Cervical Cancer Prevention Week 2021 #SmearForSmear

This week, 18-24 January 2021, is cervical cancer prevention week. With the delays, disruption and changes in healthcare provision as a result of prioritising treatment of patients with COVID-19, I wanted to take this opportunity to highlight the importance of raising awareness of cervical cancer and the steps which can be taken to prevent it.

Cancer Research UK estimates that cervical cancer is the 14^th most common cancer in the UK accounting for 2% of all new cancer cases in females in 2017. Between 2015 and 2017, 3,152 new cases of cervical cancer were reported, and peak rates of cervical cancer are in individuals aged between 30-34 years of age.

Cervical screening (a smear test) is offered to all women and people aged between 25-64 by the NHS Cervical Screening program. Cervical screening checks on the health of your cervix by removing a small sample of cells. This sample is then sent off for testing with the results usually returned to you within 4 weeks by post.

Since the end of December 2019, all cervical screens in England, Scotland and Wales also check for HPV (human papillomavirus). HPV is estimated to cause 99% of all cervical cancers, and NHS England estimated that routine checks for the virus could prevent around 600 additional cancers per year.

According to a survey undertaken by Jo’s Cervical Cancer Trust between 29 May and 9 June 2020, fears about COVID-19 and not wishing to put an additional strain on the NHS (amongst other reasons), resulted in around 1 in 8 women delaying attendance at their cervical screening appointments. This is a worrying trend. Coupled with an overall reduction in the past 10 years of women taking up the offer of cervical screening, I believe that there needs to be an increased awareness of the program as a whole and a greater understanding of the barriers preventing individuals from participating in the same.

The NHS advise that the symptoms of cervical cancer are not always obvious, which is why it is important for individuals to attend cervical screening appointments; however, screening will not prevent every case of cervical cancer so an awareness of the possible symptoms is vital.

Common symptoms of cervical cancer include:

• unusual vaginal bleeding;
• pain or discomfort during intercourse;
• unusual, unpleasant or changes to your vaginal discharge; and/or,
• pain in your lower back or pelvis.

As with most cancers, early diagnosis and treatment is linked to outcome. Whilst the majority of cervical cancers are diagnosed relatively early (57% at stage I), delays in diagnosis or misdiagnosis may result in cancer progression and/or fertility saving treatment no longer being an option.

Being told that you have cancer is frightening for any patient; however, subsequently finding out that the same could have been prevented, or that the medical treatment you received may not have been appropriate can be devastating. In some cases, taking steps to investigate the possibility of a legal claim may be appropriate. For such a case to be successful, it would need to be shown that any delay in diagnosis or treatment had an impact on outcome. Usually this means that it would need to be shown that the delay meant that the cancer progressed to a more advanced stage.