Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Offering screening to women under 25
- Bernard J Charnley (19 February 2007)
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Women under 25 deserve better
- George Kassianos (12 March 2007)
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Bernard J Charnley, Consultant Histopathologist The Old Vicarage, Defynnog, Brecon, Powys. LD3 8SB
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The policy not to screen women under 25 does indeed announce the message that screening that age group does more harm than good: Dr Herbert and Dr Smith appear to disagree with this view, presumably because they believe the treatment is of insignificant harm measured against the disease prevented. Wales has had a policy of screening from age 20 and the results merit study. I have been supplied with suspend codes for residents of Wales and Merthyr Tydfil who were tested by Cervical Screening Wales as of May 1st 2004. These correspond closely with colposcopy and treatment. They indicate a 20 year old Welsh woman joining and staying in the programme can expect a one in three chance of having cervical epithelial ablation therapy by her early to mid thirties. In Merthyr residents the chance is one in two. Faced with a 20 year old who wants to be screened a General Practitioner should advise her that starting screening at this age often comes with several hospital trips and cervical ablation therapy attached, and detail these risks based on knowledge of the figures in the population served by the local laboratory. The chances of being offered ablation therapy decline in the late thirties but remain significant. I doubt that many women sign up to a lifetime of cervical screening aware that if they attend as advised, they are odds on sooner or later going to get treatment. The cervical screening programme has quietly morphed into a cervical epithelial ablation programme. If ablating the transition zone in 60% of the participating population who constitute about 80% of the total population reduces cervical cancer by 40% perhaps every woman should be offered cervical epithelial ablation therapy without preceding smear at age 20. I hope adoption of vaccination against papilloma viruses renders this programme obsolete. Pending this I suggest telling women how this programme works and getting informed consent on joining is urgently needed. Competing interests: None declared |
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George Kassianos, GP Pnincipal The Ringmead Medical Practice, Leppington, Bracknell, RG12 7WW
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I was reading with great interest the letter on “Women under 25 should be offered screening”. The authors highlight a very important problem for us General Practitioners but also for Gynaecologists and Histopathologists. The withdrawal of cervical cytology service to the under 25-year old women has been a retrograde step that goes against the principal of early prevention. Only last month, I was trying to explain why we did not call in for a smear a young girl under 25, whom we have now found to have carcinoma of the cervix with metastases. The patient and her family are devastated. Had she been able to have a routine smear, she would have stood a chance of being healthy today. This case highlights the importance of allowing GPs to screen women for cervical neoplasia earlier than the age of 25 years. Also, the need to think seriously about introducing another very important preventive measure; immunisation against human papilloma virus. Both these measures must be implemented with speed and should be accompanied with a meaningful and appropriate campaign by the DoH to persuade young women to come forward for their smears and vaccination. Dr George Kassainos
Competing interests: Member of the Cervical Cancer Initiative, spokesperson on immunisation for the RCGP, spokesperson for the British Travel Health Association, Father. Editorial note
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