by Dr Smruta Shanbhag, Consultant Gynaecologist and Gynaecological Oncologist
Cancer research UK reports that there are 3256 new diagnosis of Cervical cancer each year in the UK. This means that 9 people are diagnosed with cervical cancer every day. There have been 853 deaths from cervical cancer between 2017 and 2019. It is the 14th most common cancer in people with a cervix in the UK. It is diagnosed most often in women between 30 -34 years old in UK. 520 cases each year are linked with deprivation.
Since the early 1990s, cervical cancer incidence rates have decreased by around a quarter (24%) in females in the UK (2017-2019). Over the last decade, cervical cancer incidence rates have remained stable in females in the UK (2017-2019).
Cervical cancer screening in UK
Cervical screening checks the cells of your cervix and detects any abnormal changes before they can turn into cancer. It is not a test for cancer, it is a test to help prevent cancer. Cervical screening saves at least 2,000 lives each year in the UK.
Cervical cancer screening was introduced in UK in 1960s. Cervical screening is available to women and people with a cervix aged 25 to 64 in England. The first invitation is sent to eligible people at the age of 24.5 years. People aged 25 to 49 receive invitations every 3 years. People aged 50 to 64 receive invitations every 5 years.
How has cervical screening changed present time?
Since screening was introduced, it has also helped us understand the causes of cervical cancer. We now know that the Human Papilloma Virus (HPV) is a cause of cervical cancer. It is also known to cause penile cancer and neck cancer.
The HPV vaccination programme started in 2008, which was offered to girls and young women, and in 2019, this was extended to school-age boys.
Cervical screening looks for HPV. If HPV is found, the smear is tested for any abnormal cells. If there are no abnormal cells, a follow up smear is arranged for 12 months’ time. This will check to see if the immune system has cleared the virus. Most HPV infections are short lasting, and slightly abnormal cells often go away without treatment when the virus clears. If HPV persists, abnormal cells can, if left untreated, turn into cancer over time. If there are abnormal cells, the person is referred to the hospital for colposcopy. If abnormal cells are found, they can be treated so they do not get a chance to turn into cervical cancer.
Now that human papillomavirus (HPV) primary testing and vaccination have been implemented across the UK, we can expect to see cervical cancer incidence decrease even further, with more lives predicted to be saved.
Who is offered cervical screening?
Anyone who has a cervix is eligible for cervical cancer screening.
All eligible people who are registered with a GP (as female) automatically receive an invitation by mail. However, current cervical screening IT systems are not able to register trans men (assigned female at birth) and those registered as ‘non-binary’ gender. In these circumstances, the GP practice or a healthcare team managing gender reassignment should send screening invitations. These individuals are eligible for cervical screening if they have a cervix.
What is HPV?
As a consultant gynaecologist, I repeatedly see clients referred to colposcopy with abnormal smear test. Very often, there appears to be shame over having this infection or confusion and/or anger that a partner has passed it on to them when they have been faithful.
HPV is the name for a very common group of viruses that cause warts. Most people will get some type of HPV during their lives if they have ever been sexually active. It does not mean one of the partners has cheated or been unfaithful in the relationship. It is very common and nothing to feel ashamed or embarrassed about. One can get HPV from any kind of skin-to-skin contact of the genital area, oral, vaginal or anal sex and from sharing sex toys. Using condoms is not protective against HPV infection.
There are some types of HPV called high risk types of HPV that can cause cervical cancer. In most cases your body will get rid of HPV without it causing any problems. But sometimes HPV can stay in your body for a long time.
The current cervical screening test identifies people with HPV infection and helps identify changes to cells in the cervix which could develop into cancer if left untreated.
Myths around cervical cancer screening / cervical cancer vaccination
Throughout my career in Gynaecology over the last 28 years, of which 16 years have been as a consultant in Gynaecological Oncology, I have heard some common reasons why people (friends and family) choose to not go for smears.
- I am not currently in a sexual relationship, so I don’t need a smear: If you have ever had sexual contact, you can have HPV infection
- I have had the vaccine at school, so I won’t get cervical cancer: The vaccine reduces your risk to get cancer, but you can still get abnormal cells and cancer.
- I am embarrassed, what if they tell me I have this HPV infection: There is nothing to be ashamed or embarrassed, this is a common infection
- I have only had one sexual partner, so I don’t need this test/ vaccine: Your partner may have had HPV infection before meeting you
- My daughter is not one of those girls who has sex outside of marriage, so she won’t need the vaccine: She may marry someone who may have HPV infection
- I have heard its very painful: you should discuss this with your practice nurse instead of not attending. We have various tips and tricks to make this as comfortable as possible
- I have heard it takes away your virginity: this is not true
- I am very busy; it is so difficult to get an appointment to fit around my job: you should discuss this with your GP practice
How are we trying to increase cervical cancer screening uptake?
Because of the various reasons why people may not feel able to take up the offer for traditional cervical screening, there have been various studies for alternative methods. These are extending screening intervals from 3 to 5 years,Self-sampling (people can take their own vaginal swab without a speculum or urine sample) which can be done at home or in a clinic, urine-based screening for high-risk HPV and testing high risk HPV in menstrual blood. It is not a routine part of the cervical screening programmes in the UK currently. The later are still under further study.
What is the National Invasive cervical cancer audit and its medicolegal implications?
When someone is diagnosed with cervical cancer, the NHS performs a review of all records connected to an individual’s cervical screening history from the past 10 years. This was introduced so we can improve monitor quality and effectiveness of the screening program, compare the screening histories of individuals who develop cervical cancer with those who do not and support learning and development.
Affected individuals are invited to share the result if they wish to have this information.
This has led to medicolegal claims where the audit has identified that the smear tests were under-reported previously.
Summary:
Is cervical cancer preventable: Yes, 99.8% of the times, cervical cancer is a preventable cancer if precancerous cells are detected and treated early, which stops them from developing into cancer.
Is cervical cancer curable: Yes, it is a curable cancer if detected early. The earlier the detection, the better is the chance of cure with less aggressive treatment options.
The cervical screening program is essential for both of these to happen.