NHS row brews over the Jade Goody effect
Charity calls for lowering of age for first smear tests
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Jade Goody, seen with partner Jack Tweed, is said to be very happy the number of women having cervical smears has risen since her case was made public
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Defending the reality TV star Jade Goody's decision to "die in the public eye" of cervical cancer, the publicist Max Clifford said she had given three reasons. First, she wanted to make as much money as possible for her children. Second, it kept her busy and, third, the number of women having cervical smears had gone up by more than 20 per cent as a result of the publicity around her case and that was something she was "very happy about".
The first two of her objectives has attracted broad public sympathy but yesterday her third wish divided the medical community and set a leading sexual health charity on a collision course with the NHS cancer screening service over the age at which screening should start. Marie Stopes International used Goody's case to bring pressure on the NHS cervical screening programme in England to lower the age of the first smear test from 25 to 20, to bring it into line with Scotland, Wales and Northern Ireland.
"The high-profile case of Jade Goody shows this disease is a potential threat. Certain lifestyle choices which are increasingly common among younger women and teenage girls, such as smoking and having unprotected sex at an earlier age can increase the risk of developing cervical abnormalities. Bringing screening for English women into line with the rest of the UK can only be beneficial," said Liz Davies, Marie Stopes director for UK and Europe. A spokesman for Marie Stopes said most other countries with screening programmes, within and outside the UK, started at 20 or even earlier. "Our main point is that England sits alone in terms of the developed world. To fly in the face of what everyone else does is arrogant and odd. It suggests there is an economic reason here – cost is always an issue with the NHS."
But Julietta Patnick, director of the NHS Cancer Screening Programmes, said such a change would be detrimental: "It would be a shame if the Jade Goody effect were to be deflected on to an argument about screening for the under 25s. Abnormalities in the cervix are very common in that age group and we think screening at that age would lead to more harm than good," she said.
"We follow the International Agency for Cancer Research recommendations. The Netherlands and Finland don't start until age 30. There are countries that start earlier – Australia at 18, Germany and Greece at 20 – but many European countries start at the same age as us or later including Belgium, France, Ireland and Italy."
Until 2003, the NHS cancer screening service started inviting women for cervical testing at age 20. But the age was raised to 25 after research emerged of its negative effects.
Writing in the programme's 2008 annual review, Professor David Luesley, a specialist in gynaecological cancer at the University of Birmingham, said changes to the cervix are common in women under 25 but they are mostly natural and harmless and cause no symptoms.
However, if detected at screening, they result in unnecessary investigation and treatment. The removal of tissue from the cervix in these procedures also increases the risk of a later premature birth, especially for younger women.
Professor Luesley said there were fewer than 50 cases of cancer a year in the under 25s (1.7 per cent of all cervical cancers in women under 70) and fewer than five deaths. Women with symptoms (eg, bleeding) should go for a check-up but screening was targeted at women without symptoms
Ms Patnick said the number of women under 35 coming for cervical smear tests had been falling for a decade, for reasons that were not understood. In the past decade, coverage of 25- to 29-year-olds had declined from 79 per cent to 66 per cent and in 30 to 34-year-olds it had fallen from 84 per cent to 77 per cent.
Anecdotal evidence suggested younger women were more embarrassed by the procedure, possibly because the trend to later childbirth meant they were less accustomed to gynaecological examinations.
Ms Patnick said: "At 27, Jade Goody is right in the middle of the age range we are trying to reach. What happened to her is a tragedy but if it brings more women in for screening that will be a good thing."
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Comments
Interestingly I have heard similar stories from others. Cancer transcends social class and age, as does the feeling that 'it won't happen to me' - it can, and it does. 5 recorded deaths - but how many of those who have cervical cancer are recorded as something else? My mother died of ovarian cancer which ravaged her body but the death certificate read - pulmonary embolism. Other cancer related deaths are recorded as pneumonia et al.
I agree there are economic costs - 'the value of life' is indeed a valid economic study but, when it's your life, what really matters is preserving it - especially when it's a young life with dependents. Even if we're just considering harsh economics - the cost of bringing up children via the state is greater than that of healthy working parents contributing to the economy, The cost of a smear and early preventative treatment is far less than the economic and psychological costs of the more advanced stages, not just for the individual but for those left behind, should tragdy strike. Is the 25 age limit just another short-term saving with long-term costs? Girls are more sexually active and from a younger age - Britain has a very high teenage pregnancy rate - an early smear won't prevent preganancy but it may mean a young mother lives to see her children grow-up.
However if a women becomes sexually active before this then she can have a smear test done at her GP's
The spokesperson for the NHS Cancer Screening program Ms Patnick, does not seem to be very compassionate in regards to her comment "Abnormalities in the cervix are very common in that age group and we think screening at that age would lead to more harm than good,". even if only one life is saved because of early screening should be enough to consider lowing the age to 20 or as in America, once a girl becomes sexually active, then it means one less death. But if you dare to read between the lines of the NHS's views, you clearly can see it's about money, not saving lives.
Celia Palmer
Leeds
Girls are sexually active at a young age these days and it is essential to reflect this in cervical cancer screening.
If it isn't down to age, then why not allow budget for this and perform a 10 year study taking smears from all women over 20 years old and then you can see if it is beneficial.
But please, do not insult our intelligence by saying it is not down to cost because if we are talking cost, then a hospital managers salary has to be the most over inflated ever.
Get your priorities right please and at least be honest about it.
Amen to that. I worked in the NHS, and saw first hand how much money is pumped into management pockets rather into healthcare.
I can't believe how insensitve Ms Patnick comments screening at an early age can do more harm than good. Imagine if she had a loved one who wasn't offered screening at an early age and got the prognosis Jade got, too late. Would she still have the "more harm than good" attitude?
My sister died not of cervical cancer but another rare carcinoma form and Jade's is yet another form of this horrible cancer disease. This caused myself and family to look at food in general and well being in ourselves. Also being a healer I recognise the natural therapies that are often suggested by spirit to help those that are supposed to survive to do so.
We can't all rush to the nearest healer with success though, some healing is not meant to be, noor can we all access what we need cheaply to help us when we need it. We also cannot totally rule out the medicine the NHS has to offer. However there is a book worth reading which I recommend to cancer sufferers. What is out there is the "Cancer Step Outside the Box" by Bill Henderson and you should read the cures of advanced cancer that has helped cure people within weeks of implementing the ideas of healthy foods and anti-oxidents. Also give 'Eat Right for your Type' by Dr D'Adamo a go and eat for your blood type... All used alongside the conventional treatments but with interesting results and fantastic results.
Please God Jade reads this and others with the same problem.... I do not think she wants me ringing up offering hands on healing... but I would offer this if it helped, but I do think give the book and foods a go Jade, see what happens.... If healing is meant it will happen... Positive thinking and a turn round of thoughts always help heal too.... And if you out there another person suffering give this a go... Particularly the first book....
Wouldn't it be a great thing if inner work and healthy food suggestions that work cured you all and brought the information to the world.... thoughts and prayers with all who read this for a positive result. Alison
When I was diagnosed with it myself, over 5 years ago, I did a lot of research and the simple fact is that, whilst all women show abnormal cervical cells from time to time, only those who also test positive for that virus (a limited number of strains of HPV) are at risk from developing the disease.
In the US women are routinely tested for HPV when they go for a smear test .. then they screen those women who are at risk more frequently. This was the case even six years ago...
So why them does the NHS not do this? A large proportion of the costs would be regained from not having to carry out so many colcoscopies (which are currently employed on an overkill basis on thousands of women who are not at risk). Just as importantly, why is it that any of these facts are not common knowledge in the UK? We have much publicity on testing for the gene related to breast cancer, yet this test is so much simpler and cheaper and long term would probably save so many more lives.
My understanding is that the number of women getting tested has been falling over the past few years that seems to me to be the bigger problem than funding. If the target age group is not prepared to be tested to help prevent cancer then the message is not getting across. This disease kills- how much plainer can you make it!
Having been through the treatment myself some years ago, I feel that women are not given enough information from their Drs about the severity and of the consequences of HPV if not treated.
I was never a fan of Jade but having seen the way she has coped with this news, and in the public eye, I really admire her for the courage she has shown during these very sad few weeks. I lost my Dad to cancer 3 years ago, my Aunt in September and now my Uncle has just been diagnosed. My Dad died just 3 wks after diagnosis and it was the chemotherapy that killed him. Jade has been through Chemo and I wonder whether it is worth going through the pain of the treatment when in most cases it doesn't cure the cancer. I would be interested to hear other views on chemo treatment.
I would also like to question the treatment of Diamorphine in cancer patients. My Dad and My Aunt were given diamorphine and the drs and nurses don't explain to the patient or the family members what the effects of diamorphine are, they tell you it is for the pain, but the reality of it is that once they administer diamorphine the patient will no longer be able to communicate properly and will die within days of having the diamorphine. I think they should talk to family members about what to expect at this time.
How well I remember the absolute agony she felt if one knocked her chair accidentally as the cancer had spread to her bones.
I left UK as soon after qualification and registration as possible. It is very difficult for the general public to realise how appalling the standards are in the NHS for those who cannot afford private treatment.
You have nurses taking the smears,and even I believe undertaking colposcoy clinics. What third world standards the women of the UK have to tolerate.
With girls becoming sexually active at 13 and 14 years to delay cervical smears until age 25 is nothing short of negligent.(Not to mention the need for screening for sexually transmitted organisms-the over 100 strains of HPVbeing but one).
Finally as I am such a slow typist I would like to expand greatly on this subject,but have not the time.
The standard of the people reading the smear tests leaves a great deal to be desired not to mention the long delays in reporting.
Ah well (says the NHS) they are only women!
Jade is a public person and this disease is to show the power of God in the name of Jesus Christ. Whatever happens, we are all sinners and somebody paid the price for our wrong doing. Jade Goody is a daughter of Abraham who is now under evil spirit power. Jesus came to set the captive free. We all will die but it is the time Jade Goody. Let some body passes this message to her.
This is above NHS power or any other body in the world. It is now in the power of God, the creator of the heaven and the earth who gave us His power through Jesus Christ. Whatever we bound on the earth, will be bound in the heaven. As a son of God like Jade, I bound this cancer and and I declare her healing in Jesus name. The name who is above all names.
JADE YOU WILL NOT DIE NOW. YOU HAVE SOME MORE YEARS TO LIVE ON THIS EARTH.
(Orom from London)