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Cervical screening in under 25s 'has no impact on cancer rates'

By Lilian Anekwe

A study by leading researchers in cancer epidemiology UK appears to back the Department of Health's decision not to lower the age for cervical screening from 25 down to 20.

The research, published online in the BMJ, found Cervical screening in women aged 20-24 has little or no impact on rates of invasive cervical cancer up to age 30.

In May health minister Ann Keen rejected the call to lower the age women are invited for cervical screening from 25 to 20, and opted to draft new guidance for GPs who ‘do not always giving appropriate advice' to young women presenting with possible symptoms of cervical cancer.

A study of 4,012 women aged 20-69 diagnosed with cervical cancer between 1990 and 2008 and a matched group of 7,889 healthy controls found no evidence that screening women aged 22-24 reduced the incidence of cervical cancer.

Screening women between the ages of 30 and 37 reduced the risk of cervical cancer over the following five years by up to 60, but screening at ages 20-24 had no detectable impact on cervical cancer rates under the age of 30.

A separate set of studies, also published in the BMJ online, suggested the Department of Health's policy of referring women early for further investigation may not be backed by evidence.

The TOMBOLA study, of 4,500 Scottish women aged 20 to 59 women with low-grade cervical abnormalities referred for colposcopy, found that though more high-grade pre-cancerous lesions were detected, it caused more side effects and pregnancy complications.

A cost effectiveness analysis also showed that immediate colposcopy is no more or cost effective than regular surveillance.

Professor Peter Sasieni, professor of biostatistics and cancer epidemiology at Queen Mary University of London concluded: ‘The question of screening women aged 20-24 will

decrease in importance as the cohort of women vaccinated against HPV types 16 and 18 reach their 20s.

‘If it is questionable whether screening is worth while in unvaccinated women aged 20-24, there can be no doubt that the risk of cancer in women aged under 25

Who are vaccinated before exposure to HPV will be low enough to make screening at such an age unjustifiable.

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