Cervical cancer screening – ensuring messages and services are relevant to everyone

By Dr Christine Campbell, University of Edinburgh, Christine.Campbell@ed.ac.uk

Thankfully, the number of women diagnosed with, and dying from, cervical cancer has fallen dramatically since organised cervical screening  was made available in the 1960s, in line with many other high-income countries. More recently, the introduction of the HPV vaccine for secondary school girls aged 11 to 13 years old brings another vital element of cervical cancer prevention for the future. However, most women in Scotland aged older than 26 years have not received the HPV vaccine and for the next three decades will be invited to screening until the upper age limit for screening (currently 64 years). Given that six women are still diagnosed with cervical cancer every week in Scotland it is really important that screening services are optimised to remove as many barriers to screening as possible.

It has already been shown that  breast and bowel screening participation in Scotland varies by ethnic group: the Chief Scientist’s Office in Scotland has recently funded a  research project to look at what extent this is the case for cervical cancer screening, and develop interventions to support the NHS in offering screening in culturally sensitive and appropriate ways.

Over the next two years, researchers at the University of Edinburgh, working with academic and NHS colleagues across Scotland, will carry out four linked studies. First, we will describe patterns of attendance to cervical  screening among different ethnic group using anonymised linkage of cervical screening and self reported ethnicity in the 2011 Census. In parallel, we will interview white Scottish women and those from ethnic minority populations (South Asians, Eastern Europeans, Chinese, and Black African / Caribbean) to better understand attitudes to, and concerns about, screening as well as ask their views about how best to  address these issues. We’ll also summarise the evidence in the scientific literature. Finally, bringing the findings of these strands together  we’ll then work with the NHS, ethnic community groups, the Scottish Government and relevant charities such as Jo’s Cervical Cancer Trust, to design new and more inclusive ways of offering screening to women, relevant to specific communities where they are needed most.

Postscript from the Editor: One of the more optimistic papers in the Lancet Public Health  is an article on the results of a validated dynamic model of human papillomavirus (HPV) vaccination, natural history, and cervical screening which estimates an end to cervical cancer in  Australia. It is estimated that cervical cancer could be eliminated (threshold four new cases per 100 000 women) by 2028 (range 2021–35 based on the specific modelling data used). The authors also predict that the mortality associated with cervical cancer could decrease below one death per 100000 women by 2034.