"Cervical screening in England starts at the age of 25, in line with World Health Organization (WHO) recommendations, and is supported by advice from leading scientists in this country. The policy in England changed in 2003 following research carried out by Cancer Research UK and in line with the International Agency for Research on Cancer recommendations, an agency of the WHO.
Evidence has shown that screening young women under the age of 25 may produce a false positive result, suggesting that there are abnormalities when in reality their cervix is still developing. This can lead to unnecessary investigations which may damage the cervix and possibly lead to premature births later in life. Screening women from the age of 25 reduces the number of unnecessary investigations and treatments in younger women, thus helping to reduce anxiety.
The Department of Health is committed to ensuring that the age at which women are invited for cervical screening is based on the latest available clinical evidence and is in the best interests of young women. In May 2009, the independent Advisory Committee on Cervical Screening (ACCS) conducted a formal review of the evidence relating to the risks and benefits of cervical screening in women under the age of 25. The Committee was unanimous in deciding there was no reason to lower the age at which screening commences. The reasons for not lowering the screening age were:
- cervical cancer is very rare in women aged under 25. In 2007, there were 2276 cases of cervical cancer in England. Of these, 52 cases (2.3 per cent) were in women under 25;
- there is no clear evidence of an increase in the incidence of cervical cancer following the change to the screening age limit in England;
- no new scientific evidence was available to support the reintroduction of screening in women aged under 25;
- there is evidence that treatment following screening in this age group can lead to an increased risk of subsequent premature births, increasing the risk of babies dying or having disabilities; and
- one in three young women screened aged under 25 would have an abnormal result, as opposed to one in 14 for all women screened, and there is evidence that this causes distress and anxiety.
However, as part of the action plan agreed following the ACCS review, a working group was set up to produce a new guideline to assist primary care in the management of young women who visit their GP surgeries with gynaecological symptoms, such as abnormal bleeding. The resultant clinical practice guidance for the assessment of young women aged 20-25 with abnormal vaginal bleeding was published in the March 2010 GP bulletin.
A great deal of other work is also underway. Key messages on the signs and symptoms of cervical cancer, produced with experts, the voluntary sector and patients, were launched in partnership with The Eve Appeal. The key messages are aimed at the general public, and are available on the NHS Choices website at www.nhs.uk. NHS Cancer Screening Programmes are undertaking audits on all young women diagnosed with cervical cancer to see how many had symptoms and what their symptoms were. NHS Cancer Screening Programmes have also commissioned the Cancer Research UK Primary Care Education Research Group to produce a leaflet setting out the benefits and harms of screening at different ages. The leaflet Why cervical screening is not offered to women under 25 years is currently in the final stages of production and versions will be available for both clinicians and the general public.
The cervical screening age range will be a standing item on the agenda of ACCS meetings. The ACCS reviews all new research to assess its significance to the screening programme, and NHS Cancer Screening Programmes maintains an online database of literature relating to cervical screening, and publishes Cervical Screening: Literature Update twice a year. This can be viewed online at www.nhs.thescienceregistry.com. If further evidence is published that warrants another formal review of the screening age range, then this will be done.
Since autumn 2008, girls aged 12-13 have been offered vaccination against the human papillomavirus (HPV) as part of a routine programme to protect against two strains of HPV that cause over 70 per cent of cases of cervical cancer. In addition, young women under the age of 18 will receive the vaccine as part of a catch-up campaign running until 2011. The vaccine will save up to 400 lives for each school year of young women immunised."
