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Friday, 23 February, 2001, 00:02 GMT
Smears success 'masks cancer risk'
Smears pick up pre-cancerous cells
Smears pick up pre-cancerous cells
The national cervical screening programme has been a victim of its own success, says a leading expert.

Despite preventing up to eight out of 10 cancers, there is a "negative feeling" about the programme, according to Dr Amanda Herbert, a cytopathologist from St Thomas' Hospital in London.

She says there has been a significant increase in pre-cancers, which could have led to cancer in at least a third of cases.

But the success of cervical screening at picking up the pre-cancers has meant an increase in cancer has not happened.

Without screening, we would probably be seeing an epidemic of cervical cancer in young women

Dr Anne Szarewsk
Imperial Cancer Research Fund
Dr Anne Szarewski, of the Imperial Cancer Research Fund (ICRF), said the research mirrored an early study the organisation had carried out, showing screening had prevented about 6,000 deaths from cervical cancer between 1991 and 1997.

And the IRCF estimates that by 2025, screening could prevent 5,000 cancers a year.

She said: "Certainly without screening, we would probably be seeing an epidemic of cervical cancer in young women "

Cervical cancer is now rare in the UK because of the success of the screening and treatment programmes, according to the St Thomas' research which was published in the Cytopathology journal.

Dr Herbert said there was a perception that the screening programme was not a success, because the cancer was quite rare.

But over the last 30 years, rates of invasive cervical cancer have halved, when the incidence of pre-cancers shows they could have doubled without screening.

Since 1987, there have been about 19,000 cases of the most serious kinds of pre-cancers picked up, found in one to two per cent of smears.

If, as is estimated, one in three develops into cancer, there could have been around 7,000 to 8,000 extra cases of cervical cancer.

Cases of cervical cancer peak in women in their 40s and 50s in an unscreened population.

But since 1981, the pattern in England has not mirrored that trend

Risk treatment

Dr Herbert said that treating pre-cancers, most effectively detected in women in their 20s and 30s, was a treatment of risk, rather than disease, picking up potential cancers decades before they might otherwise have shown up.

The human papilloma virus, spread through sexual intercourse, is the main cause of cervical cancer, meaning young women are more at risk because of the likelyhood of them having several partners.

Dr Herbert said the incidence of invasive cancers had fallen by 40% over the last 10 years, a period when the risk of the disease had more than doubled.

Screening programmes elsewhere had reduced incidence by 70%, said Dr Herbert.

She added: "There is no reason to believe that the current well organised programme in England and Wales has not been even more successful in preventing a similar proportion of cases, although it has taken a regrettably long time to reach that goal.

"These findings tell us that just because cervical cancer is now much less common, we mustn't become complacent - the risk is still there - it is crucial that women have regular tests and do not miss the opportunity to reduce that risk".

"One of the main reasons for looking at this was that there has been so much negative feeling about the screening programme. That is totally unjust."

She added that there was a false perception that laboratory staff were not doing an important job.

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15 Jan 01 | Health
UK tests cervical cancer vaccine
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