Smear tests fail to cut deaths in young women: Cervical cancer continues to take its toll, even though the number of people being screened has doubled in the last five years

THE NUMBER of women having cervical smear tests has doubled in five years but the national screening programme appears to be having little impact on deaths from cancer of the cervix in younger women.

A report published yesterday on the first five years of cervical screening, since the programme was formalised in 1988, shows a clear decline in deaths in women over 45, although this trend was evident in the 1950s.

Cervical screening began in the 1960s but it was not until the late 1980s that health authorities had organised computerised systems to call and recall women between the ages of 20 and 64 at five-yearly intervals for tests at their GP surgeries.

In 1988, the National Co-ordinating Network for the National Health Service Cervical Screening Programme was established.

The new report from the co-ordinating network shows that eight in 10 women aged 35 to 64 are being screened. Among those at high risk - older women aged 60 to 64, in whom cervical cancer is more common, and those who live in inner cities - coverage has more than trebled from 25 per cent in 1988 to 81.3 in 1993.

The report says that of the 14,896,990 women aged 20 to 64 in England, 11,442,054 have had a smear test at some time in the past five-and-a- half years - a coverage rate of 82.9 per cent. 'But a great deal more needs to be done,' Dr Muir Gray, secretary of the programme, said yesterday.

He said one possible reason for the lack of progress on cervical cancer death rates in women aged 25 to 44 was that cervical cancer was becoming more widespread, allied to changes in sexual behaviour.

Dr Elaine Farmery, programme chairman, said: 'Being a nun is the best way of preventing cervical cancer. But sexual habits and practices have changed dramatically since the programme was introduced in the Sixties.'

Dr Gray said the task for the next five years was to increase the number of women having tests and standardise the way smears were checked in laboratories. He ruled out annual testing.

'If you screen annually you would have a massive increase in women with false positive results and the amount of anxiety caused for the extra benefits is not worth it. At the moment our priorities are to increase coverage and the five-year recall system.'

He said screening would always produce a proportion of false negative or false positive results and publicity which followed laboratory errors tended to increase false positive rates when lab technicians became anxious about missing abnormal cells on the slides.

Between 5 and 6 per cent of smears are 'unreadable' because they are not properly taken or an infection masks the cells. The error rate has been reported at 6 per cent.

Overall, 5.5 million women in the UK are screened each year and about 90 per cent of them have healthy cells. Dr Gray said deaths from cervical cancer had reduced by 1,000 since the 1960s, when 2,500 women died annually in England and Wales.

But the programme is expensive to run - at pounds 100m a year, the cost of each life saved is pounds 100,000, he said.

This compares with pounds 10,000 to pounds 15,000 for the cost of a life saved through breast cancer screening, which costs pounds 40m. Breast cancer kills 15,000 women a year.

Alison Paton, clinic manager at Marie Stopes International, the women's health charity, criticised the programme for its insensitivity. 'We receive 800 telephone calls a week from women who are frightened,' she said.

'Many are still receiving a two-line letter from the doctor telling them their smear is abnormal and that they should return for a repeat in six months. They think they have only a short time to live.'

One woman had become so fearful of having a smear that she asked for an anaesthetic; others asked for valium.

Julietta Patnick, national co-ordinator for the programme, said GPs and practice nurses were now trained in the techniques. 'We must go on with the improvements,' she said.

Ms Paton said the reasons for the low impact on death rates were not established. 'It may be that virulent forms of cervical cancer are more common.' Other reasons might include more sexual activity started at a younger age and greater use of the Pill, instead of barrier contraception, in the 1970s.

First Five Years of the NHS Cervical Screening Programme; National Co-ordinating Network, Anglia and Oxford Regional Health Authority, Old Road, Headington, Oxford, OX3 7LF.

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