Sophie Jones's death is tragic but smear tests for teenagers are not the answer

http://www.theguardian.com/commentisfree/2014/mar/18/sophie-jones-death-smear-tests-teenagers

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The family of a young woman who was denied a smear test and tragically died of cervical cancer are campaigning to lower the cervical screening age to 16 (it is currently 25 in England). At the last count the petition had more than 130,000 signatures.

Sophie Jones was 19 and died completely unnecessarily. She had been suffering from severe stomach pains for months and, on visiting the doctor, had asked for a smear test but been refused because of her age. Cervical cancer was diagnosed in November and she died on Saturday. A smear test could have saved her life. Nonetheless, lowering the cervical screening age to 16 is a terrible idea and I urge you not to sign the petition.

Every now and again, a young woman dies from cervical cancer and as a result campaigners will call on the government to lower the age at which cervical screening commences. Their anger that the cancer of their loved one went undiagnosed is entirely understandable, especially when, as in Sophie's case, the patient has presented with symptoms which could indicate cervical cancer. Sophie's symptoms meant she should have been granted a smear test, but that doesn't mean that all the other girls her age should be. Smear tests are not, we forget, strictly tests at all. Their purpose is not to diagnose cervical cancer but to try and prevent cancer from developing. This risk is gleaned from cell changes on the cervix. If you are under the age of 25, the changes are so great that testing becomes fairly pointless. One in three women under the age of 25 will have an abnormal result (compared to one in 14 for women over 25). It has been found again and again that 25 is the tipping point at which the benefits of cervical screening outweigh the risks. This is why the age should not be lowered – the number of false positives could lead to many young women being referred for painful treatment unnecessarily.

I had an abnormal smear when I was less than one month past my 25th birthday, and I can testify that the treatment is painful. Without wanting to go into too much detail, imagine being scraped out with an electrically charged spoon. The radio was playing while they did it. If I didn't hate Coldplay then, I certainly do now.

Obviously when I got the letter I thought I had cancer. I didn't realise that most cell changes are normal and that having a pesky fluctuating cervix does not mean that you are going to die. While I'm glad I had a smear test, I'm aware that had I taken it a month earlier, in all probability they would have sent me away. It was not a pleasant experience and it did, to an extent, traumatise me. It's certainly not something I'd wish unnecessarily on a teenage girl.

The more you start talking about your abnormal smear, the more you hear the words "yeah, me too". I've lost count of the number of women who have told me their stories. Most didn't have cancer and didn't even need treatment. Lowering the age would mean many more "me toos".

There's a school of thought which argues that women shouldn't have smear tests at all. I do not subscribe to that but studies have shown that the majority do not have any benefit. The likelihood of getting an abnormal result is much higher than the likelihood that you'll get cancer, but for the small proportion of women who do go on to develop cancer, a smear is crucial.

Thus far, medical evidence does not suggest a need to lower the age for cervical screening. A 2009 study published in the BMJ found no evidence that screening women aged 20-24 reduced the incidence of cervical cancer at age 25-29. In other words, cervical screening at this age has little or no impact on rates of invasive cancer up to the age of 30.

It's easy to get swept up in the emotion of a campaign such as that of Sophie's family – her death was preventable and her doctor failed her. But, as with many things, education and improving access holds the key. Women need to be taught not to panic so much when they get an abnormal result and to recognise symptoms – it is a scandal that we are this ill-informed about our own bodies. Doctors need to be reminded how to respond when young people show signs of the disease, and we need to be making sure that teenagers are getting all three HPV jabs, especially those from non-white ethnic groups. Making sure these measures are taken would be a fitting tribute to Sophie.