May 08 2009

When to stop cervical cancer screening?

There’s on-going debate about when cervical cancer screening should be stopped.  Current UK recommendations suggest that those over 50 should have screening every 5 years, whereas those between 25 and 49 should be screened every 3 years.  This is much less frequent than in the US, where screening is every year.  This decreases to every three years if you are over 30, have never had an abnormal smear, and in a monogamous or low-risk relationship.  If there is a change in the relationship, it is recommended to undergo screening yearly until stable.  Women over the age of 65 and have never had an abnormal smear are given the option of not having any more tests.

But UK researchers are worried about calls to end screening in women over 50.  They found that although few women have abnormal smears, about 1% will show abnormalities.  They did not comment on the severity of the abnormality or whether it required intensive treatment.  Statistics show that most cervical cancer occurs in young women, under 35 years of age.  Most of the cases are due to infection with HPV, which is sexually-transmitted.  However, the HPV may remain dormant and cause problems later in life, so some cancers may occur in those older than 35.

It’s interesting to note that they would consider ending the programme of screening in women over 50.  After all, you cannot say that women over 50 suddenly stop having sex.  In fact, many of them are still very active.  Some have entered into late-life relationships with new partners.  Some of these partners may be much younger themselves.  I remember attending an infection control seminar where it was reported that some older women were coming home from cruises, where they had “one-night stands” with a fellow passenger, with sexually-transmitted diseases, including HIV.

There is this public perception that older people do not engage in sex.  Perhaps, it’s like denying your own parents having sex.  So, until someone is free and clear of the act, they should probably continue to be screened for cervical cancer.

On the flip side, I can never understand why some women insist on having smears done when they’ve undergone complete hysterectomies.  Is it because their doctor is trying to get extra payment?  I would not be in a hurry to have it done unnecessarily.