Cervical cancer screening in older womenBMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n280 (Published 05 February 2021) Cite this as: BMJ 2021;372:n280
All rapid responses
The revelation that half of all cervical cancer deaths among women occur over the age of 65 is very significant especially in view of our aging society (1). While it’s clear that catch-up HPV testing for those that were inadequately screened would result in fewer deaths from cervical cancer, to ultimately succeed, testing must be part of a comprehensive educational program driven by general practice (1).
Access to accurate information is always a key success factor. There is evidence that cervical screening uptake among women over 50 has been decreasing due to poor patient understanding about the risks of cervical cancer (2). Many women wrongly believe that their perceived risk of cervical cancer is low due to HPV infection being acquired through sexual intercourse (3). While HPV infection can clear without treatment, depending on the type of infection and severity of cervical epithelial changes, these lesions can progress to cervical cancer up to 20 years down the line (4).
In contrast to recent policy decisions that have diminished the roles of GP during the Covid-19 pandemic, reducing cervical cancer deaths is a perfect opportunity to position general practice at the heart of this program (5). More relevant and reliable information needs to be provided to the older demographic of women, explaining that their current age and lifestyle does not necessarily eliminate their risk of cervical cancer. Who better to do this than the trusted GP that has historically provided continuing and comprehensive care. Through careful consultation there would no doubt be an increased uptake of cervical screening, especially for vulnerable women over 65. Bottom line: better outcomes and fewer deaths. Appropriate financial support by government and community healthcare would elevate success further. In addition, the return on investment would be significant and would benefit all stakeholders. A 2014 study showed that improving cervical screening rates could save the NHS £10 million per year (6).
Thus, the question posed by Gilham et al. should lead to a resounding affirmative response. A catch-up HPV test for women over 65 should be provided to save lives. The subsequent vital question of how this is best accomplished is easily demystified by involving our invaluable GP’s. Their active leadership along with the appropriate governmental support would put the incidence and rate of cervical cancer in the UK on a forever downward trend.
1. Gilham C., Crosbie EJ., Peto J. Cervical cancer screening in older women. BMJ 2021;372:280. doi: 10.1136/bmj.n280.
2. Marlow AV., Ryan M., Waller J. Increasing the perceived relevance of cervical screening in older women who do not plan to attend screening. Sex Transm Infect 2020;96:20-5. doi: 10.1136/sextrans-2019-054120 pmid: 31395750.
3. Cervical Cancer – Causes. [Cited 11 February 2021]. Available from: https://www.nhs.uk/conditions/cervical-cancer/causes/.
4. Braaten KP., Laufer MR. Human Papillomavirus (HPV), HPV-Related Disease, and the HPV Vaccine. Rev Obstet Gynecol. 2008;1(1):2-10. pmid: 18701931.
5. Park S, Elliott J, Berlin A, Hamer-Hunt J, Haines A. Strengthening the UK primary care response to Covid-19. BMJ2020;370:m3691. doi:10.1136/bmj.m3691 pmid:32978177
6. Salter J. Behind the Screen. Jo’s Cervical Cancer Trust. 2014. [Cited 11 February 2021]. Available from: http://www.demos.co.uk/files/Behind_the_screen_-_web.pdf?1402772155
Competing interests: No competing interests