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.
Latest figures show that on average every week 1,300 fewer 25–29-year-old women attended for their smears than in 1995.
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 with almost 80% in 1995.
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, one million did not accept their invitation.
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. 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.
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. Of these the largest single proportion (25.9%) occurred in the 25–29 age group, which equates to 5,147 women.
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 30-34-year-olds, whose attendance is down by around 800 per week compared with 1995. Attendance has fallen from 84.3% in 1995 to 78.0%.
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.
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. As in England, woman aged 25-29 had the lowest attendance – 72.6%. Among those aged 30-34, attendance was 78.6%.
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.
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."
European Cervical Cancer Prevention Week 2007, which runs from 21 to 28 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.
Find out more about cervical cancer and the importance of having regular smear tests on www.cervicalcancerweek.com
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