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

My first one was at 21 shortly before they raised the age. I found it very odd that when I was 23 I was going for my second smear when a lot of my peers at university had not even had their first one yet due to being a year or so younger than me.

I had a smear at 21 in scotland I had a smear before then as i had a urinary tract probelm and then got thrush , I think it is shocking that English women have to wait till they are 25 ,

I sympathise completely with the view that smears should start sooner or be more frequent, but Bela is right - screening programmes are about balancing risk for the overall good of the public health (and I don't at all mean that to sound callous, like many here I have had cancer scares and have friends and family living with cancer). The balance of risk has to be taken into account, as Bela describes above. But where symptoms present this should be followed up and taken seriously.

I went to have a look at the Jo's Trust website, as I think they had campaigned on this issue. At the moment it looks as if they are focusing on raising awareness generally rather than on the age issue specifically. In which case this thread will be a godsend to them, reminding younger woman of the need to ensure they can be screened (does the NHS have your latest address, for example?).

But OP I wish you all the best and hope you are soon fully recovered.

Tribpot I agree that symptoms should be investigated appropriately.
A screening test is for people without symptoms.
Bleeding between periods, pain, heavy periods, odd discharge, urinary tract infection - none of these are an indication to take a cervical smear. Why?

1. The cause is unlikely to be cervical related
2. If it is related to the cervix then it is often either an infection (therefore a microbiology test is more appropriate) or an inflammed/wide ectropion which can bleed readily (referral to GU or Colposcopy for investigation and treatment).
3. Non-cervical origin - various. Options include looking at changing hormones, and gynae referral for conditions such as fibroids or endometriosis.

A small number of women might have cervical cancer with certain symptoms - a direct referral from the GP to colposcopy is far quicker.
In the main the reason we can screen and detect pre-cancerous changes is because the natural history of the disease is to progress slowly

OP - apologies for hijacking your thread, my very best wishes for your treatment.
I've had a LLETZ myself and you can feel a bit wobbly afterwards so it take easy for a couple of days.

OP I totally agree. At the age of 21 I was already under treatment for the same as you (CIN 3 changes). The testing age in my NHS trust must have been lower at that time (?) as I started having them when I was about 16. If I didnt have my first one until I was 25 Id have lived with the severe changes unnoticed for lord knows how many years and tbh the thought of what might have happened makes me feel a bit sick. And same as you I had the colposcopy and within a week was having the treatment to remove the cells.

It sounds like you have to have loop diathermy which is the hot wire thingy. Please dont worry about the actual procedure. They give you a local ane....anae.....numbing agent, and its a bit uncomfortable, like the smear itself so its not too bad. You may also be able to smell burning which is perfectly normal but a bit unnerving if you arent expecting it. The worse part for me in all honesty was there was a student in there who kept having a right old nosey up there, and the stirrups.

Afterwards its a bit sore and you might bleed for a few days. I remember I went home, got on the settee, popped 2 co-codamol and put on Friends and just relaxed. Its more mentally painful than physically IYSWIM?

The good thing is afterwards you'll have smears alot more regularly and they will keep an eye on you. Ive had loads of smears since and each one has been fine up to now

Wow! The thread has carried on without me, thank you so much for all the responses it's really lovely.

Feeling better today, was a bit shaken the other night

It just shocked me because my job means I'm away. If screens didn't start until I was 25; ten to one id have been away when I was called up. And I'd have probably put it off and rebooked when I was back/remembered. If I left this CIN3 another 18 months/2 years, who knows what would have happened? And if it happened to me, it can happen to other girls, too.

Many thanks to the posters who've put up links to Jo's Trust; I have looked with great interest and so has DH. Very informative and reassuring.

Thank you gribble

Sorry to sound ignorant but this is a genuine question. Here goes:
Now that girls are having the HPV jabs at 12, will they still need cervical smears at 25? Is that because the HPV does not cover them against ALL the viruses?

The vaccine protects you against the most common cause of cervical cancer but it will not wipe out all cervical cancer.

If the uptake it high enough then it's possible that the age at which smears start will be revised, since there will be a different balance of gain (cancers detected and treated) vs risk (false positive, treatment undegone for no reason, potential side effects of that treatment).

yanbu.

If girls start having sex at 13/14 (which some do) they could be shagging around for nearly 10 years before their first smear.

Better to worry someone and cut out a chunk of their cervix than getting cancer.

FWIW when I got my CIN3 and had to have treatment I was a nervous wreck and had diazepam for a while, still, a lot better than getting cancer. I didn't have sex until I was 22 and had smear tests from the start, I was as low risk as you can get and still ended up with a hysterectomy in my 30's.

Trills - the screening programme will probably swap over to primary HPV testing at that point. The first cohort were vaccinated in 2008 aged 11-12 so will be eligible for screening in about 7 years time. The % coverage vaccine uptake has been >90% in some areas.
The rate of high grade abnormalities is currently about 2% of workload, the rate should drop to 0.6% which will make as you rightly say the false negatives/positives more likely. The haystack will be far bigger.
Cytology will probably be used as a triage if the HPV test is high risk type positive.

Bela, I think I can safely state I did not understand one single word of your post :)

YANBU - it should be lowered. I don't agree that people will be having unnecessary treatment either. If you have an abnormal smear that detects minor changes then you are invited back for a repeat smear 6 months later. If the repeat smear is still showing minor changes then you have a colposcopy. Depending on what is found in the colposcopy you may/may not be offered treatment. They don't just whack of chunks of cervix willy nilly!

I thought this was interesting reading. I worry that the hpv vaccine will make people think that they don't need to have screening because they think they can't get cervical cancer if they get the vaccine. :(

Tribpot - my last post replying to Trills?

I understood it and it had my name at the front so I'm happy :)

I asked the nurses at colposcopy about this- they said that under the old system for every case of a woman under 25 with possible cancerous changes, there are 100 who find the experience of a smear at such a young age so traumatic that they never have another. By 25 women are more sexually experienced, have possibly had children, and are more likely to not be scared off.

Good grief! If they find a smear traumatic, childbirth will probably be the last thing on their minds!

YANBU.

I had a smear at 21, all fine - no CIN, nothing. I had one at 25 (the age was increased so I didn't get one in between), I had cancer. Had I had a smear at 23 perhaps I could have avoided a cancer diagnosis.

Thanks Trills :)
There are big changes in the CSP at the moment. Triage with HPV testing is coming in from April for low grade abnormalities and Test of Cure for those who've had treatment. There are two major change this will mean for women attending for screening:

1. Women having a low grade abnormality will have their sample also tested for high risk HPV types. If positive then they will be referred straight to colposcopy. If negative they will be on routine recall (3 or 5 years).
2. Women who have had CIN1+ (not cancer or CGIN) will also have HPV testing on their first cytology test after treatment. If positive then they will be referred straight to colposcopy. If negative they will be on 3 year recall.

This will reduce the number of follow up cytology tests women need to have. With this there's a drive for more centralisation of the screening labs, to make the HPV testing cost-effective and I guess to prepare for the likely changeover. It's an interesting time in screening!

SoundofHerWings: the reason for changing the screening ages is in the official discussion of the national screening committe (as mentioned up thread) is here. All the evidence was reviewed, presentations made by interested parties including Jo's trust - it's linked from the NHS CSP website which is worth a look round itself to understand the screening programme and development of abnormalities more.

Oh snowboarder I'm so sorry.