Medical Mistake Claims - Simpson Millar LLP

Cervical Screening Test Mistakes

Author: Neil Fearn  Bullet  Dated: 17/04/2013

It is estimated that screening prevents up to 3,900 cases of cervical cancer each year in the UK, but do all women need smears? Do women who have been in monogamous or even celibate relationships, or women who have only had sex with other women actually need regular testing?

Under the NHS Cervical Screening Programme, all women between the ages of 25 and 64 are regularly invited for a test to screen for cervical cancer every 3 to 5 years. The system is automated, so as long as you're registered with a GP you should receive a letter asking you to make an appointment. As a result of research that looked at the optimal frequency for cervical screening, women are now invited for their first test at 25. They're then invited every 3 years until the age of 49, and every 5 years from 50 to 64.

From 65, only those who have not been screened since the age of 50, or who have had recent abnormal tests are offered another test.

Dr Anne Szarewski, Clinical Senior Lecturer at the Wolfson Institute of Preventive Medicine Queen Mary University of London says that we know that cervical cancer's caused by a sexually transmitted virus - the human papilloma virus – and if you've never had any form of sexual contact, which includes touching, then you're probably okay but there are very few people actually who've never had any form of sexual contact either touching or penetrative sex or oral genital - because it includes all of those.

Dr Szarewski identifies that there are 2 problems. One, is that we know that the human papilloma virus can lie dormant for many years and can then resurface for whatever reason, so that even if a woman has had no sexual contact for maybe 20 years it can suddenly come up again. The other problem is that how do you know you're in a monogamous relationship - you may know you're monogamous but you can never be 100% sure that your partner hasn't. It is very difficult for anyone to actually be able to say that they're 100% sure that they're in a monogamous relationship always.

You may have picked something up before you entered a current relationship or your partner may have done and that could come to the surface later.

Even in the situation where there is perhaps an older couple who are monogamous but are not having sex anymore, or haven't had sex for 10 or 15 years the problem is that HPV that was there 15 years ago could resurface.

Dr Szarewski explains that in fact there's a theory that because your immune system gets weaker and weaker as you get older so it may actually be that as you become elderly your immune system stops being able to clamp down on the virus that it's been clamping down on for years and suddenly that virus comes to the surface. So you may have caught the virus at the age of 25 but as you get older your immune system gets weaker and so it allows the virus to resurface again.

There is also a perception amongst a lot of women that cervical cancer is a disease of the younger woman and that it happens in their 20s, but the most common age for cervical cancer is the 30s and 40s. There is a second peak of women in their 60s and 70s and it's thought that this may have something to do with this so-called latency of the virus, that it kind of resurfaces after many years.

With regards to same sex relationships if neither of them had had any other partners ever then they would not require regular smear tests but the big problem is that most lesbians have had a heterosexual relationship at some point. And so if they've had a heterosexual relationship then they could have caught the HPV and then they could 10 years later even still be passing it on.

Dr Szarewski states that for everybody there is about an 80% chance that at some point during our lives we'll catch HPV but the important thing is that for most people their own immune system is going to just get rid of it and they'll never even know they had it. However, smoking makes you less likely to get rid of your HPV because again it affects the immune system, so your immune system isn't as capable of getting rid of the virus and so a minority may harbour the virus in the long term and the trouble is we don't know which minority.

Cervical screening isn't perfect. It can be difficult to tell an abnormal cell from a normal one, especially in the early stages of precancerous changes. In some cases that are reported as normal, abnormal cells are in fact present. This occurs in between 2 and 20% of tests, depending on the technique. However, more reliable tests are being developed. Conversely, some tests are read as showing an abnormality when no disease is present, which can lead to women undergoing unnecessary intensive treatment. But it is still the case that some results are incorrectly read and reported with the result that cancerous cervical cells are not diagnosed in a timely manner causing a significant delay in diagnosis by which time the cancer may be clinically invasive, whereas if the smear had been correctly recognised as abnormal, treatment with a simple local method of therapy by colposcopy before the cancer developed would be given thereby avoiding more extensive treatment such as hysterectomy and its consequences.

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