Cervical screening age change no cause for alarm

Changing the cervical screening age is not cost cutting, it's based on evidence

Bumping up the age of first cervical cancer screening will not put younger women at risk, a study confirms.

Come December, women will begin HPV screening at age 25. Previously, they underwent cytology screening from age 18.

Concerns have been raised that this change would mean cervical cancer may go undetected in younger women.

But a study of almost 30 years of data from the Queensland Centre for Gynaecological Cancer the Queensland Cancer Registry found extremely low rates of cervical cancer in women under 25.

A total of 56 women, aged 13 to 25, were diagnosed with cervical cancer over the study period.   More women under 25 with invasive cervical cancer were detected after presenting with symptoms (39%), rather than following a routine pap smear (26%).

Patients with asymptomatic cervical cancer might “theoretically suffer as a consequence” of the new screening program, the authors said. But because the numbers were so low, raising the age of first screening to 25 would have a “negligible effect” on the overall rate of cervical-cancer diagnosis.

Of the 56 patients diagnosed with cervical cancer over the 28-year period, most underwent surgery and four had metastatic disease at presentation, with 75% being alive and disease-free at the end of the study.

Two of the paper’s authors were members of the steering committee for the National Cervical Screening Program.

“This study just adds to an already large body of evidence that suggests that the optimal age of starting screening is 25,” Professor Karen Canfell, an epidemiologist and the chair of the cancer screening committee at Cancer Council Australia, said.

Professor Canfell’s study in the MJA last year found that cervical cancer screening did not affect cervical cancer rates in women aged 20 to 24. By comparison, cervical cancer rates fell by around 50% for women over 25 after screening began in 1991.

Not only was cervical screening unlikely to detect cancer in women under 25, it could also lead to overtreatment, which carried potential risks of later obstetric complications, Professor Canfell said.

Dr Lara Roeske, a GP and liaison physician at VCS Pathology in Victoria, said there was some community misunderstanding around the changes to the program.

“This is not a cost-cutting measure,” she said. “It is based on evidence.”

Aust N Z J Obstet Gynaecol 2017, online 4 June