Lower the age you are offered a cervical screening (smear test) from 25 to 16

I would like women to be offered a smear test from the age of 16 in the UK instead of having to wait until you are 25.

Many women have signs of cervical cancer but are not offered a smear test until they are 25 years old. I believe you should be offered a smear test from the age of 16 as this is when you are legally allowed to be sexually active.

Cervical screening is vital in the early detection of cervical abnormalities that could cause cancer. The NHS cervical screening programme saves an estimated 5,000 lives per year, and is a key part of the Government’s commitment in the NHS Long Term Plan to detect 75% of cancers at stage 1 or 2, and for 55,000 more people to survive cancer for five years in England each year from 2028. Routine cervical screening is only offered to women between the ages of 25 and 64 in England because screening beyond this age range can cause more harm than good. However, anyone of any age worried about cervical cancer or who notices any symptoms should not wait for a routine screening appointment and see their GP as soon as possible.

Screening programmes and policy are based on the advice of the United Kingdom National Screening Committee (UK NSC). Using research evidence, pilot programmes and economic evaluation, it assesses the evidence for programmes against a set of internationally recognised criteria.

The UK NSC carefully weighs up the harms and benefits when recommending a new screening programme, or a modification to an existing one. It is only where the offer to screen provides more benefit than harm that a screening programme is recommended. The UK NSC looked at the evidence for the age at which cervical screening is first offered in 2012. It found that screening women under the age of 25 causes more harm than good.

This is because cervical screening doesn’t test for cancer, but for the human papillomavirus (HPV) and abnormal cells which, if left untreated, can develop into cancer. These abnormal cells are very common in younger women, and in the vast majority of cases will resolve with no intervention required. As changes are very common in a young woman’s cervix, women screened twice (at 20 and 23) before the age of 25 have a 1 in 3 risk of having an abnormal test result (on at least one occasion) and a 1 in 20 chance of being treated.

Research shows that an abnormal test result and unnecessary treatment can lead to significant anxiety for this substantial group of women. Follow up investigations can also be harmful, including the risk of women subsequently suffering premature labour.

You can read more about the UK NSC’s research and recommendations here: https://legacyscreening.phe.org.uk/cervicalcancer, https://webarchive.nationalarchives.gov.uk/20150401104305/http://www.screening.nhs.uk/cervicalcancer

Following the 2012 recommendation a frequently asked questions document was developed to help answer some common questions about the decision. This can be found at: https://legacyscreening.phe.org.uk/cervicalcancer-qa

The UK NSC regularly reviews the evidence for screening programmes to take into account the changing factors that can influence a programme, such as new screening technologies, and will change its recommendations if necessary.

Because almost all cervical cancer is caused by HPV, another important facet of preventing cervical cancer is vaccinating against this virus. The HPV vaccination programme reduces the incidence of HPV infection circulating in the population by vaccinating girls and young women, thereby preventing cervical cancer related to HPV infection. The first dose is offered in school year 8 in England and Wales to girls 12-13 years old.

The vaccine has led to a dramatic reduction in HPV infection in young women in England, and will reduce the risk of cervical cancer in this population. The incidence of HPV infections in sexually active women aged 16-18 years fell from 17.6% prior to the immunisation programme in 2008 to 4% in the period 4-5 years post vaccination.

HPV circulation is further decreased by offering the HPV vaccine to boys. From September 2019, boys in school year 8 have also been offered the HPV vaccine.

A sustained programme of HPV vaccination is eventually expected to save over 300 lives a year and prevent precancerous lesions in girls that require invasive treatment and can cause significant distress. Modelling produced by the University of Warwick estimates that by 2058 the HPV vaccine currently being used may have prevented up to 64,138 HPV-related cervical cancers and 49,649 other HPV-related cancers in the UK. Further information on this can be found at; https://www.gov.uk/government/news/hpv-vaccine-could-prevent-over-100-000-cancers.

With this vaccination offer and the potential harms of screening women younger than 25, there is little evidence in favour of lowering the age of cervical screening. Even though the screening programme only applies to women between the ages of 25 and 64, it is important however that all women should be vigilant of the symptoms of cervical cancer. Women of any age should see their GP if they are worried and not wait for a cervical screening appointment. Symptoms include bleeding between periods, during or after sex, or after you have been through the menopause, and unusual vaginal discharge.

Department of Health and Social Care