Leading article: Cancer screening: a new chance

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The very public suffering of Jade Goody, who left hospital this week to spend the time that is left to her with her children, has turned the spotlight as never before on arrangements for cancer screening. Ms Goody, it is reported, had taken a cervical smear test several years ago, but failed to respond when recalled for further testing. The rest is the ultimate cautionary tale for our times.

One response has been a sharp increase in the number of young women asking for a test. Some GP surgeries registered a rise of more than 20 per cent. Cancer Research UK reported a seven-fold increase in people consulting its cervical cancer web page in the days after Ms Goody's received news of her diagnosis.

But it is not only young women who have taken notice. The Government has just announced a review of the age at which women in England will be offered screening. An expert review panel is to recommend later this year whether the minimum age for routine smear tests should be reduced from 25 to 20. Tests used to be provided for all women aged between 20 and 49. That changed in 2003, when the age for regular screening in England was raised to 25, while remaining at 20 elsewhere in the UK.

There may have been an element of cost-cutting in the decision. But the clinical reasons should not be dismissed. Earlier testing was said to have detected relatively few cancers, while turning up a large number of false positives that reflected very small irregularities. Not only were women needlessly alarmed, but some were subjected to invasive and risky treatment that in the end proved unnecessary. Something similar can be said of screening for breast cancer, where the correlation between early detection and reduced mortality rates is more complex than it might seem.

One reason for reverting to earlier testing for cervical cancer is that women are becoming sexually active earlier than in the past, and this can be a factor in susceptibility. Another reason is that more than one-third of cervical cancer cases diagnosed in the UK every year are terminal. Another reason would be to take advantage of the Jade Goody effect in encouraging take-up.

Last year only two-thirds of women aged between 25 and 29 attended for their smear test; in some parts of the country the proportion was much lower. This year, the figures should be higher. For the positive trend to continue, however, the NHS needs to do two things.

Some women stay away because they fear a physically unpleasant experience administered by unsympathetic staff. That needs to change. A more common reason, however, is the sheer inconvenience of a screening system organised according to health authority boundaries, which requires attendance at a particular time and place within standard working hours.

Women need much more flexibility than this. Drop-in centres, mobile labs and workplace clinics would all help. Jade Goody has already done more for cervical cancer screening than any government campaign could ever do. The NHS must not squander its opportunity.

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