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To join a Welsh GP in order to get smear

(81 Posts)
99problems Tue 02-Apr-13 11:50:17

Not sure if this is even possible, but I am considering joining a Welsh GP practice so I am eligible for a smear test. I'm 23, in the age group that were too old for the cervical cancer jab and too young for smears. I know all the arguments about why women under 25 are not routinely offered smear tests but I believe it really comes down to budget.

A colleague, the same age as me, has recently been diagnosed with cervical cancer. Her doctor told her living in Wales has probably saved her life as the cancer wouldn't have been detected had she lived 10 minutes away in England. She had no symptoms whatsoever. I work in Wales so joining a practice there would be practical and closer to work.

My mum needed treatment for an abnormal smear at a similar age to me, so I really am anxious about having a test. I enquired into having it done privately and was quoted £300! No way I can afford that.

So WIBU? As I said I'm not even sure if it would make me eligible as I'm not Welsh.

DragonMamma Tue 02-Apr-13 14:15:02

I'm Welsh and have never needed to give proof of address when I've moved out of area and needed to change practices.

YANBU, I've recently had my 5th smear and I'm only 30 this year...I think my first was at 16/17 but still not sure how I've had so many. I know plenty of women who have had abnormal cells longer before the age of 25 here.

99problems Tue 02-Apr-13 14:17:08

DragonMamma do you mean in English practices you would still be entitled to smear or do you mean when you have moved around Wales? I wonder if they'd be stricter here as the practices would be so close to the border.

DragonMamma Tue 02-Apr-13 14:21:56

Sorry, I meant changed areas locally. When I moved around the country I stayed registered with my hometown practice out of pure laziness.

I would still chance it - don't mention it at the registration as they ask you whether you're up to date with them, when I wasn't they booked me in there and then for the following week.

99problems Tue 02-Apr-13 14:23:57

Thanks DragonMamma, if I get nowhere with local GUM tonight I will try Wales.

specialsubject Tue 02-Apr-13 14:31:54

you need a Welsh home address to register with a Welsh GP.

I'm sorry about your friend - but as you realise, her situation has no bearing on you. It does indeed come down to budget.

your friend doesn't have to pay for her prescriptions, either.

HoneyStepMummy Tue 02-Apr-13 14:39:15

After having my 1st abnormal PAP at 25 I had them every 6 months for about two years. Very grateful to have private medical insurance.
I believe raising the age limit has all to do with saving money. My friend is a GYNO and she said that you don't need to have PAPs until you are sexually active, even then 5-10 years after becoming sexually active is fine first your first PAP. Apparently it takes 5-10 years for HPV to alter cells. So if someone first has sex around 14 and has several partners, they are going to need a PAP before 25.
This just reminded me that I really need to make an appointment for myself. Good luck OP, hope you find a solution that works out for you.

NightFallsFast Tue 02-Apr-13 14:39:33

In my area of the UK the labs won't test smears from ladies under 25 unless it's paid for privately, so whichever GP you went to the answer would be the same. I you have symptoms the GP would examine you/do swabs/refer rather than take a smear.

The most recent research I've seen said there was no overall benefit to doing smears in under 25s once the benefits and harms were analysed, but I understand your concerns.

ISingSoprano Tue 02-Apr-13 14:41:53

Please don't keep blaming the GPs. The laboratory will reject the sample if you are outside the screening age. It is NOT the GPs fault.

dayshiftdoris Tue 02-Apr-13 14:43:05

www.cancerscreening.nhs.uk/cervical/research-theimpact.html

That is the critical review of the evidence which led to the screening programme for England deciding to leave the age of first smear at 25yrs.

It's a contentious issue that has led to much discussion in the media and in the medical journals but one thing is absolutely agreed by all - The cervix is still maturing in the early 20's and immature cells can look like the early changes the cervical smear is looking for. They will never be cancer and are just normal cells which are immature... Thus you will get a large number of women who will have abnormal smears, indicating treatment that have no need for treatment.

No one disputes, in the medical research, that this maturing cervix exists but those in favour of smears under 25 argue that should 'abnormalities' be found in the under 25's the treatment should be a watch, wait and monitor not treat... but so far the decision in England is to not screen under 25yrs.

When your GP said 'More harm than good' it was this he was referring to... treatments for abnormalities is a LLETZ (Large loop excision of Transformation Zone) basically a mm of cervix is taken away and tho these are much better than the old cone biopsies some of the LLETZ can be very invasive and they can have implications on pregnancy and labour....
When it comes to treating a very, very early change that would become cancer then the benefits FAR outweigh the risks but the potential in the under 25 is you are removing NORMAL, HEALTHY cervix.

If you went for a smear in England (unless you paid private) even if someone took the smear the lab would probably return it. If you have symptoms they suggest referral to gynaecologist not smear and they won't even accept under 25 smears from a gynae cons unless its been discussed first.
I don't know about paying for treatment but some PCTs might say so because again they might argue that treatment in this age group is not indicated because of the changing cervix mimicking the very early changes to the cervix.

I don't think you are being unreasonable but I would ask that you read the NHS screening website and then make an informed decision to either pay privately or not and to have treatment if very early changes are discovered.

I did a literature review at masters in this area last year and what got me (and apologies OP for the side bar) is that the numbers of women aged 25-29 having smears (percentage wise of those eligible for smears) has been in steady decline for TEN YEARS! Even the Jade Goody publicity only caused a plateau for one year in this age group. Recent research has linked this decline directly to the increase of women under the age of 35yrs dying from cervical cancer.

The focus at present is to improve numbers of 25-29yr olds having smears as the risk of women dying from this cancer is much, much greater than in the under 25s.

dayshiftdoris Tue 02-Apr-13 14:52:11

Forgot to say also that HPV is presenting its own considerations and some countries are now trialling treatment ONLY for those women who are positive for HPV. If the HPV is negative then they say not to treat early changes.

However, there are rare documented cases of cancers in women who have never had sex and are HPV negative so even this is not a given.

If you have always used barrier methods of contraception then your risk of contracting HPV is much, much lower.

Wandastartup Tue 02-Apr-13 14:59:47

You don't need a welsh address( have English patients registered with welsh gps) but there are huge problems in terms of accessing healthcare from Wales ie cannot choose like in England. All care needs to take place at certain defined hospitals for the area. If you are keen to have a smear test I would pay and avoid the welsh NHS if at all possible..,

x2boys Tue 02-Apr-13 15:01:30

there is a solutin to having to have adress north wales is only abouth about an hour from us and a couple i used to wor with had a static caravan on a caraven park so they were able to register with GP in north wales

Forwardscatter Tue 02-Apr-13 15:14:17

What dayshift says. Cancer Research say the same thing.

MrsHoarder Tue 02-Apr-13 15:19:45

I went to check the Marie Stopes website and their Bristol centre does smears too if you are near the southern end of the border could that help? Otherwise Leeds is surely closer than London?

Well, you could go to another FPC and give a different name/age etc. Their filing system isn't the same as the hospital or GP's and it is possible to give 2 different lots of details.

I have no idea how this would affect test results though, when people are talking about immaturity of the cervix?

littleducks Tue 02-Apr-13 15:52:40

I had a smear done by a NHS gynae consultant (I had some issues with bleeding as I hadnt ever had one due to age she did one to cover the bases when investigating other issues). It wasnt rejected by a lab, surely they cant do that.....your GP must be allowed to do one, for example of you had worrying symptoms?

99problems Tue 02-Apr-13 16:07:39

Thank you dayshift, if the lab did return a sample, is it true they give a 'normal' result or will they let you know they haven't tested it?

Options seem pretty scarce, either pay but then pay for treatment if an abnormal result is found, which I can't afford

OR

Try Wales in the hope that they will do it.

What confuses me is, why is England the only place with this upper age limit? And in light of the evidence, surely women should still have a choice as to their preference - take the risk of unnecessary treatment or wait until they are 25? I'm in a position where I feel I have made an informed desician, but have very little choice. Women under 25 do get cervical cancer, and whilst it is rare, it happens.

littleducks Tue 02-Apr-13 16:52:01

They should let you know they haven't tested it. I have just had a blood sample returned ad they tested for everything except for HIV as the midwife forgot to get me to sign something, there was a clear marking that it hadnt been tested for that.

VivaLeBeaver Tue 02-Apr-13 16:55:36

GP said if a private smear gave me abnormal result, I'd have to pay for treatment

I can believe that. I know someone who had a private MRI which showed she needed surgery. PCT refused to fund it as they said she was a private patient. Which according to her broke every rule/guideline in the book, she got her MP involved and everything as couldn't afford the 22k cost.

A charity ended up paying for her surgery in the end as PCT wouldn't budge.

99problems Tue 02-Apr-13 19:21:17

That's awful Viva. Just got back from GUM, they wouldn't give me a smear. They did insist on a full STD check though hmm. Not happy.

AnyFucker Tue 02-Apr-13 20:11:28

99, this does sound utterly frustrating

im not a 100% sure if you do need a Welsh address, particularly if you are on the border, as I know patients who live in England but have a Welsh GP.

Tiggles Tue 02-Apr-13 20:46:48

No idea about needing a Welsh address to register with a welsh GP, but I am fairly certain that I read somewhere that if you start having private healthcare for an issue then you can't just decide to revert back to having NHS treatment.

Hatescolds Tue 02-Apr-13 20:55:42

Where I work ( GP) if you are under 25 the sample is discarded by the lab and never processed hence why most GPs will not offer this service- it is not that we do not paid for it.

If you have symptoms suggestive of a problem ( bleeding after sex/ pain/ etc) then you must be seen and examined and really unless is clear reason we refer colposcopy( gynae) who examine and can send smears if indicated.

Hatescolds Tue 02-Apr-13 20:58:45

Sorry I forgot to say that even if I were to send one stating a clinical indication for smear below 25 it would still be rejected because as stated above a smear is only a screening test ,if you have clinical symptoms without clear cause it is referral that is indicated not a smear test

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