A number of GPs have been approached by women under the screening age of 25years following the tragic death of Jade Goody.
This is advice from Mr John Bevan (Portsmouth Hospitals Trust - Consultant Gynaecologist and lead on Cervical Cytology Screening)
My understanding and opinion is that the current advice remains and is that screening cytology is from age 25 and Jane Goody's cervical cancer should not alter that advice. 'One case makes bad law' The risks of anyone under the age of 25 having cancer is extremely low and there is little evidence that screening prevents that risk. Screening of young women usually fails to prevent the small number of women who would develop cancer under 25 from doing so and leads to unnecessary investigation and treatment.
If there are any changes to this advice then we will circulate. However advice on screening clearly should be coming from Public Health Specialists at the PCT.
Clearly screening is a different issue from women with symptoms. If a woman under the age of 25 has symptoms i.e persistent pcb then she should be investigated for infective causes i.e. Chlamydia in the first instance and if concerns are raised about the appearance of the cervix then referral to general gynaecology rather than colposcopy as colposcopy is currently overwhelmed by approx double number of referrals. This is because women who have never been screened or have dna'd are coming forward to have cytology and clearly this is a group at risk. I would point out that very very rarely do patients referred with abnormal cervices have anything abnormal! Only invasive cancers will be detectable to the naked eye. These would amount to no more than about 20/yr for the whole of our population of 500,000.
Speaking to the laboratories they do not refuse slides from women outside the programme. So our advice is to do what you believe is best for your patient. If she has symptoms she needs a thorough gynae or GU assessment. If she is asymptomatic you may go ahead if you wish but you will need to explain the risks of false positives and negatives in this age group.
FS April 09
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