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Creating a culture of cervical screening

Although cervical cancer is extremely rare in women under the age of 30, it can cause severe ill-health and threaten women's lives. Pauline Beddoes at Marie Stopes International looks at the way in which the government has been forced to respond to the recent media focus on the disease ...

Pauline Beddoes
Nurse Manager
Marie Stopes International

Recent months have seen a flurry of cervical screening stories hit our newspapers. The tragic story of Jade Goody, who died from cervical cancer, created a platform from which more individuals told of their personal experiences, including the courageous family of Claire Walker-Everett, who died from cervical cancer at the age of 23.1

Currently, cervical screening begins at the age of 20 for women in Scotland, Wales and Northern Ireland. However, women in England wait until the age of 25. The Quality and Outcomes Framework (QOF) centres on the provision of standardised, high-quality, preventive healthcare for all, and places cervical screening within its additional services domain. With this in mind, the current screening devolution is nonsensical.

Therefore, I was delighted when the Department of Health in England recently announced that the screening start age might be lowered, subject to a review of evidence relating to the risks and benefits of cervical screening in women below 25 years of age.2

Such recent announcements have raised public awareness of cervical screening, and at Marie Stopes International we have seen an increase in the number of young women coming forward for testing. However, although over four million women in the UK are invited every year to attend for a smear test, worryingly in 2007–08 only 66.2% of those aged 25–29 invited for a cervical screen attended.3

I am hopeful that the screening start age will be lowered back to 20 when the evidence review is presented to Ann Keen later this year. However, as nurses, we will have a significant role to play in ensuring that young women actually attend screening.
Being on the frontline of healthcare service provision, we can implement a few simple practices to encourage women to make cervical screening a priority. 

For example, in addition to the NHS call and recall system,4 we can maximise screening participation by reminding eligible women of the importance of cervical screening during appointments for other areas of healthcare; for example, when providing contraception consultations. In my experience, we lose young women from the screening system when they move homes, so we must remind them of the importance of keeping their contact details regularly updated.

Adequate samples of cervical cells are also vital to the process, so regular and effective training of team members completing the smear tests, and the use of the liquid cytology method, could be beneficial. Also, talking women through the process of the screening test in "real-life" language (for example, likening the cytology brush to a mascara brush) may assist in eradicating any worries women have about the procedure, and counselling women to ensure they fully understand their smear result may help to promote effective treatment and follow-up for women with screen-detected abnormalities.

Ironically, the need for screening became even more important following the introduction of the cervical cancer vaccination programme. We need to educate young girls to ensure they realise that the vaccine does not make them immune to cervical cancer, and encourage them to start thinking about their cervical health as early as possible.

Early detection and treatment can prevent around 75% of cervical cancers developing in women,5 so the government's decision to review the case for reducing the screening age in England is fantastic news. But it is crucial that we develop a screening culture among young women. Please join me in prioritising cervical screening, thereby playing a fundamental role in cervical cancer prevention and ultimately saving women's lives.

References
1. Claire's Message. http://www.clairesmessage.org/main/about-claire.html
2. Department of Health (DH). Cervical Screening Age: Experts to Review Evidence. Available from: http://nds.coi.gov.uk/environment/fullDetail.asp?ReleaseID=395348&NewsAr...
3. Jo's Trust. About Cervical Cancer. Available from: http://www.jotrust.co.uk/about_cervical_cancer/index.cfm
4. National Health Service. NHS Cervical Screening Programme. http://www.cancerscreening.nhs.uk/cervical/index.html
5. Macmillan Cancer Support. Can cervical screening prevent cancer? Available from: http://www.cancerbackup.org.uk/Aboutcancer/Screening/Cervicalscreening/C...