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New evidence supports a lower age for cervical cancer tests

Study shows cervical cancer detected earlier with regular screening

OnMedica staff

Tuesday, 07 April 2009

Pressure is growing for the age at which women begin smear tests to be reduced following evidence from a study that shows the benefits of routine cervical screening in young women.

Researchers writing in the BJOG: An International Journal of Obstetrics and Gynaecology found that in screened women, cervical cancers were more likely to be diagnosed at an early stage and at a younger age, leading to a better prognosis.

The researchers studied data collected in Southampton and South West Hampshire on 382 women who had been diagnosed with invasive cervical cancer between 1985 and 1996.

They compared "screen-detected" cancers – cancers found as a direct result of an abnormal smear reported during the routine screening test while a woman was asymptomatic – with symptomatic cancers detected when a woman complained of symptoms over time.

The authors found that during this period, the proportion of symptomatic cancers fell significantly, while the proportion of screen-detected cancers increased.

Despite the increase in screen-detected cancers the overall cancer rates were significantly lower in screened women because of treatment of precancerous conditions.

The authors stress that cancers were increasingly detected in young women and were seldom found on the first cytology test.

Their findings may present an argument against delaying the first screening invitation to the age of 25 years, in line with the wishes of TV reality star Jade Goody, whose recent death has prompted much publicity and a review of the screening age by the Department of Health.

The NHS Cervical Screening Programme (NHSCP) was introduced in 1988. As a result of this programme, the incidence of cervical cancer fell from 18.4 in 1988 to 8.8 in 2005.

Lead research author, Dr Amanda Herbert, from the department of histopathology at St Thomas' Hospital, London, said: “The audit justifies the major improvements in quality control implemented during the 1990s.

“It shows the importance of regular screening, especially in young women in whom most cases of high-grade CIN (cervical intraepithelial neoplasia) are successfully treated and in whom early screen-detected cancers are more likely to be found.”

Professor Philip Steer, BJOG editor-in-chief, said: “This study demonstrates that in addition to lowering overall cancer rates, cervical screening can also help to detect cervical cancer at an earlier stage, leading to better outcomes.

“Cervical cancer screening remains an important way to prevent cervical cancer. All women eligible for cervical screening are strongly encouraged to attend routine cervical screening.”

BJOG 2008; DOI: 10.1111/j.1471-0528.01989.x.

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