MINI-SYMPOSIUM: CERVICAL CYTOLOGYCall and recall cervical screening programme: Screening interval and age limits
Section snippets
Age at first screen
The appropriate age at which to start screening depends on the underlying age-specific incidence of cancer, the (possibly age-specific) sensitivity of the screening test to detect pre-cancer and the effectiveness of treatment of screen-detected neoplasia. In England, the incidence of cervical cancer in women under 25 years of age is low (2.5 per 100 000 women per year),3 but the prevalence of human papillomavirus (HPV) is high4, 5, 6 and one in six smears in this age group is abnormal.3 Collins
Screening interval
In 1986, the IARC1 published a meta-analysis of the effectiveness of cervical screening using data from case–control studies (some of which were nested within cohort studies) from eight countries. In total, they studied 1381 women with squamous cell carcinoma of the cervix and 2259 age-matched controls. They found that the highest impact on incidence rates comes from screening every 3–5 years between the ages of 35 and 64 years. Screening women aged 25–34 years every 3 years or less has a
Screening in women over the age of 50 years
Van Wijngaarden and Duncan34 suggested that screening should stop at 50 years of age in women who had been adequately screened in their 40s. Their study in North-east Scotland found that cervical neoplasia in women over 50 years of age mainly occurred in women who had been inadequately screened. Cruickshank et al.35 calculated that an extra 9000 women who were adequately screened under the age of 50 years underwent screening to detect one case of CIN3. However, Flannelly et al.36 using data on
Screening women over the age of 65 years
Since the 1960s, screening beyond the age of 64 years has been considered unnecessary in most countries, provided that women have had three consecutive negative smear results. This recommendation was based on the low prevalence of pre-invasive disease in this age group. However, there is some controversy regarding when screening can be effectively and securely stopped.
At the beginning of the call–recall cervical screening programme in England, there was concern and debate regarding the
Side effects/barriers to screening
The most important side effect of and barrier to health-seeking behaviours and participation in screening, follow-up or treatment is anxiety and fear.2 In cervical screening, this comes from misunderstanding by women and health providers of the meaning of a positive smear result (specifically pre-cancerous lesions), a negative test result (usually interpreted as no risk instead of low risk) and an inadequate/unsatisfactory result.2
Other hazards of the screening programme are unnecessary
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A model to assess the effect of vaccine compliance on Human Papillomavirus infection and cervical cancer
2017, Applied Mathematical ModellingCitation Excerpt :Indeed it may take decades after acquiring HPV infection to develop pre-invasive cervical lesions and cancer [11]; the slow and complex cervical carcinogenesis is described in Malik et al. [1] and references therein. Sasieni and Castanon [12] note that the incidence of cervical cancer in women under 25 years in England is low (peak CIN3 incidence rates are observed in women aged 25–29, though not all CIN lesions develop into cancer). The same authors observe that the cancer rates are, in absolute terms, appreciable at 25 years of age for most countries studied, and 30 years in Finland, Netherlands and Japan in particular.
Chemoprevention of cervical cancer
2006, Best Practice and Research: Clinical Obstetrics and Gynaecology