GMTV’s Dr Steele is wrong to promote cervical screening in under 25s
BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d6167 (Published 28 September 2011) Cite this as: BMJ 2011;343:d6167
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We agree with Margaret McCartney1 and fully support the English
policy of not doing smears in the under 25's. Treating lesions that were
destined for spontaneous regression can cause lasting harm to young women
and is wrong. All the referenced studies she cites reiterate this.
Symptomatic young women (intermenstrual or post coital bleeding etc)
should be screened for infection, if necessary treated in general practice
and if continuing symptoms referred to gynaecology. Doing a smear is not
appropriate.
How counterproductive then is the misguided policies of Wales, Scotland
and Northern Ireland who happily screen from age 20? Why are they free to
ignore evidence based medicine, waste money, harm young women and foster
an impression that England is denying lifesaving screening? Also
embarrassing to us, as BMA members, is the BMA 2009 ARM motion that was
carried after a few minutes debate " That this meeting strongly
recommends to the Department of Health Advisory Board that the lower age
limit for screening should be 20". This is no way to formulate policy on
a highly technical and emotive issue.
We urge the BMA to retract that resolution. We also hope the other
nations have the courage to follow the evidence, change to first smear at
25 and ride out the ensuing tabloid bleatings. As Margaret concluded it
is the "right thing" to do.
1. McCartney M. Why it is wrong to promote cervical screening in
under 25s. BMJ 2011;343:d6167
Competing interests: No competing interests
Margaret McCartny ends her article by saying we should "do the "right
thing" and stop performing smears for all women under 25"
It may be relevant that she writes from Scotland, where, along with Wales,
cervical screening still starts at the age of 20.
To address the question she poses at the top of her article but doesn't
directly answer I suggest that most "illegal" under-age smears done in
England are a result of the GP responding to the patient's anxiety or
indeed direct request.
Surprisingly in the context of the rigid and inevitably confrontational
ban on under-25 smears the principle of patient choice at the edges of a
screened population is already well established within the NHS.
Women over 70 "are encouraged to request" continuing with mammography and
the over 70s can also request bowel cancer screening.
And in the case of prostate cancer where there is no formal screening
programme, faced with the the same issues of harm and benefit raised by
the under-25 smear, men are encouraged to make an "informed choice" about
being screened.
Asymptomatic women aged between 20 and 25 should have the same right to
choose for themselves whether the distress of having a smear taken and the
resulting limbo of waiting for a result and any further and possibly
detrimental treatment is less than the worry of not being screened.
They have a right to information and professional guidance not a blanket
denial.
Promotion no, English NHS availability yes.
Competing interests: No competing interests
Dear Dr Hall
Surely you would tell a 17 year old that breast screening is
ineffective and harmful. Patient choice should not exclude medical
professional values - we should not acquiesce to interventions which are
of no value to the patient or which clearly do more harm than good.
Framing this as a patient 'choice', when we do not advertise the harms of
screening as well or clearly as the possible benefits, is misleading and
unhelpful. Sooner or later women are going to wonder why the medical
profession didn't give them the full facts.
Competing interests: No competing interests