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Cervical cancer screening upper age limit could move to 75 in light of new study

The committee in charge of health screening programmes is going to review findings of a new study that recommends increasing the upper age limit for regular smear tests to 75.

Researchers modelled the benefits of cervical screening in older women, and found that increasing the upper age limit led to ‘decreases in cancer risk later in life’.

Currently, the NHS carries out cervical cancer screening in women up to 65 years, but the UK National Screening Committee said it will review these new findings and ‘consider its results’.

The study, published in The Lancet Oncology, assessed the impacts of screening older women, comparing different screening tests – cytology (smear) and HPV – and projecting the risks for women who stopped screening at different ages.

They found that ‘increasing the age at which women stopped cytology screening to 75 years led to incremental decreases in cancer risk later in life’, with a 70 year-old woman reducing her average remaining lifetime risk from one in 588 if she stopped screening, to one in 1,206 if she had a negative cytology test.

The risk dropped to one in 6,525 if she had a negative HPV test, and one in 9,550 if she had a negative co-test for cytology and HPV.

The paper said: ‘We found that cervical cancers in later life, which might have been underestimated by policy makers because registry data generally do not remove women with hysterectomies from denominators, could be prevented in later life with cytology screening up to age 75 years.’

Senior lecturer and honorary consultant gynaecological oncologist at the University of Manchester Dr Emma Crosbie said: ‘Current UK practice is to stop cervical screening at age 65 if the exit screen is negative. However we know that the peak age incidence of cervical cancer is bimodal, the highest peak at age 30-34 years and a second peak in women aged 70-74 years.’

She added: ‘Continuing to screen women into their 70s can reduce risk further by identifying and treating premalignant disease of the cervix, although at a diminishing rate of return. These results make a strong argument for continuing screening beyond age 65 years.’

UK National Screening Committee director of programmes Professor Anne Mackie said: ‘The UK’s independent expert screening committee looks forward to reviewing the findings of this new international research and will consider its results.’

The study also found that HPV testing provides ‘strong reassurance’ against future risk of cervical cancer in women aged 55, potentially meaning that they may not need future tests if they get a negative result.

HPV testing is not currently carried out as a first-line test by the NHS in England, but this should be changing in the near future.

Professor Mackie said: ‘HPV primary testing will be rolled out into the English cervical screening programme by the end of 2019.’

Earlier this year, figures revealed that just one out of 207 CCGs met the cervical cancer screening target for under 50s, with the national results falling short of the 80% target, with just 69.7% uptake.

The low coverage led to NHS England and Public Health England commissioning a new text messaging service to promote attendance to cervical screening appointments across all 32 London CCGs, as London was the worst performing area.


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