Lower the age for smear tests

koan_2

I definitely had one before I was 25. The guidelines must have changed recently, probably, as someone says, because there were too many false positives and traumatic treatment was forced on young women who in many cases neither wanted nor needed it.


But the point I'd like to make here is, the tests should by all means be offered, but they should never be pushed on women, as this can be very counter-productive.


With regards to smears preventing cancer, it's like saying going to the dentist prevents tooth decay. It doesn't, - not eating sugar and brushing and flossing your teeth well prevents tooth decay.

Smears (IF taken properly and read properly) CAN detect pre-cancerous changes. But the way to help prevent getting cervical cancer is to use condoms and have the HPV jab (or abstain!)


Slightly off-topic but last night I heard an appeal for an ovarian cancer charity, another very worthy cause.

Naturally I am sorry that this young person has lost her life. She was let down by the NHS, who should have let her have the test if she requested one.

securityguy

claire16c wrote: »

I think it should be lowered to 21, what it used to be. Im not sure that 16 would be an effective use of resources.

That's using the large randomised controlled trial that you conducted while doing your PhD, whose statistical power is such that the previous studies are all now irrelevant, I take it?

In the case of people having symptoms, then it shouldnt matter what age you are and that is where the mistake lies in this case.

Right, and that's why this discussion is so futile. In the case in question, the GP was probably at fault. End of. There is little reason to perform tests which have poor selectivity (ie, give a lot of positives in healthy subjects) in asymptotic populations where the baseline rate is low and the implications of false positives are quite significant (miscarriages amongst women who have had cone biopsies, in this case). But once someone has symptoms, the fact that most people don't have symptoms is irrelevant: the case in front of you has symptoms, and should be treated appropriately. You don't fix that problem by performing a load of extra tests on the asymptomatic population.

koan_2

By the way just in case anyone is reading and concerned, you can have smears + HPV test done privately if you want to.

Lozzy88

I honestly think if it was set at a younger age it would be ignored as may young girls will be very embarrassed and not see the bigger picture.

I have just had my first smear (aged 25) and I was contemplating not going despite having had 3 children and knowing the risks (both of my sisters and mam have had abnormal cells removed) but I did it and I would happily do it again, I have no idea why I was so worried.

pm04gn

heartbreak_star wrote: »

I am incredibly sorry for your loss.

But I'm going to go out on a limb here (and probably get flamed for it) - I won't sign this petition. Smear tests are done at an older age due to the fact that cervical cell changes in younger women are usually totally normal - a smear test does not detect cancer, it detects changes in cells.

Bringing the age down would likely lead to a lot of false positives and potentially nasty treatment done on young women that don't need it, risking their fertility in the meantime.

I am afraid Sophie was the exception to the rule of normal changes, and I am so sorry to hear about her.

HBS x

I am 100% with you, no flaming from me.
A smear test is a screening not a diagnostic test and should not be used as and when or to investigate symptoms.
Somebody should have examined this young girl and if the cervix appeared abnormal then she should have been referred directly to colposcopy. I suspect something went wrong with this process.
There are also no other details about the cancer so we have no guarantee that sampling the transformation zone of the cervix would have detected a cancerous change.
No reason to put thousands of girls/women through unnecessary investigation (biopsies etc) when the cervix is not mature and changes are likely to resolve.
I also think you'd struggle to get girls that young to consent to screening/examination. Until recently the age in Wales was still 20 (now 25) and there was no great rush to test the moment it was available.

Person_one

claire16c wrote: »

In the case of people having symptoms, then it shouldnt matter what age you are and that is where the mistake lies in this case.

I have to agree that this is the key thing here. People who have symptoms shouldn't be ignored, it seems some GPs have got the funny idea that 25 is a magic number and that smears are somehow forbidden before that age.

bagpussbear

What many seem to forget is how much this will cost the NHS to do if they lowered to 16 as a matter of course.

Cervical cancer in under 25's is pretty rare, so like all procedures the cost have to be weighed against the benefits. This country doesn't have the money to do it unfortunately.

That's why the petition won't get anywhere I'm afraid, in my humble opinion.

The NHS let this poor girl down but not in that they don't offer the smear test routinely to under 25's, but that she, as an individual, should have been given one given her request, her pain, and symptoms.

koan_2

bagpussbear wrote: »

The NHS let this poor girl down but not in that they don't offer the smear test routinely to under 25's, but that she, as an individual, should have been given one given her request, her pain, and symptoms.

Yes, it's a bit like breast cancer screening, which is offered to older women only (I think it's aged 50+?) but obviously if someone younger presents with symptoms it needs to be investigated. The answer is not to subject everyone to the screening willy-nilly.

securityguy

bagpussbear wrote: »

What many seem to forget is how much this will cost the NHS to do if they lowered to 16 as a matter of course..

It would be particularly ineffective to do that now, as current 18 year olds are the first cohort who routinely received HPV vaccination (might be current 19 year olds). There's some debate about the long-term effectiveness of HPV vaccinations, and time will tell, but there is little serious doubt about their short- to medium-term effectiveness. By next year, the vast majority of women under 20 will have been vaccinated (there's a catch-up programme), and in five years' time the vast majority of women under 25 will have been vaccinated and the whole discussion will be somewhat moot. Routine testing will continue because no vaccination is 100% effective, takeup isn't 100% and there's a need to study long-term effectiveness. But leaving aside all the reasons why smear testing in under-25s is very dubious even at current rates of cervical cancer amongst young women, in five years' time the baseline rate will be far, far, smaller.

securityguy

koan wrote: »

Yes, it's a bit like breast cancer screening, which is offered to older women only (I think it's aged 50+?) but obviously if someone younger presents with symptoms it needs to be investigated. The answer is not to subject everyone to the screening willy-nilly.

https://twitter.com/trishgreenhalgh/status/445613203964567552

Trish Greenhalgh's "How to read a paper" should be essential reading for anyone who wants to be able to, er, read medical papers.