Friday, February 5, 1999 Published at 01:27 GMT
Restricting cervical screening could save millions
Smear tests cost £34 per person
Restricting routine cervical cancer screening for postmenopausal women could save the NHS millions, says a new report.
But it could mean up to 600 women slip through the net and develop cancer.
Researchers from the University College, London, and the Queen's Medical Centre in Nottingham say that stopping screening for postmenopausal women who are considered to be at low risk of developing cervical cancer could save up to 25% of smear test costs and 18% of colcoscopies.
The money could be channelled into other aspects of health care or targeting women at high risk more effectively, they say.
Women are referred for colcoscopies, which are internal examinations, if their smear test results are abnormal. Most do not have cancer.
The debate about whether to reduce the number of women who are routinely screened for cervical cancer has been raging for some time.
British women between the ages of 21 and 64 are currently screened once every three to five years.
The researchers have calculated the effect of excluding postmenopausal women with a history of regular smear tests with normal results and women who have not previously been infected with high risk forms of human papillomavirus (HPV), a sexually transmitted virus which is thought to be a major cause of cervical cancer.
Writing in the British Medical Journal, the researchers say that women over 50 are thought to be at low risk of having HPV, although they admit that prevalence of the virus in older women has been little studied.
They calculate that women over 50 are up to half as likely to be infected with HPV.
They add that withdrawing the women from screening could reduce the stress associated with the tests.
However, the researchers admit that it is difficult to speculate on incidence rates because there is not enough information available on how cervical cancer affects older women or about the rate of false negative tests.
There are also concerns some women with a high risk of cancer would slip through the net.
Julietta Patnick, national coordinator for the breast and cervical screening programme, said it was far too early to talk about removing women from the screening programme.
"We have only had a national screening programme since 1988. We have not got enough well-screened women going back over a long period to consider it safe to withdraw women, but we will certainly be considering it in the future," she said.
But Jean Mossman, chief executive of CancerBacup, said it was not worth talking of reducing screening when many women still did not get regular checks.
"At the moment we cannot guarantee that women go for tests regularly so it is entirely inappropriate that we should stop screening women who are at most risk," she said.
She added that, because screening was not routine yet for all women, it was impossible to say if women in their 50s had a low rate of HPV infection.
And she added that 600 missed cases of early stage cervical cancer could not be dismissed.
"It is not just the person who is affected, but their family as well," she said.