Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Age for screening cervical lesions
- Souhail Alouini (5 July 2009)
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The earlier the screen, the better
- Edwin M Mapara (10 July 2009)
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Age for starting cervical screening.
- David B. Johnson (20 July 2009)
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Human papilloma virus, sexual behaviour and logical places of infection and malignancy
- Nikola N. Ilankovic (4 August 2009)
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Souhail Alouini, Gynaecologist and Obstetrician Centre Hospitalier Regional d'Orléans, 45000, France
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The age for screening of cervical cancer by the smear test in England remains at 25 years (1). However, in 2009 the objectives of cervical screening in our countries are no more destined for cervical cancer only, but also for the pre-cancerous lesions of the cervix that are accessible to curative and simple treatments (laser, cervical resection). As cervical intraepithelial neoplasia (HPV+) potentially evolving into carcinoma are sexually transmitted diseases, the cervical screening should be started in the year which follows the mean age of the first sexual intercourse, i.e. around 18 years (2) but not at 25 years. References 1. Wise J. Age for starting cervical cancer screening in England will not be lowered. BMJ. 2009;338:b2583. doi: 10.1136/bmj.b2583. 2. Mitchell K, Wellings K. First sexual intercourse: anticipation and communication. Interviews with young people in England. J Adolesc. 1998;21:717-26 Competing interests: None declared |
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Edwin M Mapara, Health Promotion Manager Community Health ActionTrust (CHAT)
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I have always wondered why the age for cervical screening is 25 years, yet in Scotland and Wales it is 20 years of age, just after the teenage period. Why is that so? With known facts and risks that cancer of the cervix; is the second most common cancer in women in UK; there are 24,000 abnormal screens every year; 100 types of human papilloma virus; early sexual intercourse predisposes; multiple partners or "links"; relationship with HIV infection; "UK's sexual revolution and sexual culture is reason enough. With almost 900,000 cases of sexually transmitted infections, the earlier the screen, the better! I would definitely go for 20 years of age, even if it is just to make one diagnosis. The agony, excruciating pain and suffering that these patients go through in their terminal stages is torture. Edwin Competing interests: None declared |
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David B. Johnson, General Practitioner/Gynaecologist. Brecon,Powys,Wales.
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Dear Sir, many readers will have noted that "the Government have ruled that 25 should remain the age at which women start screening for cervical cancer in England" and that "young women with gynaecological symptoms are not always being given the right advice from their GPs" - with the inference that GPs could do better and that this would make a difference to cervical cancer. This appears on the surface as the usual "GP bashing" that the current government have gone in for over recent years. In fact, the statements arise from advice from Professor Henry Kitchener, chairman of the Advisory Committee on Cervical Screening. Professor Kitchener is right to note that many smear abnormalities, but not all, in women aged 20-25 are often mild and would regress with time, and that they can lead to unnecessary investigation and treatment. It is a balance of overall risks and benefits. In Wales, we screen from age 20. One has only to see one young patient with invasive cervical cancer to be persuaded. What is very wrong is the suggestion that GPs may be at fault. The majority of young women presenting with irregular vaginal bleeding or vaginal discharge will have common causes for their symptoms - vaginal infection, cervical ectopy ("a cervical erosion") or breakthrough bleeding on the Pill etc. Very few symptomatic young women will have invasive cancer of the cervix - it is a rarity. Exhorting GPs to try harder and do better is thus a smoke-screen - it does not help the debate or young women - and it causes extreme irritation to hard-working GPs. If we want to make a difference, we have to do cervical smears and detect cervical pre-cancer (screening is for precancer, not cancer - as your article suggests!). Naturally, the Government looks at the expense and Professor KItchener fears over-loading English colposcopy clinics with many minor abnormalities. We need common healthcare policies in the UK - this should not be a quaesi-political area - patients deserve better. The squamo-columnar junction at this age is readily accessible on the ecto-cervix. I would suggest a common UK policy: (1)do 3-yearly smears from age 20. (2)in younger women - keep under annual smear surveillance if there are low grade abnormalities eg. mild dyskaryiosis etc (3)only colposcope and treat those with moderate dyskaryosis or worse. This gives young women safety and meets the logistical constraints. Criticising GPs is not the answer - Professor Kitchener needs their help and needs to engage with Primary Care not alienate it. signed Dr David Johnson. FRCOG,MRCGP.
Competing interests: I am a practising colposcopist in Wales. |
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Nikola N. Ilankovic, Professor, Head University Clinical Center, Belgrade YU-11000
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The locations on the body of sexual transmitted infections with human papilloma viruses, can correlate with "inovationes" in sexual behaviour. It is logical that the viral affects (condilomata, precancerous lesions and carcinoma) can be located on cervix, vulva, glans penis, prostata, anal region, oral region and tongue, head and neck, larynx, oesophagus and breast. Very important is the possible causal connection between human papilloma virus infection and breast carcinoma. Data show that apart from the heart and the kidney, the virus has been found in all other organs that have been analyzed so far, i.e., prostate, urinary bladder, oral cavity, larynx, esophagus, stomach, colon, liver, vagina/vulva, endometrium, ovary, breast, penis, anus, skin, and lung. Some of the detection rates are remarkable, e.g., colon cancer up to 97%, lung cancer 80%, and breast cancer 74% (Petersen I, Klein F., 2008)*. Double primary carcinomas (cervix and breast) in the same person is not rare.** The occurrence of a second malignancy in a patient with a known malignant tumor is not uncommon. It could be supposed the same or similar etiology (Viral?, HPV ??) or coincidence of different etiological factors. Maybe the new antiviral therapy and the Gardasil vaccination can be helpful for different types of malignancy, especially for very frequent and dangerous breast, anal and ovarian cancers. * Pathologe. 2008 Nov;29 Suppl 2:118-22. ** http://www.google.com/search?q=double+carcinoma+cervix+breast&rls=com.microsoft:en -us:IE-SearchBox&ie=UTF-8&oe=UTF-8&sourceid=ie7&rlz=1I7ADBS Competing interests: None declared |
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