Europe Campaigns For Widespread Cervical Screening Programmes While Attendance In England Among Young Women Decreases For The Eleventh Year Running

Europe campaigns for widespread cervical screening programmes while attendance in England among young women decreases for the eleventh year running

On the eve of Europe's first cervical cancer prevention week, England is seeing a continuing large-scale drop in smear test attendance among young women, according to recently published figures from the Department of Health. [1, 2]

Latest figures show that on average every week 1,300 fewer 25 to 29 year old women attended for their smears than in 1995. [1, 2]

Although some 660,000 women in the 25-29 age range are invited for screening in England, only 69.4% of them (457,496 women) accepted their invitations, compared to almost 80% (79.7%) in 1995. [1]

This decline of 10.3% over 11 years reflects a drop of some 68,000 young women each year coming forward for screening.

Overall, around 4.4 million women aged 25-64 were invited for cervical screening across England in the financial year 2005/06. Of those, 3.4 million attended - but one million did not accept their invitation. [2]

Experts think this decline in young women coming forward could be because the screening service has become a victim of its own success.

The incidence and mortality rate from cervical cancer has been decreasing in the UK since the screening service was introduced in 1988. [3] Cervical cancer now accounts for approximately 1,000 deaths per year in the UK. This compares to the estimated 6,000 deaths that experts predict would result from cervical cancer if there was no organised screening programme. [3]

This decrease in cervical cancer cases is a direct result of the screening programme, which detects precancerous lesions, enabling treatment before progression to cervical cancer can occur.

The latest figures show that in England, 19,847 women had cervical smears suggestive of CIN3, the most severe precancerous change and immediate precursor to cervical cancer. [2] Of these the largest single proportion (25.9%) occurred in the 25-29 age group, which equates to 5,147 women. [2]

If 201,720 young women aged 25-29 years are not attending for their smear test (30.6% of invitees), the figures would suggest that more than 2,000 of them are likely to be found with CIN3. These women are at high risk of developing invasive cervical cancer if they continue to avoid screening.

A similar trend in falling attendance is also reflected in 30 to 34 year olds whose attendance is down by around 800 per week compared with 1995. [1,2] Attendance has fallen from 84.3% in 1995 to 78.0%. [1, 2] In Scotland, a similar trend has been seen over recent years. A report published in August 2006 by NHS Quality Improvement Scotland (NHS QIS) revealed that while every NHS board was still exceeding its attendance target of 80%, general uptake has fallen in recent years. [4]

The report stated: "There is some evidence that fewer younger women are attending and this has to change if we are to sustain our efforts to prevent cervical cancer in Scotland." [5]

The NHS QIS called for locally based awareness campaigns to be put in place, encouraging attendance and explaining the importance of being screened. [4]

Commenting at the time of publication, Jan Warner, NHS QIS Director of Performance Assessment and Practice Development, warned: "There is a concern that the success of the programme is beginning to change attitudes to cervical cancer. The programme is hugely effective, but we must not allow the idea to take hold in the public mind that cervical cancer has in any way been beaten." [4]

Wales has also seen attendance at screening across all ages fall from a peak of 85.8% in 1992/93 to 75.4% in 2005/06. [4]

As in England, woman aged 25-29 had the lowest attendance - 72.6%. Amongst those aged 30-34, attendance was 78.6%.[6]

Aside from lack of awareness of the continuing danger of cervical cancer, embarrassment has also been cited as a potential barrier to young women coming forward for smear tests. [7]

But experts are puzzled as to why today's young women are more embarrassed to attend screening than equivalent invitees five or 10 years ago.

Speaking at a recent Royal Society of Medicine conference, in London, Julietta Patnick, Director of the NHS Cancer Screening Programmes, said: "We are currently exploring the reasons why women don't attend for cervical screening and our preliminary results indicate that they think it may hurt or that the experience will be embarrassing. Of course we are keen to understand why women today may be more embarrassed than perhaps 10 or 20 years ago.

"Another key issue could in fact be the effectiveness of the screening programme - a reduction in rates of cervical cancer means it is now a far less common disease so people don't tend to worry about it so much - most people may not know anyone who has had the disease."

Professor Alison Fiander, gynaecological oncologist, Wales College of Medicine, University of Cardiff, said: "It is worrying that the very women most at risk of precancerous cervical disease -younger women -are those that are choosing to stay away from screening in increasing numbers."

Professor Fiander added: "CIN3 rates have been rising in women since the late 80s. The peak incidence occurs in the 25-29 year old age group. Although cervical screening has reduced the number of cases and deaths from cervical cancer the challenge is now to address an epidemic of CIN3 in young women."

Dr Anne Szarewski, Clinical Consultant for Cancer Research UK, who researches into HPV, said: "It's a big worry if young women start to miss their smears. The peak age for cervical cancer to strike is while women are in their late-30s, but it can occur earlier."

The UK is one of only seven nations amongst the EU's 27 countries that has a nationally organised cervical screening programme (the others are Denmark, Finland, Hungary, the Netherlands, Slovenia and Sweden).

[8] A recent study of trends in cervical cancer in 13 European countries found it was being held steady or reducing in countries that had screening, but was increasing in those without screening, such as Spain and Slovakia. [9]

European Cervical Cancer Prevention Week 2007, which runs from 21st to 28th January, is an initiative led by the European Cervical Cancer Association (ECCA) and designed to promote better awareness of all aspects of cervical cancer and, in particular, the importance of having regular smear tests.

Pamela Morton, Director of the cervical cancer charity Jo's Trust and board member of the European Cervical Cancer Association (ECCA), said: "Women in the UK are fortunate to be invited regularly for a free smear test so it is disappointing when 20% do not attend. For some this can have a tragic outcome. "

"The first European Cervical Cancer Prevention Week is a great opportunity to raise awareness within the EU of the importance and success of national screening programmes. We must stop 30,000 European women dying every year from this preventable disease."

Women who would like to know more about cervical cancer and the importance of having regular smear tests can log onto the GlaxoSmithKline website http://www.cervicalcancerweek.com.

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Press release issued on behalf of GlaxoSmithKline (GSK).

GlaxoSmithKline is committed to the prevention of cervical cancer and supports the European Cervical Cancer Prevention Week.

Notes:

About European Cervical Cancer Prevention Week

European Cervical Cancer Prevention Week 2007, which runs from 21st to 28th January, is an initiative led by the European Cervical Cancer Association (ECCA) and designed to promote better awareness of all aspects of cervical cancer and, in particular, the importance of having regular smear tests.

The European Cervical Cancer Prevention Week is supported by unrestricted educational grants from GlaxoSmithKline, Roche, Grand Lyon, Rhone Alpes, Digene, Innogenetics, TriPath Imaging, Vodafone and Norchip.

About HPV and cervical cancer

Cervical cancer is a major global health problem, with nearly 500,000 new cases occurring each year worldwide. It is the second most common cancer - and the third leading cause of cancer deaths - in women worldwide. [10]

In the UK each year, almost 3,000 new cases of cervical cancer are reported and there are more than 1,000 deaths. [10] It is the second most common cancer in women under the age of 35 years in the UK. [11]

Cervical cancer is not hereditary. It is caused by persistent infection with cancer-causing HPV. All women who have a sexual relationship are at risk of HPV. [11-14]

HPV is very common and easily transmitted through close sexual contact [11] - full sexual intercourse is not necessarily required.[12-14] The risk begins with first sexual activity. [12]

Up to 75% of sexually active women will be infected with HPV at some point in their lives.[11, 12]

There are cancer-causing and low risk strains of HPV. Cancer-causing strains can cause cervical cancer. The two most common HPV strains associated with cervical cancer globally are 16 and 18, which account for approximately 70% of cervical cancers. [11]

Cervical screening is an important preventative tool against cervical cancer and the UK operates a highly effective screening programme. It has been estimated that without a screening programme, up to 5,000 more UK women would die each year from cervical cancer.[11] Women should attend for regular cervical screening.

About GlaxoSmithKline

GlaxoSmithKline - one of the world's leading research-based pharmaceutical and healthcare companies - is committed to improving the quality of human life by enabling people to do more, feel better and live longer.

GlaxoSmithKline is committed to the prevention of cervical cancer and supports the European Cervical Cancer Prevention Week. For more information go to http://www.cervicalcancerweek.com

References

[1] NHS. Cervical Screening Programme: England 2004/2005.

[2] NHS. Cervical Screening Programme: England 2005/2006.

[3] Peto J, et al. The cervical cancer epidemic that screening has prevented in the UK. Lancet. 2004 Jul 1723;364(9430):249-56.

[4] NHS QIS. NHS QIS Press release: Success of Cervical Screening Highlighted as Mortality Rate Plummets; 2006.

[5] QIS. Scottish Cervical Screening Programme 2005/2006.

[6] Wales CS. Cervical Screening Programme; 2005/2006.

[7] Sutton S, et al. Sociodemographic and attitudinal correlates of cervical screening uptake in a national sample of women in Britain. Soc Sci Med. 2005 Dec;61(11):2460-5.

[8] ECCA. Cervical cancer in Europe: A recognised public health problem in Europe. 2007.

[9] Bray F, et al. Trends in cervical squamous cell carcinoma incidence in 13 European countries: changing risk and the effects of screening. Cancer Epidemiol Biomarkers Prev. 2005 Mar;14(3):677-86.

[10] Ferlay J, et al. Cancer incidence, mortality and prevelance worldwide. Available at GLOBOCAN 2002; 2002.

[11] CRUK. Cancer Research UK Cancer Stats; 2003.

[12] Baseman JG, et al. The epidemiology of human papillomavirus infections. J Clin Virol. 2005 Mar;32 Suppl 1:S16-24.

[13] McIntosh N. Human papillomavirus and cervical cancer JHPIEGO strategy paper No. 8; 2000.

[14] Burk RD. Human papillomavirus and the risk of cervical cancer. HospPract(Minneap). 1999;34(12):103-11.

For further information please go to:
GlaxoSmithKline And
http://www.cervicalcancerweek.com