Smear-test uptake is low, despite the fact that the service is free through most GPs. So could Jade Goody’s story lead to an increase in cancer awareness among women?
THE PLIGHT OF a 27-year-old woman dying of cervical cancer in the public eye is not a pretty one, but tragic Jade Goody, by talking openly about her diagnosis and the terminal nature of her illness, has focused attention yet again on the need for women to have regular smear tests.
In the UK, where the reality TV star and mother of two is hoping to be well enough tomorrow to fulfil one of her final wishes of a big white wedding to her 21-year-old boyfriend, figures indicate many younger women are not availing of the free cervical cancer screening service on offer.
Prof Julietta Patnick, director of NHS Cancer Screening Programmes, says trends over the past decade have shown a decline in the number of women between 25-35 years of age accepting their screening invitations.
It’s not clear why – a study to determine the reasons is under way – though it may be because younger women feel more invincible and view cervical cancer as something only older women need to worry about.
Smears taken during screening identify abnormal cells in the cervix or neck of the womb, which could lead to cancer in women with no other symptoms. This allows for early referral for further investigation or treatment if abnormalities are found.
In the Republic, a national cervical screening programme only began last September so it is too early to say what the overall uptake in different age groups is like. Under the programme any woman aged 25 to 60 years can make an appointment to have a free smear test at her GP if her GP is registered with CervicalCheck, the national screening programme. The majority of GPs are now registered, as are many practice nurses.
Around 1,000 women a day are now being screened, a spokeswoman for CervicalCheck confirmed, though she couldn’t say if more women were coming forward for smears as a result of Jade Goody’s story being widely publicised.
Goody’s publicist Max Clifford claimed there had been a 20 per cent increase in the numbers of women presenting for smears in the UK since her diagnosis last August. One hospital – University Hospital Lewisham in southeast London – said it had carried out 21 per cent more tests in the months since she was diagnosed. But when asked if the NHS cancer-screening programme has noticed an overall increase, Prof Patnick says: “At the moment we are unable to categorically verify any statistics relating to whether there has been an increase in cervical screening invitation uptake since Jade Goody’s diagnosis of cervical cancer last year.” Annual screening statistics for 2008/2009 will not be available until September.
DR SEAMUS CLARKE, a GP in Clones, Co Monaghan, says there were more women seeking to register for free smear tests at his surgery in recent weeks but he feels this has been mainly due to advertising of the national screening programme on TV rather than Jade Goody's situation. The adverts began on February 9th.
“She may have given some impetus to the situation but most of the people coming in in the last seven days have come on the back of the advertising campaign,” he says.
But experiences among GPs differ. Dr Gerard Bury, who practices in Dublin’s south inner city, says he isn’t conscious of any change in attendance patterns for smears in the recent past. “I haven’t seen any case come along to prompt more to come forward,” he says. He adds that uptake of smear tests had been very low, between 10 and 15 per cent, in his area for many years. His practice had put a lot of work into trying to inform women of the benefits of availing of smear tests but clearly there were issues around cost and the long delay in getting back results that were stopping women availing of it. “Hopefully with the new service [CervicalCheck] we will see a lot more women coming forward,” he says.
CervicalCheck guarantees women they will have the results of their smears, which are sent to Quest Diagnostics in the US for analysis, within four weeks.
Meanwhile, Dr Martin Daly, a GP in Ballygar on the Galway/Roscommon border, says Jade Goody’s case is a timely reminder to women to present to their general practitioner for a cervical smear.
“It’s clear from this case that women in their 20s can contract an aggressive form of cervical cancer and cervical screening may not pick up all of the cases. A vaccination programme would provide a more comprehensive form of insurance against cervical cancer in women living in this State,” he says.
The Minister for Health Mary Harney announced in November that plans to give all 12-year-old girls the HPV vaccination to guard against the most common strains of the virus that cause cervical cancer were being shelved for the moment because the country couldn’t afford it. The estimated cost was around €10 million.
“There were ways the Government could have examined to deliver this vaccine to the vast majority of the target population without incurring the cost that the Minister quoted in the media,” Dr Daly says.
There has, he adds, been “quite a demand” reported by his colleagues for the vaccine to be administered privately. “The issue here is [that] the actual cost is prohibitive for many people and, whilst the pharma companies seem to be doing discount deals for private hospitals and clinics, many GPs are unable to avail of those type of discounts to pass on to their patients.”
The vaccine, given in three doses, generally costs around €600 if obtained privately at GP surgeries.
Cervical cancer, which causes more than 70 deaths in Ireland each year, is rare in young women. Figures from the National Cancer Registry show that of the 286 new cases diagnosed in 2007, none were in the 0-19-year age group; 104 were in the 20-39 age group; 121 were in the 40-59 bracket. Fifty-five cases were recorded among women aged 60-79 years; six in women aged 80 years and over.
Prof Walter Prendiville, a consultant obstetrician and gynaecologist at the Coombe Women’s Hospital, Dublin, says cervical cancer in women under 30 years is “very, very uncommon”.
It is “extremely rare”, he adds, in women under 25 years and this is why the screening programme begins at age 25. He explains that women under 25 can have quite a lot of abnormal smears “but the great majority of those mildly abnormal smear problems will clear over time”.
Prof Prendiville says that, by delaying screening until 25, you’ll avoid having to subject an awful lot of young girls to repeat smears and perhaps unnecessary treatment.
He points out that some forms of cervical cancer are more aggressive than others but in most people the pre-cancerous stage – which can be successfully treated if picked up during a smear – lasts 10 to 15 years.
ON THE MOREaggressive types of cervical cancer, he says: "You can't identify which ones they are, unfortunately, and it's probably true that some cervical cancers have a relatively short pre-cancer phase and they are the ones that are hard to pick up. The screening programme is designed to reduce the chances of getting cervical cancer to a very low rate."
In the UK the cervical cancer screening programme, which was introduced in 1989, has reduced the number of cervical cases and the number of deaths by two-thirds, he says.
“We didn’t start a screening programme until this year despite the fact that everybody knew we should have.
“Screening really works and if you have routine regular smears from 25 the chance of getting cervical cancer is very small, not zero, but very small,” he stresses.
Once cervical cancer is diagnosed Prof Prendiville says a woman’s chances “depend very much on the grade and the stage”. If it has spread to distant organs – as in Jade Goody’s case – then the success rate is very low.
Prof Prendiville’s advice to women trying to avoid cervical cancer is to attend for regular smears and to get their daughters vaccinated. “Screening will prevent 70 per cent of them and if you give vaccination along with screening you’re up to 90-95 per cent . . . vaccination works and appears to be very safe and we really should start it.”
On the Government’s decision not to begin a national vaccination programme, he says: “Nearly every country in Europe now is adopting a vaccination programme . . . I mean the cost of it compared to the cost of looking after women with cancer or the cost of it compared to what’s going on in the banks, it’s a pittance . . . You’ve got to prioritise what’s important and I think this is important; double the tax on cigarettes, that would pay for it.”
HOW TO GET SCREENED
The Irish Cancer Society says it is aware that there is a high level of concern among women about cervical cancer in response to the Jade Goody diagnosis.
Women who are concerned about cervical screening and/or cervical cancer can speak in confidence with a specialist cancer nurse by calling the Irish Cancer Society's National Cancer Helpline on freephone 1800-200700 (open Monday to Thursday 9am–7pm and Fridays 9am–5pm).
Alternatively, visit cancer.ie for more information on cervical screening and/or cervical cancer.
The State now provides a free nationwide cervical screening programme called CervicalCheck for 1.1 million eligible women aged 25-60 years.
Women in this age group can avail of the programme by making an appointment to have a smear test with a local GP. They will then be registered with the programme and screening will be provided every three years for women aged from 25 to 44 years and every five years for women aged from 45 to 60 years. CervicalCheck can be reached at cervicalcheck.ie or by calling freephone 1800-454555.
There are more than 4,050 smeartakers now registered with CervicalCheck, around a quarter of whom are practice nurses. The CervicalCheck website will tell you if your GP is among them.
Cervical cancer is the eighth most common cancer among women in the State. Breast, bowel and lung cancers are the most common ones.