Lower the age for smear tests

claire16c

There's a lady on the tv now with terminal cancer who is talking about how she had symptoms at age 23 but because of that was refused a test or any other investigations. So by the time it was discovered it was too late.

She said she doesn't agree with lowering it to 16, but perhaps 20.
But that if you do have symptoms you should be referred to a gynaecologist regardless of age. So sad to watch.

The leaflet tea cake posted seems to say the same thing that investigations can still be done but in this lady's case she just got fobbed off by the dr.

koan_2

claire16c wrote: »

There's a lady on the tv now with terminal cancer who is talking about how she had symptoms at age 23 but because of that was refused a test or any other investigations. So by the time it was discovered it was too late.

She said she doesn't agree with lowering it to 16, but perhaps 20.
But that if you do have symptoms you should be referred to a gynaecologist regardless of age. So sad to watch.

The leaflet tea cake posted seems to say the same thing that investigations can still be done but in this lady's case she just got fobbed off by the dr.

There are two different issues here: 1) routine screening of asymptomatic women under the age of 25 , and 2) allowing access to appropriate tests and treatment for women who present with symptoms.

The first does not need to be addressed, and will hopefully not be changed based solely on an emotive campaign in the media, but the second one evidently does.

claire16c

koan wrote: »

There are two different issues here: 1) routine screening of asymptomatic women under the age of 25 , and 2) allowing access to appropriate tests and treatment for women who present with symptoms.

The first does not need to be addressed, and will hopefully not be changed based solely on an emotive campaign in the media, but the second one evidently does.

Which is likely to be the case with many types of cancer. I think they've just started a campaign to encourage women over 70 to check their breasts as it doesn't necessarily mean you won't get breast cancer when you turn 70.

securityguy

claire16c wrote: »

There's a lady on the tv now with terminal cancer who is talking about how she had symptoms at age 23 but because of that was refused a test or any other investigations. So by the time it was discovered it was too late.

She said she doesn't agree with lowering it to 16, but perhaps 20.
But that if you do have symptoms you should be referred to a gynaecologist regardless of age. So sad to watch.

The leaflet tea cake posted seems to say the same thing that investigations can still be done but in this lady's case she just got fobbed off by the dr.

The problem is that if someone has symptoms, then a smear test in isolation is inappropriate: there are other conditions that can give rise to those symptoms, which even if not potentially fatal can cause infertility and other serious problems. Those need to be investigated as well as the (small) risk of cancer. And if someone does, indeed, have symptomatic cervical cancer than a smear is a very poor means of investigating it. On the other hand, performing smear tests on young, asymptomatic women will result in a large number of cone biopsies being performed which will increase the rate of complications in pregnancy, when almost all of the identified abnormalities would resolve spontaneously. "I had a biopsy and my pregnancy was OK" is a modern version of "my granny smoked 80 a day and lived to be 100": these things are about trends and tendencies, not absolutes, and cone biopsies are absolutely not risk or consequence free.

These sorts of emotive campaigns are addressing the wrong problem: symptomatic cases should always be investigated, and if GPs are refusing investigations of symptoms on the grounds of age then they should be struck off (and, I suspect, might well be). But performing large numbers of screening tests on populations where the baseline rate is very low is inefficient, ineffective and potentially damaging. The starting age for screening was raised to 25 from either 20 or 21 for precisely this reason: the false positive rate is just too high, and the effect on the overall morbidity rate was essentially zero.

I refused prostate screening for precisely this reason, and would continue to do so unless symptomatic: the incidence of detection is low, the consequences of the biopsies are potentially serious, the life extension (ie, the difference between outcomes for people whose occult prostate cancer was detected while it was asymptomatic, and whose prostate cancer was detected following them having symptoms) is approximately zero. The risk of refusing screening is very low (provided you go to the doctor with symptoms, you will do no worse if you do indeed have prostate cancer), the potential benefit (not being incontinent and impotent in your fifties) is quite high.

Little_Gem

I believe the age should be lowered, perhaps not all the way down to 16 but I would support a drop to 21. I recently had my very first smear test at the age of 25 and was diagnosed with cervical cancer, I had no previous symptoms. Yes it is rare but it does happen and the fact that both Scotland and Wales have an earlier starting age for testing yet the UK doesnt start until 25 is just crazy. I've heard lots of stories of girls with symptoms being turned away just because they are under 25. I think if we arent going to the drop the age then its the attitude of SOME (NOT ALL) GP's which needs addressing as too many are too quick to dismiss peoples symptoms just because they are young.

j.e.j.

Little_Gem wrote: »

I believe the age should be lowered, perhaps not all the way down to 16 but I would support a drop to 21. I recently had my very first smear test at the age of 25 and was diagnosed with cervical cancer, I had no previous symptoms. Yes it is rare but it does happen and the fact that both Scotland and Wales have an earlier starting age for testing yet the UK doesnt start until 25 is just crazy. I've heard lots of stories of girls with symptoms being turned away just because they are under 25. I think if we arent going to the drop the age then its the attitude of SOME (NOT ALL) GP's which needs addressing as too many are too quick to dismiss peoples symptoms just because they are young.

Therein lies the problem. Not with the screening age. I would let the experts decide on the right age for screening. So-called abnormalities found in younger women often tend to right themselves.

You are right about GPs needing to change their attitude if they really are turning away young women with symptoms. I hope they are called to account!

securityguy

j.e.j. wrote: »

Therein lies the problem. Not with the screening age. I would let the experts decide on the right age for screening. So-called abnormalities found in younger women often tend to right themselves. !

This is the problem with rational analysis of screening. It's tempting to believe that treatment of occult conditions uncovered by screening is "lifesaving". The problem is, you don't know how many people would have gone on to develop the condition, and you don't know how many people who would have gone on to develop the condition have the outcomes improved by earlier treatment. But you do know that some people will be treated unnecessarily, and of those people some will be seriously harmed. As a species we're very bad at reasoning about risk, and statistical education is such that even a book aimed at the general educated reader, like Trish Greenhalgh's "How To Read A Paper" will be difficult for many people to access. Reading primary research is hard for most people. So the problems of screening tests for low-probability conditions in asymptomatic populations are hard to explain, and tend to evoke a suspicion that "they" are just saving money.

I've refused prostate screening. I'm trying to explain to my wife why post-50 mammography (given she has no family history) is unlikely to be worthwhile. For my daughters, both of whom have had HPV vaccination, I'd be interested in working out the benefit, if any, of cervical screening as they get older. I would certainly refuse statins, unless my risk were absolutely massive. In each case, the evidence of overall life extension is very, very limited.

Lioness_Twinkletoes

nettienoo70 wrote: »

I think its about giving woman the choice, Sophie asked for one and was refused

Young women that are genuinely concerned could pay for a test. Cost circa £100.

rpc

Lioness_Twinkletoes wrote: »

Young women that are genuinely concerned could pay for a test. Cost circa £100.

Or they could so something useful/sensible, such as insist the GP follows the process stated earlier or justifies why it is not necessary. You can always ask for a second opinion.

teaandcakeordeath wrote: »

To sum it up- no doctor in the country is recommended to offer a smear to a young woman experiencing the above symptoms- history should be taken, an internal physical exam should be performed, abnormal cervical appearance warrants an urgent referral for colonoscopy within two weeks, lesions and polyps get a non-urgent referral to a gynaecologist and no obvious changes results in pregnancy test, sti screen, treatment etc.

emmaj30

I have signed the petition as I believe it should be lowered to age of consent - ie 16. If a woman is old enough to be making the choices to be having sex then the same should be applied for her sexual health. I remember that my first smear test was when I was 18. 25 is too late.
The NHS have all these new adverts about seeing a doctor if you have symptoms for such and such ie bleeding after sex or in middle of period, pain when having sex and then when this poor girl goes to the doctors they refuse her a test! If you have these symptoms but are under the official age then you should be able to get a test! We are numbers to the NHS not people.