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Guideline to help GPs spot cervical cancer early

Guidance on symptoms and diagnosis in under-25s aims to reduce deaths

OnMedica staff

Thursday, 04 March 2010

New guidance will help GPs to identify symptoms and diagnose cervical cancer in young women, says the Department of Health.

The Advisory Committee on Cervical Screening (ACCS) recently recommended that the age for cervical screening should remain at 25-64 years because cervical cancer occurs in only about 50 women under 25 every year. But it is diagnosed late in many of these young women because when they present with abnormal vaginal bleeding they experience a delay before full pelvic examination, sometimes of 4-6 months.

Health Minister Ann Keen said: “The independent Advisory Committee on Cervical Screening (ACCS) told us that screening women under the age of 25 did more harm than good but that more work needs to be done to ensure patients with symptoms are treated correctly.

“This new guidance will support GPs and practice nurses to identify symptoms and refer where necessary to specialist services.”

The guidance gives GPs an easy-to-follow algorithm to help in the management of young women who present with post-coital bleeding or intermenstrual bleeding, starting by looking at the woman’s sexual and contraceptive history and leading through examination to referral.

The guidance re-emphasises the existing NICE Referral Guideline for Suspected Cancer (2005) which clearly states that that when women present with gynaecological symptoms, “the primary healthcare professional should undertake a full pelvic examination, including speculum examination of the cervix.” The guidance also says that this could be performed by a practice nurse experienced in cervical screening, and gives a link to order the NHS Cancer Screening Programmes publication Cervix chart for sample takers in primary care.

National Clinical Director for Cancer Sir Mike Richards said: “We have heard from a number of young women under the age of 25 who developed cervical cancer and they all had symptoms but did not receive a full pelvic examination to check for abnormalities in the cervix.

“To help GPs follow the correct procedure we have produced a pathway which maps the steps they need to take when women aged 20-24 present with post-coital bleeding and bleeding between menstruation.”

Chairman of the RCGP Professor Steve Field said: “We welcome this new guidance; it is a really positive step that will assist us in making earlier diagnoses for younger women aged 20-24, which will in turn improve the outcomes for those at risk, and ultimately save lives.”

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