Although the UK’s cervical screening programme has reduced cervical cancer mortality rates by 60-70% in the last 30 years, screening uptake rates have fallen by 3.1% from 2004/5 to 2014/5.
According to a new review published in The Obstetrician and Gynaecologist (TOG), there is a need to adopt new methods of screening and increase engagement among women. The review found that despite the programme’s success, take up rates of cervical screening have fallen from 80.3% in 2004/5 to 77.2% a decade later. Just 63% of women in the UK aged 25-29 went for a smear test in 2014. Overall, one in five women between the ages of 25 and 64, and one in three aged below 35 are missing the opportunity to avoid this largely preventable disease.
The paper reviews all available evidence on the effectiveness of the UK’s cervical screening programme, as well as analysing the role of the human papillomavirus (HPV) as way of further reducing the incidence of cervical cancer.
Dr Theresa Freeman-Wang, consultant gynaecologist and co-author of the TOG review, said: “It is incredibly worrying that so many women are missing out on cervical screening. Young women who have been vaccinated against HPV may think that they are not at risk of cervical cancer, however, although the vaccine is effective against the two most common strains of HPV which cause around 70% of cervical cancers, it doesn’t prevent all of them, so it is essential they go for cervical screening from the age of 25.
“Research shows that inconvenience, a fear of cancer and concerns about the procedure put women off from making an appointment. Ensuring that coverage does not decline any further, remains an important public health issue.”
With more than 99.7% of cervical cancer cases caused by human papillomaviruses (HPV), there is growing support for HPV testing to be incorporated into the cervical screening programme; either as a co-test, or as a stand-alone primary screening test. Evidence shows that HPV testing is better at detecting potentially premalignant abnormal cells compared to current cervical screening, and involves longer screening internals, meaning testing could be reduced from every three years to six.
HPV primary screening is being evaluated in six centres across the UK to consider whether it should be rolled out across the rest of the UK. HPV testing is already being used across England and Northern Ireland to triage women who have had a cervical smear. Those who are HPV-positive and therefore at higher risk are referred for further investigation (colposcopy) while those who are HPV-negative do not need the procedure and go back to being screened every three or five years. Falling cervical screening rates have also prompted calls for a self-sampling HPV test. Research shows that women who avoid screening due to time pressures, risk perceptions, lack of knowledge and psychological barriers, consider it more acceptable to take a vaginal swab or urine sample by themselves.
The review also confirms the success of the HPV vaccination, predicting that it will ultimately save 400 lives each year. The programme was introduced in the UK in 2008 for girls aged 12-13 years old, with a two year catch-up jab for those 14-18. Research suggests the vaccine is 94% effective in preventing moderately abnormal cells.
