Cervical smears - are you playing Russian roulette?

New figures from NHS Digital show that for the second year running, numbers of women attending for their smear test have dropped across England, Wales and Scotland. About 4.2 million women a year are invited in England, and just over 3 million had a smear in England last year.

A few years ago, women were invited at different intervals, depending on where in the UK they lived. Today, there's consistency - you're invited every three years from 25-49 and every five years from 50-64 years old. Clearly if your smear isn't completely normal, you may be invited back sooner or referred on for further testing.

Earlier this year, Jo's Cervical Cancer Trust released a survey which showed that the figure was even higher among women over 50, with one in three not going for a smear or delaying their appointment. On average, they delayed screening by two years, but for many it was much longer. One third of women claimed their decision was down to embarrassment, one in five found it painful and one in four blamed a lack of convenient appointments. These low levels of screening may well explain why the risk of being diagnosed when the cancer is more advanced is higher in over-50s.

Most cancer screening tests aim to pick up early cancerous abnormalities to allow you to be referred on for further tests. What I hear from my patients is that they're terrified of 'the C word' and they'd rather not know. My take is clear - earlier diagnosis often means less drastic treatment, as well as a better long term chance of cure or cancer-free survival.

But with cervical screening it's even more clear-cut. Cervical screening isn't actually looking for cancer - instead, it's looking for changes which could put you at risk of cancer in the future. If these are found, you are invited for a more detailed examination of the cervix, called a colposcopy. At this stage, further tests and/or treatment will be offered, which can get rid of any abnormalities before they turn cancerous. In other words, the cervical screening programme actually prevents cancer from developing in the first place.

And actually, since the beginning of this year the cervical cancer test in England at least has become more sophisticated still. The vast majority of cervical cancers are caused by a few strains of a virus called HPV, or Human Papilloma Virus. Until now, testing for these 'high-risk' strains of HPV has been confined to cervical smear samples which show evidence of an abnormality. But going forward, every smear sample will be tested automatically for these strains.

If no high-risk HPV is found, women can be reassured about minor changes in their cervical smear which would previously have triggered a referral for colposcopy. And women who do have evidence of high-risk HPV can be monitored more carefully, even if their cervical smear shows no evidence of abnormal cells. This is important because our bodies' immune system often gets rid of the virus with no harm done - it's women who have persistent evidence of high-risk HPV who are at risk. They can be offered colposcopy or more frequent smears to make sure that any abnormalities that do develop are picked up and treated at the earliest possible stage.

I have no idea why smear test uptake levels are falling. It may be that the 'Jade Goody effect' - the increase in smears seen after the tragic news of Jade Goody's death from cervical cancer - is fading. It may be that women believe cervical cancer is less of a worry, since the introduction of immunisation for girls aged 12-13 against HPV. In fact, cervical cancer often takes years to develop, and the vast majority of women at risk today have never been protected by immunisation.

But whatever the reason, the statistics are clear. Cervical screening saves 4,500 lives a year in England, and any drop means more lives are put at risk. It's free, it takes minutes and it actually prevents cancer. Whatever you do, don't ignore that brown envelope.

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