Wednesday, 17 June 2015

Cervical Cancer screening

This week is Cervical Cancer screening awareness week. 

Screening for various diseases has been one of the medical success stories of the last 50 years, along with vaccination programmes and improvements in drug treatments. But before they can be successful, these various tests, injections and medicines need to be proved effective and safe, and moreover, a political decision must be made to utilise them, and then political will is needed to take their use seriously.

About 3,000 cases of cervical cancer are diagnosed each year in the UK, which amounts to 2% of all cancers diagnosed in women. NHS Choices says that ‘since the screening programme was introduced in the 1980s, over 64 million screenings have taken place in the UK, and the number of cervical cancer cases has decreased by about 7% each year.’[1]

But testing cervical cancer actually began in the 1960s. One of the reasons NHS Choices talks about the ‘1980s’ is because the screening programme for cervical cancer was missing that last element of a successful medical programme for many years: political will to take its use seriously.

In 1964 the members of the WI passed a resolution urging HM Government and regional hospital boards to provide comprehensive facilities for routine smear tests. The NFWI began working to publicise the test amongst its members - members were encouraged to take advantage of screening facilities in their communities if they were available, and notified when the BUPA medical centre’s mobile unit for screening was visiting nearby.[2] At this time many women had never taken this innovative new test and information was needed to help encourage them to take this step for their health. In 1966, the National Cervical Cytology Screening Service began, which allowed the taking of smears as part of normal medical care, every five years. Priority screening was given to those over 35 and the NFWI helped distribute information about the test to members.[3] GPs were paid to carry out smears on women over 35, but were able to refuse to screen younger women who asked for a check.[4]  Women at greatest risk were not necessarily being tested, and the follow up procedures for those who had been tested positive were inefficient.[5]

The WI wanted to find out whether the cervical screening system was actually working: was it working for the women it was designed to serve? The NFWI joined the Women’s National Control Campaign, and together they began the first major survey of women’s experiences of smear testing in 1983, to discover exactly how much women knew and whether the system was working to meet their needs. In January 1987[6] the 9,000 responses were published in conjunction with Women’s National Cancer Control Campaign and the results were shocking. 65% of women had not been asked to have a smear by their doctor and that 23% had not wanted to bother their doctor to ask for one.[7]

The WI launched a campaign for better screening facilities, more public information and an effective recall system.[8] Anne Stamper, chairman of the NFWI Environment and Public Affairs Committee, pledged the WI would help educate its members, but again reiterated political decisions must be made in the interests of women if the screening programme was going to save lives:

  “Decisions on health matter are far too often made without consulting those most affected, in this case, women themselves… We are issuing an Action Sheet which WI members can use to campaign at grassroots level. And we are calling on all women to fight for better provision in their own areas. But these campaigns can only success if the government and district health authorities show a commitment to providing adequate screening facilities.”[9]

Later that year in 1988, the Department of Health launched a computerised call and recall system, and the first external quality assessment schemes for laboratories who were reading the test results. It was a big campaign win for the WI, and considered a watershed moment in cervical cancer screening – it’s the first thing listed on the timeline in the NHS publication ‘celebrating 20 years of screening’. Thanks to the WI and the Women’s National Cancer Control Campaign, cervical cancer screening was made more effective and taken more seriously. 

Today, screening saves saves an estimated 4500 lives each year,[10] and over the last 20 years the incidence of cervical cancer in England has almost halved.[11]

[1] Peto, J. et al. The cervical cancer epidemic that screening has prevented in the UK.
Lancet 364, 249-256 (2004). Quoted in NHS Cancer Screening Programmes. ‘Breast and cervical screening: The first 20 years.’
 NHSCSP 2008,[2] ‘Keeping Ourselves Informed’, p.70
[3] ‘Keeping Ourselves Informed’, p70 and Annual Report 1973[4] 1981 memo: Cervical Cancer: background information [pic 150015403 ]
[5] NHS Cancer Screening Programmes. ‘Breast and cervical screening: The first 20 years.’
 NHSCSP 2008,[6] Yip, it takes them that long to publish it (they had trouble analysing all 9000 responses).
[7] LSE Archives, Letter from RCOG to NFWI about the survey findings, photo 144654973[8] Annual Report 1986
[9] LSE Archives. Press release [124629211 photo] of the campaign launch, 13 Jan 1987
[10] Peto, J. et al. The cervical cancer epidemic that screening has prevented in the UK.
Lancet 364, 249-256 (2004). Quoted in NHS Cancer Screening Programmes. ‘Breast and cervical screening: The first 20 years.’
 NHSCSP 2008,[11]

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