To think smear tests should start at 21, not 25?

[PamPerdbrat]

I am in the armed forces, and they start cervical screening at 21. My last screen picked up changes. I had a colposcopy and biopsies which confirmed CIN3 (severe abnormal cell changes). I have an op in 2 weeks to remove the affected area.

I'm shocked and a bit shaken. I'm only just 24, and if I'd have been taken care of on civvy street, this would not have been picked up until next year at the earliest; when I turn 25. By which time the news could have been worse.

If it can happen to me, it can happen to other girls my age, too. AIBU to think the NHS should screen earlier? I could be being over emotional though; I am rather shocked

I had the hot wire, its ok, watch out for the LA - I've had loads of LA and thought nothing of them untill I had that one. I was high as a kite. Hit me like a tonne of bricks but completely distracted me from what they were doing!

That treatment is quicker than the colposcapy. It literally takes a few mins. I had cramp later that day but no pain.

And I have had completely clear smears since. I still get 6 monthly ones but I think the one I'm due is my last 6mth and then it will be one year and then back to the 3 year cycle.

I had wire too, didn't feel the needle for la, didn't feel the wire, couldn't look at screen. Dh was engrossed though...

Im 23, and last year went to ask for a smear test and they actually wouldn't give me one.
They told me to go private, i was so shocked and appalled.

Oh strawberry that poor girl

The main reason its 25 is that there are lots of falsely abnormal smears under 25. Also, even if you have abnormal cells when you are young, there is a chance they may resolve.

The treatment for CIN involves cutting out a portion of your cervix - i.e. removing the area thats abnormal. Whilst this usually cures the problems it can cause other problems, namely in childbirth the cervix may not hold the baby in fully and there is a risk of recurrent miscarriages (small but there). Also issues with scarring and infection. If they lower the screening age, then the number of women who suffer from the side effects of treatment that they may not have actually needed if they had waited a year or two, will rise.

Cervical cancer is very very rare in under 25s but these risks of treating CIN (potentially unnecessarily) are not. Its all about finding the balance between preventing cancer or catching it early, and not causing even more problems later on. There is no right age and it is a matter of judgement and risks. In other cancers, such as breast cancer, screening starts at 50, however, of course that does not mean a woman cannot develop breast cancer before that age, just that screening everyone under 50 has no benefits and may cause actual harm (again - false diagnosis and treatments, unnecessary surgery, even the screening i.e multiple mammograms, theoretically causing a cancer in itself)

However, all that said, any woman (regardless of age or even a normal smear result) who has bleeding after sex and odd bleeding between periods like the case above should be referred to a gynaecologist, who will perform a colposcopy and take a smear. The sad thing about the case highlighted here, is that her GP did not act on classic symptoms and her life could have been saved.

By the way, I don't agree with the age being 25 either. I think it should be younger.

They should be done from 16 or when you become sexually active. Two of my sisters were found CIN3 at thier first smears, one was 16, the other was 20, if it were now, they would probably have cancer because they wouldn't have been checked while so young.

I know pam, I read about her and posts from her on jo's trust. What a strong lady and even though she's only 4 years younger than me it makes me think of my dd (although she's only 3) and how it could be her.

Make sure you take time out to look after yourself after the op, even though it is minor I think the mental repercussions were more difficult to deal with.

sophe Is cin3 not past the stage of your body being able to regulate and eradicate? Surely just screening under 25s and keeping an eye on the ones who come back with any cin result would be a good idea? No removal of cervix needed unless it becomes necessary. I'm not being argumentative btw just questioning.

I have just made a post asking people to look at and 'like' the Mercedes Curnow Foundation for the early detection of Cervical Cancer on FB.

Mercedes died from Cervical Cancer in December at the age of 23. The foundation has been set up by her mum and family to help support young women with symptoms and they have started a paper petition to reduce the age of screening from 25 years down to 20 years. They are handing it in at Downing Street on 23rd April.Please take a look!

Sorry StrawberrytallCake, just seen your posts! Saw the first post and then made mine without reading through!! I am new to this can you tell!! Apologies

No apology necessary!! :)

The NHS cervical screening programme reviewed the age at which screening starts in 2009. The minutes of the committee meeting are available here and are worth a read as the meeting goes through the evidence and points for and against.

All CIN has the potential to go away without treatment, particularly lower grades. At present there isn't a test that can be used clinically to identify which CIN lesions won't go away, nor which would progress to cancer (or how long it would take). That's why CIN3 is usually treated.

The cytology (smear) results usually correlate but can be worse e.g. smear result can be moderate but colposcopy appearance is CIN3. This is because they are using different methods of looking for the lesion.
Comparing what the NHS CSP does with other countries is tricky because the NHS CSP has different standards - rigorous training programmes, staffing structures in the screening lab,regular monitoring of staff performance and testing (Quality assurance) and inspections (QA visits and CPA) of labs and colposcopy. This doesn't happen in the same way with private providers and medical insurance models (e.g. in the US).

Yanbu many lives could be saved.

Is it every 3 years that smear are done

Suggest you read above link Mchappypants - it is a very small number of lives that could be saved, with many women having potentially fertility affecting treatment for changes that can in some cases resolve without treatment.

The key here is understanding what screening programmes are. They will never be about the small number of people who are outside the programme as they are ineligible (however tragic). Programmes are constructed to make the most impact and best of resources to do so; it needs to be based on epidemiology, the performance of the test available and acceptable treatment. There is a balance required between potential under- and over-treatment. E.g. there isn't a national prostate cancer screening programme yet because the test which is easiest to use detects many cases of BPH (benign prostatic hyperplasia) which some may develop ca eventually. The treatment is heavy going and can cause impotence. The balance is at present tipped towards not having regular screening because it would cause more problems than it solved.

It's every 3 years 25-49 and 5 years 49-60 y/o.
The NHS CSP is structured, monitored and quality assessed programme - its performance is recognised as one of the best in the world. That's why we don't do annual screening. You would also detect a relatively small additional number of abnormal tests of women who might need treatment, but far more women who would need monitoring.
The reason we can have cervical screening is because there is a long pre-cancerous phase to the disease, usually quoted at 10-15 years.

Thanks bela, that's really interesting and informative and clearly put.

In Scotland they are done every 3 years between the age of 20 and 60

In N Ireland smears start at 20, although when I was younger it was 18. It always seemed very sensible to me, I know several people who had abnormalities picked up in their early 20s that were treated very quickly with no long term effects. As the OP says, it could be a different story if they'd had to wait.

Hope your operation goes well OP.

I'm 22 I've never had one and I do find it scary that something could be up and I dont know.

Hope the OP goes well OP.

In the Netherlands it's 35!! When I was living there and I queried this with a gyneacologist ( female btw) she advised that when they do the test they often find little abnormalities etc they are then obliged to report and that causes undue worry!!!! Eh.... what about the folks who die of cervical cancer becasue they weren't tested early enough!!!!xx

YABU unless you have read all of the literature on which the decision was based... they don't change these things on a whim you know.

'they' aren't always right though you know. I think if one life can be saved its worth it, I'm sure you would think the same if it were your dd in the same situation.

I recently found out you can pay privately for a smear test but don't know what the age constraints are. Archemedes if it is something you are worried about (you're having bleeding between periods or other symptoms) then go to your dr.