perfect. It may not always detect early cell changes that could lead to cancer.

Who is eligible for cervical screening?
All women between the ages of 25 and 64 are eligible for a free cervical screening test every three to five years.

In the light of evidence published in 20031 the NHS Cervical Screening Programme offers screening at different intervals depending on age. This means that women are provided with a more targeted and effective screening programme.
The screening intervals are:

Age group (years) Frequency of screening
25 First invitation
25 - 49 3 yearly
50 - 64 5 yearly
65+ Only screen those who have not been screened since age 50 or have had recent abnormal tests

 

The NHS call and recall system invites women who are registered with a GP. It also keeps track of any follow-up investigation, and, if all is well, recalls the woman for screening in three or five years time. It is therefore important that all women ensure their GP has their correct name and address details and inform them if these change.

Women who have not had a recent test may be offered one when they attend their GP or family planning clinic on another matter. Women should receive their first invitation for routine screening at 25.

Why are women under 25 in ENGLAND not invited?
This is because changes in the young cervix are normal. If they were thought to be abnormal this could lead to unnecessary treatment which could have consequences for women's childbearing.2 Any abnormal changes can be easily picked up and treated from the age of 25. Rarely, younger women experience symptoms such as unexpected bleeding or bleeding after intercourse. In this case they should see their GP for advice.

In June 2009 the Advisory Committee on Cervical Screening reviewed the policy of starting screening at age 25 and agreed unanimously there should be no change in the current policy.

The Committee did agree, however, that in order to ensure that all women are screened by the age of 25, invitations could be issued to them six months before their 25th birthday.

A research paper (Sasieni P, Castañón A, Cuzick J. Effectiveness of cervical screening with age: population based case-control study of prospectively recorded data. BMJ 2009; 339:b2968) focusing on women screened under the age of 25 was published in the BMJ. It stated:
'Cervical screening in women aged 20-24 is substantially less effective in preventing cancer (and in preventing advanced stage tumours) than is screening in older women'

Why are women over 65 not invited?
Women aged 65 and over are taken out of the call recall system unless they need ongoing surveillance or follow up. This is generally required if a woman has had an abnormal result in any of her three most recent tests or is recommended for early repeats owing to a previous abnormality.

Generally speaking, the natural history and progression of cervical cancer means it is highly unlikely that women of 65 and over will go on to develop the disease. Women aged 65 and over who have never had a test are entitled to one.

What about women who are not sexually active?
The NHS Cervical Screening Programme invites all women between the ages of 25 and 64 for cervical screening. But if a woman has never been sexually active, then the research evidence shows that her chance of developing cervical cancer is very low indeed. We do not say no risk, only very low risk. In these circumstances, a woman might choose to decline the invitation for cervical screening on this occasion. If a woman is not currently sexually active but has been in the past, then we would recommend that she continues screening.

I am in a same sex relationship. Do I need cervical screening?
The Human Papillomavirus ( HPV) which causes cervical cancer can be transmitted between women. Even women who have never had sex with a man can't be said to be at no risk of contracting the virus, only at low risk. Therefore it is still advisable to be screened.

 

What happens at a cervical screening appointment?

 

Invitation for cervical screening
You will receive a letter from your local Primary Care Trust or GP asking you to make an appointment for screening. You can choose whether to have it done at your GP practice or family planning clinic. Most women choose to have the test done by their GP or practice nurse. You can ask to have yours taken by a female doctor or nurse if you prefer.

Taking a sample
The sample taker should explain the procedure and you should feel able to ask any questions at any time. The doctor or nurse uses an instrument called a speculum to open up the vagina and then a spatula is used to "sweep" around the cervix (neck of the womb) and take a sample of cells from its surface. Most women consider the procedure to be only mildly uncomfortable.

Then the head of the spatula, where the cells are lodged, is broken off into a small glass vial containing preservative fluid, or rinsed directly into the preservative fluid. This is sent to a laboratory for examination under a microscope. Cytology - the study through a microscope of the cells - enables the tests to be grouped into different grades which determine what happens next.

What happens next?
You should receive the result of your test in writing in around two weeks from the date of your test.
Most women receive a normal result, which means that the cells were considered to be normal. These women are recalled for another routine test within three to five years. Of 3.3 million women aged 25 to 64 who received a result in 2010-11, 93.4 per cent had a normal result.
Some women receive an abnormal result. This means the laboratory has identified some cell changes which need further investigation. Not all abnormal changes need to be referred for immediate treatment; some may disappear without the need for any treatment. Depending upon the degree of changes, women may be asked to have a repeat test in six or twelve months, or may be referred for colposcopy.

A small proportion of women are asked to return for a second test as the first was considered to be inadequate. This simply means the laboratory was not able to assess the cells to give a result. This may be because of the presence of blood obscuring the cells, or because the sample of cells was too thick or thin. In 2010-11, the percentage of inadequate tests was 2.8 per cent.

Is cervical screening effective?
Whilst cervical screening cannot be 100 per cent effective, cervical screening programmes have been shown to reduce the incidence of cancer in a population of women. For example:

Percentage of Cancer Preventable
(Protection offered by a single negative smear)

  20-39 years 40-54 years 55-69 years
3-yearly screening 41% 69% 73%
5-yearly screening 30% 63% 73%
Sasieni, Adams, and Cuzick, BJC 2003

 

Coverage of the target population
The effectiveness of the programme can also be judged by coverage. This is the percentage of women in the target age group (25 to 64) who have been screened in the last five years. If overall coverage of 80 per cent can be achieved, the evidence suggests that a reduction in death rates of around 95 per cent is possible in the long term. In 2010/11 the coverage of eligible women was 78.6 per cent.