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Screening for Cancer

Screening hit the news recently following the release of a government ordered review to establish why there is a decline in the number of people attending. Recommendations included that patients must be able to attend cancer screening during evenings and weekends, and in locations close to their home or work. Outdated and old equipment should be replaced and a new IT system is required. Of note was that trans people and gender diverse populations are currently poorly served by screening services and this must be improved. The report said the current screening service saves over 10,000 lives a year.

What is screening?

Screening means testing people for early stages of a disease before there are any symptoms. For screening to be useful the tests:

need to be reliable at picking up cancers or abnormalities that could lead to cancer
overall must do more good than harm to people taking part
must be something that people are willing to do

Screening tests are not perfect and have some risks. You may get a false positive result (changes detected which are not really there) or a false negative result (changes are missed). So it is still important to be aware of symptoms. The screening programme should also be good value for money for the NHS. You need to be registered with a GP to get your screening invitations.

Cervical screening

Cervical cancer is rare under the age of 25 so the cervical screening programme invites women from age 25 to 64 for screening. You are invited every 3 years if you are aged 25 to 49 and then every 5 years until the age of 64. Since 2008, girls aged 12 and 13 have been offered a vaccination against the human papilloma virus (HPV) and from this September boys will also receive the vaccination. The vaccine works best in young people, before they are likely to have come into contact with the virus. Currently, the national NHS HPV vaccination programme uses a vaccine called Gardasil which protects against 4 types of HPV: 6, 11, 16 and 18. HPV types 16 and 18 are the cause of most cervical cancers in the UK (more than 70%). These types of HPV also cause some anal and genital cancers, and some cancers of the head and neck. HPV types 6 and 11 cause around 90% of genital warts, so using Gardasil helps protect girls against both cervical cancer and genital warts. A Scottish study earlier in 2019 showed a significant drop in the number of women with abnormal cervical cell changes after having routine HPV vaccination. However, the vaccination does not protect against other types of HPV that are linked with cervical cancer. This means that girls who have had the HPV vaccine still need to go for cervical screening from age 25.

Breast Screening

Overall, the breast screening programme finds cancer in about 8 out of every 1,000 women having screening. The NHS Breast Screening Programme invites all women aged between 50 and 70 for a mammogram (X-ray) every 3 years. If you are older than 70, you can still have screening every 3 years but you won't automatically be invited and you will have to contact your local breast screening unit to make an appointment. If you are younger than 50, your risk of breast cancer is generally very low. Mammograms are more difficult to read in younger women because their breast tissue is denser. However, UK guidelines recommend that women with a moderate or high risk of breast cancer because of a family history should start having screening mammograms every year in their forties. If you are younger than 40 and have an increased risk of breast cancer, you should be offered yearly MRI scans from the age of 30 or 40 depending on your level of risk. If you are known to have a gene mutation that increases your risk of breast cancer then screening is recommended to start in your 20s. If you are concerned about a higher risk of breast cancer due to a family history, talk to your GP.

Bowel Screening

On your 60th birthday you will be sent a ’poo pot in the post’. Bowel cancer screening saves lives. If detected early the survival rate for bowel cancer is 90% at 5 years and yet this has the lowest uptake rate with only 50 to 58% for people being screened in the last 6 months (breast 74%, cervical 70-74%). The screening test has recently changed to the faecal immunochemical test (FIT). This requires 1 sample, not 3 like the previous test. It detects tiny amounts of blood present due to a bowel cancer. The test is sent every 2 years from age 60 to 74. Again, if you have a higher risk of bowel cancer due to a family history or ulcerative colitis or Crohn’s disease, screening guidelines are different and you will be offered a colonoscopy (a telescope is inserted into the bowel) at a younger age. Once again, talk to your GP if you are concerned you might be at a higher risk.

Next month I will write about Abdominal aorta aneurysm screening (AAA), NHS Health checks and why the prostate specific antigen (PSA) is not a screening test for prostate cancer.

I will always recommend and encourage you to attend screening.

Stay well, best wishes

Dr Angela Paddon