Cervical cancer and the Decline in Screening

Cervical cancer can be found in the cervix and is the 4th most common cancer found in women globally. In more than 95% of cases, the human papillomavirus (HPV) is responsible, and can be transmitted through sexual contact. Therefore, women living with a sexually transmitted infection like human immunodeficiency viruses (HIV) are six times more likely to get cervical cancer.

 

This article briefly shows you the risk, preventive measures, and the decline in screening.   

 

Who is at risk?

 Cervical cancer takes around 15-20 years to develop in typical immune systems and only takes 5-10 years in immunocompromised women such as people living with HIV. Hence, such women are more likely to develop cervical cancer (1).

 

How is cervical cancer prevented?

Cervical cancer is a global health concern. To address the issue preventive and control measures have been adopted worldwide. Cervical cancer is one of the only cancers that can be prevented (2) via screening and HPV vaccination. The vaccine is given to girls between 9 and 14 years of age.

 

To further encourage its prevention, teenagers should be enlightened about cervical cancer and sexual education like using condoms to prevent sexually transmitted diseases. Likewise, women who are 30 years and above or 25 years old and living with HIV are encouraged to screen too. If suspected, treatment should be given as soon as possible (1). It is so because from 2016-2018, the peak age of cervical cases recorded in the U.K was between 30-34 years of age (3).

 

The Decline in Screening for Cervical cancer

In the U.K, between 2016 and 2018, the incidence rates decreased by 25% (3). In the U.S, there has been an increased percentage of women who are overdue for cervical cancer screening. Also, studies have shown discrepancies among some demographics, making it longer to screen for the disease and get treated (4). The studies show that Hispanic and Asian women are at a higher risk of being overdue cervical cancer screening when compared to white women.

 

The National Cancer Institute (NIH) found that the percentage of women overdue for cervical cancer screenings increased from 14% in 2005 to 23% in 2019 (8). The following population was more likely to be due for cervical cancer screening - women living in rural areas, women without health insurance, and women who identify as part of the LGBTQ+ community. Also, there is a decrease in attendance during screening in the U.K, with approximately 1.3 women not attending yearly.

 

There are different barriers preventing women from attending including cultural barriers and psychological. Problems may also include access to screening based on location or personal circumstances. For example, some may have experienced sexual violence and may not want to attend the screening (3). According to the JAMA Network Opens article, the core reason for women not receiving cervical cancer screening on time is ignorance about the disease and its screening (8).

 

 Another likely reason for women not keeping up with their screening is that, since they are vaccinated, they see no need to attend screenings. In contrast, despite being vaccinated against HPV, there is a need for routine screening as HPV vaccines do not protect against all HPVs that can cause cervical cancer.

 

An enormous decline in screening is believed to be caused by various factors such as the COVID-19 pandemic may have worsened the situation.

 

COVID and Screening for Cervical cancer

The COVID-19 pandemic had a massive effect on cervical screening and made it impossible for women to go for screening appointments. Studies show that this delay could have a seven-fold increased risk of developing cervical cancer compared to women screened with only a few months’ delay (6). In England, there was a 6- month delay in screening due to COVID. Coupled with so much strain on healthcare providers, it is unknown how this affects the screening and if all laboratories could catch up with the delayed appointments.

 

 Due to the long backlog, if there is an increase in the number of appointments, the backlog would still take a significant time to be cleared (7). Nonetheless, cervical cancer screening aims to reduce deaths; if delayed, this could increase mortality rates.

 

The Barriers affecting Attendance of Cervical cancer Screening

The following are some of factors which may influence women not attending screening appointments.

 

A limited number of appointments

Women are often booked for appointments they cannot make. It may be due to prior commitments such as work or childcare, which leads to rescheduling the appointment, and getting one is not is easy. Additionally, surveys showed that 7% of women were told there were no appointments available when they tried to book (3).

 

Limited sexual health services

Access to sexual health services in the U.K has seen a decline, with a minimal number of samples taken throughout the country. Many people may not have access to sexual health clinics as some areas only offer to restricted groups.

 

Pain and discomfort

Many women may experience pain or imagine the procedure to be painful; to avoid this, they do not attend the appointment (5).

 

Anxiety

Some women are embarrassed about their bodies and may feel anxious about the process.

Steps to improving screening

Recommendations have been made to increase the number of women screened for cervical cancer. Recommendations include:

• Audits to assess what needs to be done to improve the maximum wait time for an appointment
• Accessible alternative offers when practices do not offer to screen or have inadequate resources
• More funding to create pilot studies for self-sampling.

 

Recommendations made by patients include: making it easier to arrange appointments, for example, online, and screening should be performed by mobile screening vans. And should be easily accessible to help women who find it hard to arrange appointments around their initial commitments (5).

 

Another way to improve screening is to educate women through awareness campaigns and target groups where disparities exist.

 

By: Rachel McGhee