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New DH cervical cancer guidance alerts GPs to abnormal vaginal bleeding

By Lilian Anekwe

GPs should conduct a pelvic examination on young women who present with abnormal vaginal bleeding to rule out early cervical cancer, new guidance from the Department of Health recommends.

New GP guidance published this week says all women aged 20 to 24 who present with either postcoital or persistent intermenstrual bleeding should be offered an immediate speculum exam, which the guidance describes as the ‘critical intervention in the diagnosis of cervical cancer.'

The DH's advisory committee on cervical screening demanded new guidance for GPs after their review of the age for screening found that though fewer than 50 women aged under 25 are diagnosed with cervical cancer every year.

Cancer tsar Professor Mike Richards told Pulse: ‘I think what was happening was that patients were going to their GPs with symptoms and GPs were asking for smears, not an exam.'

‘Screening works for detecting symptomless cervical cancer but cervical cancer with symptoms is a lot rarer and in these cases the right test is a speculum exam, not a smear.'

If the cervix looks abnormal and suspicious, women should be urgently referred for colposcopy under the two week wait rule. Women with benign lesions or cervical polyps can be routinely referred, and women with no physical signs of cervical abnormalities should be offered a pregnancy or STI test.

Dr Shaun Firth, a GP in Harlow, Essex who helped draft the guidance, said: ‘GPs will probably see someone in the surgery every week with abnormal vaginal bleeding. But postcoital and persistent intermenstrual bleeding, if not explained by contraception or other aspects of their history, is a red flag.'

Cancer tsar Professor Mike Richards


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