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Cancer fear mother slams smear rule

A mother who fears she may have cervical cancer has criticised doctors for refusing to allow her to have a smear test because she claims they considered her to be too young.

Amy Cullum, 24, was told by doctors that she could not undergo the screening until she was 25.

Previously, women above the age of 20 were offered routine smear tests, but in 2004 the age was raised to 25.

Miss Cullum, from Yatton in Somerset, has always been particularly aware of the pain caused by cervical cancer - her own mother had a hysterectomy at the age of 26 because of the disease. But despite pleading with her GP surgery to give her a smear test, doctors stood firm.

Staff told her that, even if they bent the rules and tested her, the laboratory which analysed the swab would not look at her sample because she was under age.

But the mother-of-two told reporters she is terrified she may have the illness - after hearing about reality TV star Jade Goody's recent diagnosis and recognising some of the symptoms in herself.

Miss Cullum told the Western Daily Press: "I cannot believe that, what with me having symptoms, which I do realise could be something else, a history of cancer in the family and the fact I have had two children, that they will not test me."

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Do you agree with the doctors? Or is the patient entitled to a smear test? Your comments: (Terms and conditions apply)

"I feel she should have a smear to allay her fears. One should always over-ride the criteria when dealing with some patients. It
saves lives!" - Margaret Hughes, Wales

"Performing cervical screening because of symptoms can send the wrong message that a clear smear means a clear bill of health. It would appear that this woman would be better off being referred for diagnosis." - A smear taker, Hull

"This lady is not entitled to a smear test; no woman is. The national screening programme invites (usually healthy) women in a target age range to be screened and therefore an element of choice is implied. Nonetheless any woman with symptoms or needing to have medical interventions should see her GP or healthcare practitioner for advice. Interventions or treatment falling out of that consultation is then carried out. This could
include a diagnostic cervical smear. Cervical smear screening  tests are not diagnostic tools but a snapshot in time to see the state of cervical cells. However, a well publicised, health education/information-based process makes women aware of the importance of accepting these invitations. More recently the introduction of a vaccine against cervical cancer causing viruses has been a move in the right direction for future generations of young women." - GB Chambers, Bury PCT

"I think the patient is absolutely entitled to a smear test, if she's given birth she's obviously sexually active. If she's requested it on the strentgh of family history then she has given informed consent. Where is the problem here?" - Practice Nurse, Scotland

"I think the guidelines should be followed, the lady needs referral to gynae. Screening is screening not diagnostic." - Deirdre Aldhous, Wiltshire

"This is a further reason to bring the age back down to 21. However, as this person appears to be symptomatic, she should be referred to a gynae unit for urgent colposcopy." - Irene Climie, Ayrshire

"Family history of cervical cancer is not a risk factor, so on that score the lady could be reassured, but if she is symptomatic, the hospital lab would examine the smear as long as she were also referred to gynae. That's how it works in my area anyway. Jade Goody's story has a lot to answer for!!" - Carol, Derbyshire

"Here in Manchester this lady may be screened under the option clinically indicated pending symptoms. However our GPs, given her history, would examine her and due to her anxiety refer to gynaecology with no hesitation. Yes she should be entitled to her smear test." - Smear taker, Manchester

"Agreed. Thank goodness for Scotland. Screening every three years, ages 20-60. Overriding the system if concerns expressed." - Patricia Willis, Scotland

"This is age discrimination. The woman is a mother of two children with a family history of cancer. She has the right to ask for a smear test and should take the issue to BMA." - Katie Smith, York

"Is this mother's fear real? If so, this is itself an exception to the smear age application." - V Henry, N15

"I feel the smear should have been done along with referral to gynaecologist if she is having problems. This would help to allay her fears." - Smear taker

"The patient's request should be allowed." - Jill Fletcher, Kings College Health Centre

"As a smear taker I can understand the doctors' position. However, an appropriate assessment should have been carried out and if clinically indicated, then this patient should be referred to a gynae department for further exploration." - Cheryl, London

"It is essential that screening guidelines are followed. This patient sould be referred for gynae assessment under the two-week wait if she is symptomatic. This would be much quicker than waiting for routine screening results and would deliver more effective care for this patient." - Smear taker, Notts

"In Scotland we start screening at aged 21, so Miss Cullum would have had her smear by now. I think there is something very wrong with refusing this poor girl a smear, she is clearly distressed and rightly so because of her strong family history. Such a simple and relatively noninvasive test would help alleviate her anxieties. If neg then it would prevent a more expensive referral to a gynaecologist. If a doctor believes it is clinically relevant to take a smear then surely the lab should process it. It seems to me that some common sense and patient-centred care is needed here, and a need to drop the 'more than my jobs worth' attitude." - M McIntyre, Scotland

"Yes the patient is correct, she should be entitled to be screened. Here in Scotland we do test from the age of 20yrs. We can also override the system if a patient has been told to have annual smears in the past and she is on a three-year recall, she can request annual smears. I am an English Marie Curie trained PN who thinks the Scottish system, yet again, leads the way." - Caroline Stephens, Scotland

"A smear is not a diagnostic test, it is a screening test. The patient should be referred to colposcopy for assessment if she is symptomatic." - A smear taker, Newcastle

"If the patient has symptoms then a referral to a gynaecological department should be the pathway. If the doctor did the smear then where would the revised guidelines stand?" - Debbie Durk, Birmingham

"Of course she is entitled with her family history and anxiety - guidelines are guidelines and should always be overridden by clinical need." - Kirsty Armstrong, Hants

"The NHS screening programme is for women over 25 years; however, if a woman is symptomtic that falls under 'clinical reason for smear', and as such a smear may be done under the age of 25 years. We have never had a problem in ELPCT for doing smears for clinical reasons. It is not part of the screening programme." - Kathleen Grimshaw, ELPCT