Only one quarter of women with learning disability in Exeter have cervical screening

BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7149.1979 (Published 27 June 1998) Cite this as: BMJ 1998;316:1979
  1. Virginia Pearson, Consultant in public health medicine,
  2. Carole Davis, Screening manager,
  3. Chris Ruoff, Project leader, learning disabilities,
  4. John Dyer, Registered nurse (learning disabilities)
  1. North and East Devon Health Authority, Exeter EX1 1PQ
  2. Exeter and District Community Health Services NHS Trust, Exeter EX2 7JU

    EDITOR—With health authorities and trusts having just completed performance reviews of their local screening programmes (required by executive letter EL(97)67), issues surrounding access to health services have been highlighted. As part of local interest in the health needs of men and women with learning disability, we looked at the validated screening history of women with learning disability known to the Exeter and District Community Health Services NHS Trust. Of 62 women eligible for cervical screening, 15 (24%) had had a smear test in the previous five years (district average 82%). Of 12 women eligible for breast screening, seven (58%) had had breast screening within the last three years (district average 66%).

    We then surveyed the practices of the 43 women for whom recall had been postponed by the general practitioner without clinical grounds. The table shows the reasons given.

    Reasons that general practitioners gave for postponing recall for screening of 43 patients with learning disability

    View this table:

    Recent advice from the Department of Health notes that “concerns are often raised about the inclusion of people with learning disabilities in routine programmes, particularly when consent and co-operation are an issue. The staff of screening services, such as those for breast and cervical screening, require training on the special needs and problems of people with learning disabilities.”1

    We are concerned about the difference between uptake of breast screening and uptake of cervical screening, particularly in the light of the responses to our letter asking for reasons why women had not been invited by local practices. We believe that value judgments may be made about women with learning disability that affect their access to cervical screening. We have been disappointed in the level of interest in the health of this client group, particularly as a local initiative to increase awareness and interest among local general practitioners (a free study day organised by Exeter and District Community Health Services NHS Trust, which is approved for the postgraduate education allowance) has attracted minimal interest (nine (3%) of 270 general practitioners invited).

    We would be interested to know whether other people have had a similar experience in this area.


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