Cervical screening according to age and HPV statusBMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b3005 (Published 29 July 2009) Cite this as: BMJ 2009;339:b3005
All rapid responses
Cervical cytology in under 25 year olds? We have all the evidence, so why don’t we base some medicine on it ?
For many years now it has frustrated doctors working in English
Sexual Health services that the UK does not have a unified evidence based
policy on age of first smear.(1) Paper after paper is published pointing
out the sheer futility of cervical screening under the age of 25. The
editorial (2) and the paper by Sasieni, Castanon, and Cuzick (3)
categorically point out that there is no evidence of benefit for cervical
screening under the age of 25. They also point out that “because of the
high quality of the UK screening programmes the findings are probably
accurate and would apply to other countries”. Why on earth then do
Scotland & Wales see themselves so different that they have to
institute cervical screening from the age of 20? This may not be of much
interest to most practitioners in England, but those of us working in
border areas find it disheartening to have to explain over and over again
to young women why it is that their 21 year old friend who lives a few
streets away has had a cervical smear test (and in all probability a
colposcopy for “lesions” destined for spontaneous regression if left
alone!) and yet something seems to have gone wrong because she hasn’t been
invited. In our case, trying to justify the Welsh stance leaves the
patient feeling puzzled and lacking confidence in our advice and
management. Can we therefore please plead with the cervical screening
authorities in Wales & Scotland to get their act together, accept the
evidence, ride out the naïve, misguided wave of protest from trashy
newspapers and get the cervical screening age in line with England ? In
many European countries and even Australia, management of cervical
cytology and “lesions” in the under 25’s is a lucrative sideline for
Gynaecologists. They justify the practice by saying the evidence is
uncertain and the bizarre unhelpful situation in the United Kingdom gives
tacit support to their stance. Sort it out please !
Colm O’Mahony, Consultant; Nicola Steedman, Consultant; Michelle
Yong, Specialist Registrar; Elizabeth R Anderson, Specialist Registrar;
Vicki Finnegan, Staff Grade; Lynn Price, Associate Specialist.
1. O’Mahony C. There is no longer a place for underage cytology in
genitourinary medicine clinics.
Genitourin Med 1996;72:433-434
2. Cervical screening according to age and HPV status
Cytological screening under age 25 has very low effectiveness; after that
HPV genotyping helps to stratify risk. BMJ 2009;339:306-307
3. Sasieni P, Castanon A, Cuzick J.
Effectiveness of cervical screening with age: population based case-
control study of prospectively recorded data.
Competing interests: No competing interests