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Cervical Cancer screening
Please come and have a smear test when you receive a letter suggesting
you have one - we believe it is very important and do not want any of our
patients to get cancer of the cervix. We are now
using the more accurate Thin Prep
testing method (please note our Department of Health suggests much less
frequent testing than the Americans).
Women with low-grade abnormalities should have 3 negative smears at 6, 12 and 24 months before going back to routine recall. Women with high-grade disease i.e. moderate dyskaryosis or worse now have to be followed up for 10 years post treatment; they will therefore have smears at six and 12 months post-treatment and then annually for the subsequent nine years.
For more information on the importance of cervical screening see
NHS Choices
What are the symptoms of cervical cancer?
T he main symptoms of cervical
cancer are unusual bleeding from the vagina when women are not having
their period. This includes bleeding between periods, bleeding after sex
or any bleeding at all in post-menopausal women. Other symptoms may include
a vaginal discharge that smells unpleasant, or discomfort or pain during
sex.
What should I do if I have any of these symptoms?
Women of any age who are showing these symptoms should speak to their
GP urgently. Women under 25 who are concerned about their risk of
developing cervical cancer or their sexual health, should contact their GP
or Genito-Urinary Medicine (GUM) clinic.
Who is invited for cervical screening?
Within the NHS Cervical Screening Programme in England,
women aged 25 to 49 are invited for free cervical screening every three
years, and women aged 50 to 64 every five years. Women over 65 are invited
if their previous three tests were not clear or if they have never been
screened.
Why aren’t women aged under 25 invited?
Cervical cancer screening starts at age of 25 in line
with recommendations made by:
-
The International Agency for Research on Cancer, an
agency of the World Health Organisation that coordinates and conducts
research into cancer
-
Research carried out by Cancer Research UK
-
The independent Advisory Committee on Cervical
Screening
" There is minimal benefit and
substantial harm in screening below age 25. Organised programmes should
not include women aged less than 25 years in their target populations."
Research has found that screening women under the age of 25 may do
more harm than good. It can lead to unnecessary and harmful investigations
and treatments. Women below the age of 25 often undergo natural and
harmless changes in the cervix that screening would identify as cervical
abnormalities. Despite this, cervical cancer is very rare in this age
group. In most cases these abnormalities resolve themselves without any
need for treatment. Most importantly, if further treatment is carried out
it can increase a woman’s chances of pre-term delivery if she goes on to
have children in future. This can endanger both the woman and her baby.
Cervical cancer is very rare in women under 25. In 2006
the total incidence across women of all ages was 2,321 cases. There were
only 56 cases of cervical cancer in women aged under 25, which represents
only 2.4% of all cases. There were 820 deaths from cervical cancer in
England and Wales in 2007, of which 3 were in those aged under 25 (0.4% of
deaths).
Women under 25 who are concerned about their risk of developing
cervical cancer or are experiencing any of the symptoms should contact
their GP or Genito-Urinary Medicine (GUM) clinic.
See also
Cancer
screening programmes
Osteoporosis
Over the years there has been much debate about how and when to treat
osteoporosis. NICE have at last produced their guidance on primary
prevention for women who have never broken a bone and secondary prevention
for women who have. Unfortunately they have not included men in their
deliberations and there are other blind spots which we hope will be filled
in future guidance.
We strongly encourage women with an early menopause, whether it occurs
naturally or following surgery, to take HRT to at least age 50. This will
help to ensure bones reach their maximum strength before the bone loss,
which occurs after the normal menopause, begins. This loss of bone is the
major cause of osteoporosis.
The publication of the "Women's Health Initiative" trial in The Journal
of the American Medical Association and more recently The Million Women
Study has clarified that long term HRT can slightly increase the risk of
breast cancer, coronary heart disease and stroke while reducing the risk
of bowel cancer and hip fractures. It is interesting that prior to the publication of these studies the incidence of breast cancer rose year on year but since then the incidence in the USA has fallen 8.6%. This has has been associated with number of prescriptions of HRT falling by two thirds.
See also
Cancer research UK
A further analysis of the million women study published in April 2007 concluded that women who use HRT are at greater risk of ovarian cancer and of death due to it. The risk increases with duration of use: mean duration of use in the study population was 7.7 years and this was associated with a 20% increase in risk. It is related to current use, not past use, and falls back to baseline level soon after use is stopped. Crude incidence rate in the study population as a whole was 2.2 per 1,000 women; in never-users it was 2.2 per 1,000, and in users 2.6 per 1000 (rates for death from ovarian cancer 1.3, 1.3, and 1.6 per 1,000 respectively). From these figures, assuming that the differences are due to HRT the authors calculate that over a five year period there would be about one extra case of ovarian cancer for every 2,500 users (and one extra death per 3,300 users).
Very surprisingly, the study also showed that HRT with or without
progestogen increased the risk of incontinence in women who were
originally continent and made symptoms worse for women who
already had problems. The risks were highest for stress
incontinence: hormone replacement doubled the risk of new
symptoms compared with placebo . Any kind of hormone therapy
made existing symptoms more frequent, more bothersome, and more
likely to limit women's activities compared with placebo
Doctors continue to advocate the use of HRT for menopausal symptoms.
However, an expert panel has advised that we limit HRT use to five years
only - see
Net Doctor (NB 5 years = 5 years after usual menopause i.e. age 55)
Mammography
The Dorset Breast screening unit recalls women between 50 and 65 every three years for a mammogram. We encourage women to attend -see
Cancer
screening programmes
Women over 65 will not be recalled but the screening unit is happy to
arrange a mammogram if the woman herself phones 665558
You might be interested to read a review
published March 2002 showing that breast screening between ages 50 – 70
significantly reduces women’s risks from breast cancer:
“The International Agency for Research on Cancer (IARC), which
is an offshoot of the World Health Organisation, has reported that its
own study examining the evidence for and against breast screening has
found that overall the procedure is of benefit and that government
programme should continue. The group found that, on average, women
taking part in such a screening programme could expect a fall of
up to 35% in their personal breast cancer risk. Or in other terms for
every 500 women screened, over a ten year period, one of them will be
saved by breast screening. The group also reported that there was only
limited evidence of benefit for breast screening for those in their 40s,
or over the age of 70.”
Figures published by the Department of Health in March 2004 show a
marked increase in the number of breast cancers detected by breast
screening in the UK. Detection rates have been steadily increasing for
the last five years. In 1998/99 7,561 cases of breast cancer were
detected, in 99/00 8,215 cases, 00/01 8,345, 01/02 8,545 and in 02/03
9,848 cases were detected, representing a 13% increase in detection rate
compared with the previous year.
It is believed that the latest year's increase can be attributed to the
introduction of two-view mammography. This involves taking two x-ray
views of each breast at the screening appointment. Research has shown
that this technique can increase the detection rate of small cancers by
42%.
Infertility
Page last updated
November, 2011
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