Cervical Cancer Screening – The Jade Goody Effect

The Telegraph reports that the number of screening pap smears performed in the UK has declined, after an 8% blip upwards in 2009 when publicity surrounding the death of Jade Goody from cervical cancer may have led more women to have this important screening test.

NHS laboratories processed 415,497 tests in 2009-10, about 35,000 fewer than the previous year when 450,522. Miss Goody’s death in March last year prompted a 20 per cent increase in the number of Scottish women taking tests. More than 122,000 were processed between April and June last year, the statistics revealed.

The irony of course, is that British reality TV star Jade Goody did have pap smears, but chose to ignore her doctor’s recommendations for treatment when her pap smears came back abnormal.

Nonetheless, the decline in pap smears has led NHS of Scotland to initiate a campaign to reach the up to 25 % of young women who do not respond to invitations to have pap smears.

In England, women are invited to start pap smears start at age 25, while in the rest of the UK, they start at age 20. Britain’s guidelines are in line with the WHO’s, and it has been reported that Ireland may raise the start age for paps there to 25.   There are less than 60 cases of cervical cancer annually in the UK in women under age 25.  Is this enough to justify nationwide screening in women in the 21 to 25 age group?

Jade’s Mum thinks so. She has backed a local British campaign to lower the age when pap smears are initiated in Britain from age 25 to age 21 to bring it in line with the rest of the UK.

Decisions about when to initiate cervical cancer screening must weigh the risks of false positives and the risks of treatment, which can impact fertility, against the risk of missing the opportunity to prevent cervical cancer by treating precancerous changes in the cervix before cancer develops.

Here in the US, we recently upped the age for initiating cervical cancer screening  to age 21 in normal women, because cervical cancer is so exceedingly rare in women under that age unless there is some immune compromise. Abnormal pap smears in women under age 21 are almost certainly due to transient HPV infection that will never progress to cervical cancer, but which leads to thousands of unnecessary colposcopies and biopsies annually.

One Response to Cervical Cancer Screening – The Jade Goody Effect

  1. Excellent well-reasoned post. This is informative without being didactic and raises issues often brushed aside: over-testing in the presence of small real risk and under-testing due in part to lack of awareness.
    The best approach is to plainly explain options and work with women to help them choose their best path.

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