Doctors and patients confuse cervical screening with diagnostic tests

Campaigns backed by patients and families to lower the age at which women are eligible for cervical screening are understandable. They present screening to the UK public as a logical, clear headed, and obvious health need.

The age at which cervical screening starts was raised from 20 to 25 in England after a recommendation from the advisory committee on cervical cancer screening in 2003.1 Northern Ireland followed in 2011,2 and Scotland will from 2015.3 I suspect that many campaigners saw this merely as rationing. If you believe that screening would have saved a 22 year old woman’s life, and it were available in Scotland but not in England, a natural conclusion is of unfair national differences.

Yet such media campaigns would leave a useless legacy.4 From the news reports available, it’s clear that the women in recent high profile cases presented to their doctors with symptoms of cancer. Screening wasn’t what they needed. It would have only delayed referral for appropriate diagnostic tests. Indeed, the majority of women under 25 who have cervical cancer diagnosed have had smear tests—smear tests do not provide a benefit to this age group.5 NHS guidelines recommend history taking, examination, and swabs or referral to hospital for such young women with symptoms.6 Smear tests do not feature. The National Institute for Health and Care Excellence makes it plain that when a woman has symptoms of possible cervical cancer “a cervical smear is not required before referral,”7 and Scottish advice is, “Any clinical suspicion is an indication for referral and not for a cervical smear.”8

Health journalists also confuse screening with diagnostic tests, which are available at any age.9 In just one example of many instances, Dr Miriam Stoppard wrote in the Mirror newspaper in 2013 that a patient with irregular vaginal bleeding “was refused a cervical smear on the grounds that at 24 she was too young.

“I wrung my hands in despair,” she continued. “Why can’t a doctor take it upon themselves to order a smear test for a women under 25 whose symptoms suggest she could be developing cervical cancer?”10

No wonder then that patients also fail to realise that a smear test is inappropriate and tell the press, “If anyone has pain or any symptoms, please demand to have a smear test.”11

These campaigns may do more harm than good because they haven’t understood who screening is for. But, and this is one of the hazards of placing screening on a pedestal, the confusion does not simply lie with the public but also within the medical profession itself.