A 19 years old British girl recently died from cervical cancer which had been diagnosed too late ( last November ). There’s now an online “ e-petition “ to lower the age of “ smear test “ to 16. ( http://www.mirror.co.uk/news/uk-news...cancer-3257839
).


A “ Pap smear test “ might have helped the clinical diagnosis of cancer here, although its purpose is to prevent cancer from developing by recognising early changes in surface cells by microscopic examination. The problem is that about a third of women under the age of 25 may have abnormal results ( but not cancer ) and be referred for unnecessary treatment. This is the usual age at which screening is recommended to start, because far fewer have “ false positives “ after 25, and screening at a younger age doesn’t reduce the rate of later developing cancer.



Cervical cancer IS important, and while it’s very rare under the age of 25, it does mainly affect sexually active women between the ages of 30 – 45. UK screening is usually recommended to the age of 64. Cancer is not confined to old people !



Screening by examining cells from the surface of the cervix is effective and saves lives. Diagnosis at an early stage offers the best chance of cure. Prevention would be even more effective, but there are problems of awareness, cost, and availability.


While it’s relatively uncommon in the UK, it’s the second most common female cancer ( after breast ) worldwide – and in the Philippines. It’s also caused in almost all cases by a virus ( Human Papilloma Virus, or HPV ). HPV screening might be even better than examining cells, in the future.



In the UK, girls have been offered free vaccination against HPV infection for several years now. The vaccines are also available ( at a price ) in the Philippines. “ Cervarix “ protects against HPV 16 and 18 ( P 5000 for course of three ) ; “ Gardasil “ against 6, 11, 16 and 18 but is more expensive ( P 15,000 ). Of all the 100 ( + ) HPV types, these are the ones most likely to cause cancer – others may cause genital warts or be harmless.



A fifth of “ eligible “ women in the UK – and far fewer in the Philippines - don’t go for their “ smear test “. Even if / when young women have their course of vaccinations, smear testing is still recommended for the foreseeable future. A cheaper “ compromise “ screening is VIA ( visual inspection with acetic acid … yes, dilute “ vinegar “ ), following which abnormal areas can be destroyed by freezing ( cryotherapy ).



If nothing else, the publicity over this tragic 19 year old’s death from a preventable cancer draws attention to it. In the Philippines a year-long awareness programme started last September ( “ X Means Love Campaign “ ) - supported not just by the vaccine manufacturer ( GSK ) but also celebrities, like Andi Manzano. But the natural emotions aroused by this cancer need to be balanced by realistic expectations. Screening – by whatever method – has limitations, and is not always taken up by those most at risk ( through ignorance and cost ). Similarly universal vaccination against HPV is unlikely any time soon, especially if the vaccine is not free.


I have every sympathy for the family and friends of the young English girl who died from this cancer, because it wasn’t diagnosed clinically ( symptoms and signs ). But in my opinion their e-petition is misguided. Far better to attempt prevention by vaccination and - as second best - to start screening at an age ( 25 ) when any changes are more likely to be significant and require treatment.