The Castle Practice: Cervical Cancer Screening ("Cervical Smear")

Cervical Cancer Screening ("Cervical Smear")

Due to the recent publicity surrounding Cervical Cancer a number of women are understandably asking why screening does not start earlier than aged 25.

Please see the advice below issued by NHS Wiltshire or visit the Department of Health web site.

Wiltshire Cervical Screening Programme

Why is cervical screening not recommended for women under 25?

The optimum age for starting routine cervical screening tests has been a matter of national debate for some time. A definite national policy (October 2003) now states that screening should begin at age 25. It is not recommended for women under the age of 25.
The aim of cervical screening is to reduce risk of cancer of the cervix by finding and treating cell changes that could, over time, develop into cancer. As with all types of screening, the aim is to achieve this without causing too much anxiety and harm to women.
Sexually active women under 25 are quite likely to have cellular changes that are transient. There is no benefit from having transient changes detected or treated. Cancer of the cervix is very rare under the age of 25. It is not certain whether screening can prevent the rare cases of cancer in women under 25. Screening in women under 25 therefore results in tens of thousands of young women having the anxiety of an abnormal result, and many thousands having unnecessary treatment for one who might possibly be helped. This makes it unethical to recommend screening for women under the age of 25.

The numbers in the table below show how many cancers, and cancer deaths, occur in women under 25 in England and Wales each year. It also shows how many would be screened and how many would have cellular changes found on screening.

England and Wales totals	How many women are there?	If they were all screened, how many would have an abnormal result?	Without screening, how many will be diagnosed with cervical cancer each year?	Without screening, how many will die of cervical cancer each year?
Age 15 to 19	1.5 million	270,000	Approximately 2	0 to 1
Age 20 to 24	1.5 million	270,000	Approximately 40	Between 0 and 10

Source: Office for National Statistics incidence and mortality data for cancer of the cervix. 1980-2002

The number with abnormality is based on a detection rate of 18% (Lancet 1995;356:1469-73).

The new national policy means that, because of the harm involved, the screening programme is not attempting to prevent cases of cervical cancer in women under the age of 25.
A cervical cytology test is seldom useful as a diagnostic investigation in a woman under 25. It does not help in diagnosing genital warts, infections, or the reasons for a vaginal discharge. Signs or symptoms suggestive of cancer warrant urgent referral to a gynaecologist.
It is not possible to define accurately an individual's risk based on factors such as cigarette smoking, oral contraceptive use, or sexual history. The recommended starting age of 25 therefore applies to all women.