At the start of this year, health chiefs in Wales announced a big change to their cervical cancer screening programme – women would get a smear test every five years, instead of every three.
Public Health Wales called it ‘a really positive development’, while experts insisted the adjustment was a good thing, since new screening methods are so accurate in determining who will and who won’t go on to develop cancer that women simply don’t need to be seen as often.
These people added, “It might even spare some from unnecessary or potentially hazardous treatment.”
There were quite a few people who didn’t see it that way, however.
‘The blood of thousands of women will be on the hands of whoever decided to make this ridiculous and cruel decision,’ railed one commentator on Facebook.
‘Again women and girls’ healthcare is downgraded,’ another wrote.
‘This will result in increased preventable deaths.’
Quickly, an online petition was started calling for the reconsideration of this decision. It has already received 1.2 Million signatures.
‘I don’t think it sounds safe,’ says Rachel Paul, 29, from Llanelli, who started the petition.
‘I understand tests have changed, but I know of so many women who developed cervical cancer between smear tests.
‘The thought of not being able to get a test for five years is really scary.’
Katie Nicholl (pictured with her son George, and Matilda), writes about having children following cervical surgery.
On January 5, Public Health Wales issued an apology on Twitter: ‘We are sorry. We haven’t done enough to explain the changes to cervical screening and have caused concern.
‘We are working to make this clearer and more information will be available as soon as we can today and in the coming days.’
However, the organization will not reconsider its decision.
According to medical insiders speaking with The Mail, the NHS England had also planned the change for later in this year.
However, the strength of the backlash to the Welsh move means policymakers are now ‘reconsidering’.
They would ‘have to think carefully about how to present the decision in a more positive light,’ the insiders added.
Professor Peter Sasieni, a cancer prevention expert and head of medical trials at King’s College London, confirmed the delay: ‘It’s been on the cards in England for a while, but Covid delayed the change because it involves a lot of red tape which NHS systems will struggle to cope with.
‘The plan is for smear tests to move to every five years in all four nations within the next year or so.’
But the main question that women are asking is: Is it sensible to schedule fewer checks for a type of cancer that can kill 40% of patients who are late diagnosed?
Destiny Wade (28), a Kent woman, thinks she’s a good example of why 3-year screenings are necessary.
Following unusual vaginal bleedings, she was found to have cervical cancer. The three-year-old woman’s smear tests had not revealed any cancer.
‘If I waited another two years, I’d be dead,’ says Destiny, who has had to undergo multiple operations that have left her cancer-free but infertile. It is an alarming story.
Women themselves have raised the most important question: How can it be prudent to schedule fewer checks for cancers that are fatal in 40% of patients who are late diagnosed?
A petition online calling for the reverse of the decision was launched quickly and has so far gathered 1.2 million signatures
So what’s the truth?
Is it possible to increase the number of deaths due to cancer by moving screening every five years?
Firstly, it’s important to point out that the NHS cervical screening programme has been a remarkable success.
Cervical cancer rates have plummeted by over two-thirds since 1988 when it was first discovered.
A study in 1992 found that women who were not screened for cervical cancer could have seen 57% more cases.
It is estimated that around 3,200 UK females are diagnosed each year with the disease, while 800 people die.
And just three-quarters of eligible women aged between 25 and 64 turn up for their smear test – a figure experts are intent on improving.
What lies behind extending the interval between screenings is the fact that today’s tests are vastly better than those they replaced.
A smear test was traditionally performed by taking cells from the cervix and then testing them for any pre-cancerous conditions.
They were categorized as mild, moderate, severe, borderline or normal.
The treatment protocol for moderate and severe cases was always clear – the risk of cancer was significant, and so women were referred for a second investigation, called a colposcopy, during which the cervix is examined and more tissue removed for analysis.
This gives doctors more detail about the level of risk – and whether the woman needs treatment to remove the abnormal cells.
The question of what to do with women who have been flagged for a smear testing that showed mild or borderline cell changes has been a long-standing topic of discussion.
Others are monitored to monitor if cells become more abnormal. In one in three cases, these minor abnormalities disappear without treatment as the body’s immune system kicks in. However, some end up being treated – possibly unnecessarily – and this can cause problems.
A colposcopy, like a smear, involves a speculum – a duckbill-shaped device – being inserted into the vagina to allow access to the uterus. Although these procedures are uncomfortable they can also be risk-free.
This is not true for treatment of abnormal cervical cells.
You can do this in many ways. For example, you could use a heated wire loop to pull out tissue.
These procedures have their downsides.
Any treatment to the cervical ring, which is located at the entrance of the womb’s muscular wall, can lead to its weakness. This can have a negative impact on the progression of a pregnancy.
There is an increased chance that a woman who has had cervical surgery will have miscarriages or give birth prematurely.
Sometimes, treatment may also cause stenosis. This is when the cervix shrinks or contracts.
If the goal of treatment is to eliminate abnormal cells more likely to develop cancer, then this benefit will outweigh any small risks.
However, as consultant obstetric and gynaecological surgeon Clive Spence-Jones says: ‘If early cell changes are discovered, and they don’t resolve, it can cause anxiety in patients.
‘And so it might seem like the cautious approach to offer further investigations and treatment in order to prevent cancer, but this also means treatment sometimes ends up being given unnecessarily to patients who might never have progressed or developed cancer. And then you could have created a risk to future pregnancy.’
The 2020 change to the screening test marked a significant step in this direction. It now checks for HPV, which is the most common cause of cervical cancer.
HPV is thought to affect around 80 percent of adult males. In most cases, it’s harmless.
However, for reasons not fully understood, in some cases it can invade the body’s tissues, triggering cell changes that lead to cervical and other cancers.
A cervical screening sample containing HPV will be taken. Women are advised to have a colposcopy.
But, importantly, studies have shown that if a woman tests negative for HPV, she has a less than one per cent chance of developing cervical cancer within five years – hence the change in the cervical screening interval.
The move seems safe according to both doctors and cervical cancer charity representatives. Indeed, research by King’s College London in 2018 estimated that HPV screening every five years is such an accurate method it would lead to nearly 500 fewer cases of cervical cancer every year in the UK, compared with the test every three years.
Importantly, the new procedure is less precise and flags fewer borderline cases, meaning that women are not being treated too harshly.
Theresa Freeman-Wang, consultant gynaecologist at the Whittington NHS Trust in London and an expert in cervical screening and colposcopy, says: ‘Women are worried because they are used to the idea of being screened every three years. Some would like to be screened more frequently, but evidence shows that if a woman tests negative for HPV then her risk of developing an abnormality, or indeed cervical cancer, is negligible.’
This is in addition to the fact that girls, aged 13 years, have been immunized against HPV since 2008 and the boys, at the same time, since 2019. Ms Freeman-Wang continues: ‘We have a vaccinated population coming through now, and so screening every three years for them in particular isn’t necessary.’
Kate Sanger, head of policy at Jo’s Cervical Cancer Trust, says: ‘Surgery for cell changes can involve part of the cervix being taken away. It can weaken the cervix and affect a woman’s ability to carry children. You may also experience bleeding and infections, which can have a negative impact on your mental and physical well-being. It’s not something you want unnecessarily.’
Prof Sasieni adds: ‘If we test less then we free up more resources – and I don’t necessarily mean financial resources, though that’s obviously a factor. We could spend those resources finding the millions of women who aren’t currently being screened at all. There’s a massive benefit in focusing more effort on that.’
Family physicians agree. ‘A lot of women shy away from the test because they find it embarrassing, and as a result we are constantly chasing people up,’ says Dr Nisa Aslam, a London GP. ‘If we spaced out the time between tests, we might see more people coming forward.’ Dr Aslam stresses that screening is not the only means of spotting cervical cancer. ‘Just because you’ve had a smear test recently, doesn’t mean you shouldn’t look out for symptoms such as regular bleeding or, after sex, vaginal discharge, or bleeding between periods. If you experience any of these, you should see your GP.’
Rachel Paul, the Welsh petition creator, remains unconvinced. ‘Anyone like myself who is anxious should be given the option to get a smear test every three years.
‘I shouldn’t be forced into having my test every five years – it should be my choice.’
Ms Sanger says Jo’s Cervical Cancer Trust ‘fully supports’ NHS England adopting the five-year policy, but believes ‘better communication’ is needed.
She adds: ‘The cervical screening programme is getting better and better at catching cancers, and we need to make that clear.’
Over-50s needed to trial ‘exciting’ Covid pill
Eve Simmons is the Mail’s Sunday Editor
A landmark UK study has allowed over-50s suffering from Covid-19 symptoms to access antiviral medications.
No input from the GP is necessary – patients simply register their interest in taking part in the University of Oxford trial on a website.
This comes just two weeks after The Mail revealed that high-risk patients such as patients with blood cancer have had difficulty accessing the drug despite the fact it having been approved since November.
The risk of Covid hospitalisation has been reduced by half when Molnupiravir is started within the first five days.
You can take four capsules once a day for Covid. It prevents virus cells from reproducing and reduces severity.
Molnupiravir, one of many antiviral Covid therapies, was given the green light within the last three months.
When treatment is initiated within five days after symptoms develop, Molnupiravir can reduce the likelihood of being hospitalized due to Covid. You take four capsules once daily for Covid. It prevents viruses from reproducing and reduces severity.
These drugs were only offered to very high-risk patients (those with immuno system issues or cancer treatments) until now.
To determine if the drug works in these patients, Oxford is seeking healthy volunteers of middle age and older who have been vaccinated and are not experiencing any symptoms.
Individuals over the age of 18 with specific underlying conditions are eligible. Only 4,200 people have signed up so far out of an initial target of 10,600.
The trial’s chief investigator Chris Butler, Professor of Primary Care in the Nuffield Department of Primary Care Health Sciences, said: ‘It is early on in the illness, when people are still being cared for in the community, that treatments for Covid-19 could have their greatest benefit.
‘So far, a lot of the research has focused on finding out if well-known drugs can be repurposed to treat Covid-19.
‘This new trial will test whether exciting, new anti-viral treatments that are more specific to Covid-19 help people in the community recover faster and reduce the need for treatment in hospital.’
It will be possible to test the efficacy and safety of Covid treatment by providing care for household members of the participants.
Once volunteers have provided health details online and been accepted on the trial, they will be randomly allocated into one of two groups – usual NHS care, or the drug.
The post will provide the required supply of tablets for those who are in the drug category.
The trial team will also require participants to complete a 28-day online questionnaire or call them on the days 7-14 and 28.
After three to six months, follow-up calls can be made to inquire about long Covid symptoms.
Panoramictrial.org offers more information, and you can sign up for it.