Why are all women not having regular cervical screening? To the ladies in the audience (and the gents with an imagination), the answer lies in the question. A combination of fear, confusion, the struggle to book an appointment at a convenient time, procrastination and just plain embarrassment and squeamishness at the idea of a stranger poking around your cervix conspire to keep uptake of cervical screening among women who are eligible hovering stubbornly at around 78 per cent.
More worryingly still, numbers of women getting screened have been gradually falling in recent decades, down from 82 per cent at the turn of the millennium. And yet there are a lot of very persuasive reasons why all women should make their three-yearly (five-yearly if you are over 50) screening tests a high priority.
Cervical cancer, which currently affects around 3,000 women a year in the UK, is one of the only preventable cancers. Cervical screening (also referred to as the smear test) aims to prevent cancer by examining the cervix for signs of abnormal cell changes that may pre-empt cancer, and treating them so that the cancer never develops. As a by-product of this process, screening can often spot early-stage cervical cancers before they show any symptoms, and treat them at this earlier, manageable stage.
Thus, higher rates of cervical screening mean fewer cases of cervical cancer, with fewer of these being diagnosed at a more advanced stage when they are more difficult to treat, causing more pain and suffering to women and their families. We estimate that over a five year period, with 100 per cent uptake of screening, 1,176 additional lives would be saved, over and above the 5,000 lives that cervical screening is already estimated to save every year.
And now Demos research shows the full financial impact that women diagnosed with cervical cancer are facing. What the financial side of cervical cancer does, if anything, is make it personal. It is difficult to imagine yourself having cancer, but we can all imagine losing £487 a month – the average financial burden borne by women we surveyed who had been diagnosed with cervical cancer in the past. This can include anything from income lost during time off work, to additional costs such as dietary supplements, travel to and from hospital, car parking charges or childcare, to higher spending on daily living costs like energy bills, toiletries and books and films during the recovery process.
This impact is especially high for women diagnosed with the more advanced cancers that regular screening would have picked up at an earlier stage. The combined financial burden for women diagnosed with more advanced cancer is £1,102 a month.
Demos has calculated that if all women in the 25-65 age group were regularly screened, the NHS would save £10 million – almost half of what it currently spends on treating cervical cancers – while the state and society as whole stand to gain significantly from women being spared cervical cancer and the resulting impact on their working and family lives.
Compared to the huge savings on offer, investing small amounts in improving GP screening practices and public health campaigns targeting those women who are least likely to come for screening would cost relatively little – and would save thousands of lives in the long run.
Things like ‘on the spot’ smear tests during GP appointments, with the guarantee of a female nurse or GP on hand to perform the test, might overcome some of the reluctance many women feel about screening. This measure, combined with weekend or evening drop-in sessions at GP surgeries and health clinics, would help women struggling to find time for an appointment. Other countries have piloted alternative screening methods, such as self-testing and urine testing, which may also prove more appealing to women in the UK.
But finally, there is a need to make talking about cervical screening an ordinary activity – whether that involves celebrity ambassadors speaking up about the importance of screening and their own experience of it, or mums and daughters reminding each other to book their test (women aged 25-29 and 50-64 are currently the two age groups least likely to attend screening). Making cervical screening less of a taboo subject will help us stop viewing it as something to be avoided, and make the question that began this blog a rhetorical one.