Jun 7 2010 By Chester Chronicle
In the UK, 20% of women still don't attend smear tests, putting themselves at risk of leaving pre-cancerous cervical cells undetected. In the run-up to the Jo's Trust Cervical Screening Awareness Week (June 7-13), we speak to the experts about why cervical screening is so important, and to women whose lives it has helped save.
Emmeline Collin had no reason to think anything was wrong when she went for a routine smear test.
Although she had no symptoms at all, Collin was diagnosed with cervical cancer - and without the smear test, it may have killed her.
Just over a year later, the 33-year-old mother-of-one has had surgery to remove the cancer, which was caught early enough for her to have an excellent chance of a complete recovery.
She's a prime example of why cervical screening can be a life-saver, a fact which is at the core of Cervical Screening Awareness Week (7-13 June).
Currently, 20% of UK women don't attend cervical screening appointments, putting themselves at risk of becoming one of the 2,828 UK women every year who develop cervical cancer.
Jo's Cervical Cancer Trust, the charity behind the awareness week, wants to get the message across to all women - but particularly those who don't go for screening - that cervical cancer is largely preventable.
It is estimated screening saves 4,500 lives a year.
Collin, of Peterborough, Cambridgeshire, says: "There was no way I knew there was anything wrong - I just went for a routine smear as if I was going to buy a pint of milk.
"I had no symptoms and no worries.
"If I'd ignored the screening letter and thought I didn't need to go because there was nothing wrong with me, then goodness knows what would have happened.
"I had an invasive cancer growing inside me that I knew nothing about.
"If I hadn't gone, worst case scenario is that I might not be here, or I could have left it so late that I might have had to have much worse treatment."
That treatment may have involved a hysterectomy or radiotherapy, neither of which Collin had to have because her cancer was caught so early.
Instead, she had a trachelectomy, a relatively new treatment which is not yet widely available, which preserves a woman's fertility.
The surgery, which can be performed on some women who have very early invasive cervical cancer, involves removing the cervix and the lymph glands in the pelvic area, but leaving the womb in place.
"I've been left with the opportunity of having another child," says Collin, "which I would have lost if I didn't go for the screening."
Cervical cancer and the importance of screening was brought to the public's attention last year when Big Brother star Jade Goody died from the disease.
The 27-year-old mother-of-two had abnormal cells removed from her cervix on several occasions, but is reported to have ignored a letter saying abnormal results from a smear test had again been found.
As a result, she became one of around 1,000 UK women a year who die from cervical cancer.
While her untimely death in March 2009 was tragic, it led to a 12% rise - from 3.2 million to 3.6 million - in the number of women having smear tests.
However, the 'Goody effect' is now thought to have diminished.
Collin says: "I suppose some women, particularly the younger ones, might think they don't need to go for a smear because they're all right and it's easier not to go.
"But without being a doom-monger, there could be something wrong, and if they don't go for screening they won't know until it's too late."
Around 300,000 UK women have abnormal smears every year, and they will usually be recalled for a colposcopy, where a doctor uses a colposcope to magnify the cervix to see if further treatment is needed.
The colposcopy takes just 10-15 minutes, and is usually performed as an out-patient.
Depending on the severity of the abnormality, no treatment may be required as the body's immune system will sometimes deal with the abnormal cells itself.
Alternatively, the cells may be treated there and then, or a biopsy may be taken.
The biopsy will ascertain whether the cells are cancerous, in which case surgery may be the next step.
Treatment after abnormal cells are detected is very successful, with more than 90% of patients returning to normal smears.
Nearly all cases of cervical cancer are caused by the human papilloma virus (HPV), which is transmitted through sexual contact.
Although there is no treatment for the virus, 12 to 13-year-old girls are now vaccinated against the two most common high risk HPV types.
Collin's doctor, gynaecological oncologist Robin Crawford, of Addenbrookes Hospital, Cambridge, says symptoms that indicate there may be a problem with the cervix can range from bleeding between periods and/or after sex, to post-menopausal bleeding.
Such symptoms can also indicate other conditions.
But Crawford warns: "There may be no problem and the abnormality is detected by screening - hence the importance of keeping up to date with smears.
"Emmeline had her cancer detected before she had any symptoms and is able to consider a further pregnancy.
"You could call this a triumph for the screening programme."
In England, the cervical screening programme starts at the age of 25 with three-yearly smears until the age of 49, when the frequency is changed to five-yearly.
In Scotland and Wales the screening programme starts at the age of 20.
Crawford says the 20% of women who don't go for screening may simply be frightened of what the test could find, or even fear that they're being judged if the smear is abnormal.
"Some women just find it uncomfortable or have had a bad experience when they've had a smear before.
"In some cases, it's a matter of priorities and time - the smear is the least of their worries compared with work and children."
Robert Music, director of Jo's Cervical Cancer Trust, says that despite the success of regular cervical screening, which has cut the incidence of cervical cancer by 44% since 1975, there are still worries about the number of women who miss their tests.
Around one in three of those aged under 35 don't attend their screening appointment, despite some targeted campaigns on screening in bars and nightclubs.
And Music stresses that while 400,000 more women had smear tests after Jade Goody's death, figures released later this year are likely to confirm that the effect has diminished.
"From speaking to people involved with screening, the numbers are going down already, and are potentially close to pre-Jade levels," he says.
"That's a worry. It's a worry that people forget.
"Cervical cancer is largely preventable, and it's just trying to get that message across so that women will be proactive in taking steps to reduce their risk."
Music explains that part of the uptake problem stems from the fact that there's a lack of understanding about what screening's for, with some women thinking it's a test for cancer.
"It's about preventing cancer," he stresses, "and that's a key message to get out there.
"We're talking about a few minutes for a test that could potentially save your life."
- For more information about cervical cancer and screening, visit www.jostrust.org.uk