Cervical screenings reach a 20-year low. We ask how this trend can be reversed?

Every year in the UK, around 3,000 women will be diagnosed with cervical cancer, making it the most common cancer in women aged 35 and under.

Despite this, the number of women attending cervical screening in the UK is falling. Cervical Cancer Prevention Week 2019 aims to get as many people as possible knowing how they can reduce their risk of the disease. To support this, we’ve been speaking to Dr Maria Kyrgiou, Clinical Reader in Gynaecological Oncology at the Department of Surgery & Cancer, about her research, screenings and preventative initiatives. 

With the number of women attending cervical screenings reaching a 20-year low, what do you think are the barriers preventing a higher uptake?

For many women, there is some form of anxiety around having a cervical smear test and this is often the biggest barrier preventing a larger uptake. The NHS cervical screening programme invites women aged 25 to 49 for testing every three years, and every five years for those aged 50 to 64. However, NHS Digital figures show that 4.95 million out of a potential 17.6 million women are now overdue their smear test.

Another serious barrier affecting uptake is the ease of testing. Women are often very busy with work and family commitments, and sometimes it can be difficult to find time to attend a cervical screening. This has meant that the take-up of screenings is at just 61 per cent among 25 to 29-year-olds in England, and 69 per cent for 30 to 34-year-olds.

How do you think we can reverse this worrying trend? And what initiatives do you think have, or could, encourage them?

Media campaigns need to focus on reducing the anxiety around having a cervical smear, reminding women of the importance of having regular smears and focusing on the fact that cervical cancer is far less common when there is a higher uptake of screening. Jo’s Cervical Cancer Trust’s #SmearForSmear campaign is a great example of this.

I also think we need to encourage other parts of the media to explore this topic, such as TV soaps having storylines about screenings/cervical cancer as a way of bringing it into the public focus. After Jade Goody was diagnosed with cervical cancer, and sadly died in 2009, there was a jump in the number of smear tests taken by young women as the disease gained a lot of public attention. However, the ‘Jade Goody effect’ seems to have now passed and screenings are at a 20-year low.

We also need to make it easier for women to have screenings. This could be done by allowing women who work or have families to attend a screening in the evenings or at weekends, as well as offering tests at easy access clinics, like family planning centres. Technology, like smart phones, should be used to make it easier to book and receive reminders about screenings. Finally, we must continue to promote, and research new ways, of allowing for self-testing – for example human papilloma virus (HPV) self-testing kits. 

What has your research into cervical cancer and its prevention uncovered?

My group works in the field of cervical cancer treatment and prevention, with the aim of understanding the factors that promote carcinogenesis in women with HPV infection. This is a very common infection but only leads to disease in a small number of infected individuals. We have been looking into the genetic and epigenetic factors in the virus and the host, the interactions that this may have in the microbiota and the impact of the immune system. We have been trying to develop tools that will allow personalised management of women with cervical abnormalities, whether these are precancerous or cancerous changes.

How has your research impacted both the field of study and clinical practices?

We have been working on the impact that treatment for cervical intraepithelial neoplasia – abnormal growth of cells on the surface of the cervix – and early stage cervical cancer has on the fertility, reproduction and pregnancy outcomes. Many of these findings have changed clinical practice and allowed us to better balance the risk of developing cancer versus the associated risks and morbidity. My group’s research has further allowed us to better understand how the infection goes through to the procarcinogenic stages and ultimately malignant transformation and cervical cancer.

What are you expecting and hoping for from future research into the topic?

I hope that in the years to come, my group will have the opportunity to further understand the real factors that cause cancer development and develop user-friendly tools to allow clinicians to choose the women that would benefit the most from treatment and minimise interventions for those at low risk. Furthermore, there is a strong desire to expand the use of HPV prophylactic vaccines in high-risk groups, such as for women who have received local treatment for precancer. Finally, I hope to see more advances in therapeutic vaccines.