Failure to understand risk factors for developing cervical cancer could mean greater incidence and death in women over 50

• Lack of knowledge around HPV contributing to fewer older women attending cervical screening
• Calls for more research into HPV self-sampling to save lives

A lack of knowledge about the cause of cervical cancer and who can be affected seems to be contributing to older women (aged 50-64) not attending cervical screening. Almost two thirds (60 per cent) of women aged 50-64 do not know HPV* causes cervical cancer and many failed to link historic sexual activity as a threat to the virus laying dormant and developing into cervical cancer later in life. This is according to a new study[1] by Jo's Cervical Cancer Trust to mark the start of Cervical Screening Awareness Week (15-21 June).

Alongside knowledge gaps the data also revealed that 29.1 per cent of women over 50 have found the test painful since growing older, including 24.4 per cent experiencing pain since going through the menopause. There is concern that if attendance for cervical screening continues to decline among older women, more will face a later stage diagnosis of cervical cancer and potentially lose their lives.

The charity now wants to see other ways to increase uptake and is calling for more research into exploring a HPV self-sampling test** following results showing that 53.9 per cent of those that had delayed a cervical screening test said they would prefer to self-sample at home. This compares to only 20.5 per cent of those that haven't delayed screening.

A trend revealed by the study showed that many did not understand sexual activity and its relation to the disease. Regarding the statement "if I have been with the same partner for over five years I am not at risk of developing cervical cancer" 38.4 per cent of those who delay screening either agreed with it or didn't know if it was true. It is crucial that women realise that even if they have only had one partner, they are at risk of having the virus, which can lay dormant for many years and can lead to cervical cancer. This lack of knowledge is particularly concerning as 31.1 per cent of those questioned said they had had a new sexual partner in the last 20 years, including 10.1 per cent in the last 10 years and 8.2 per cent in the last five years, increasing their risk of being newly exposed to high risk HPV.

The results of the charity's research follow a study[2] published today in the BMJ which highlights concerns that if older women are not attending screening when eligible, their risk of developing cervical cancer after 65 increases dramatically.

The most recent data shows that over a third of diagnoses in England were in women over 50[3] and those aged 50-64 are more likely to be diagnosed with advanced stage cervical cancer, with 49 per cent as stage two or later. Furthermore for those out of the screening programme, there has been an increase in the proportion of cancers diagnosed as stage two or later in women aged 65+ from 62 per cent in 2007/08 to 72 per cent in 2011/12[4]. A later stage means more invasive treatments leading to a significantly reduced quality of life and a reduced chance of survival. In 2012 71 per cent of all deaths from the disease in England were in women aged 50 and over[5].

Cervical screening is the most effective way of preventing cervical cancer yet across the UK figures for 2014 show a significant drop as age increases, for example in England[6] numbers fell from 81.6 per cent of 50-54 year olds to 74.8 per cent of 55-59 year olds and 73.2 per cent of 60-64 year olds. There is also a significant drop in attendance over the past decade. There has been a 6.6 per cent[7] drop for 50-55 year olds from its peak in 2003 to now, whilst attendance for 60-64 year olds is lower today than 17 years ago.

The survey revealed the average time women aged 50-64 delay their screening for was almost four years (47.6 months) while one in 10 said they delayed for between five and 10 years.

Robert Music, Chief Executive of Jo's Cervical Cancer Trust said: "It's absolutely vital that women of all ages are educated around the cause of cervical cancer and their risk of HPV. Responses from women questioned in our research were worrying with some citing they had been 'celibate' for several years and therefore did not consider themselves to be at risk. We must remind all women that HPV is very common and can lie dormant for very long periods of time and that the best way of reducing one's risk of cervical cancer is to attend screening promptly whilst eligible.

"Almost a quarter[8] said this was a disease that was most likely to affect women aged 25-34 which suggests that many people associate it as a predominantly young persons cancer. Whilst it is the most common cancer in women under 35 it still affects women of all ages and we are particularly concerned that if women delay their screening over the age of 50, they increase their chances of not only a diagnosis after they have left the programme, but a later stage diagnosis with a poorer outlook.

"The survey shows that for many HPV self-sampling at home may take away some of the anxiety associated with screening. If it could lead to more non-attenders getting tested then we would like to see investment in research to explore its feasibility amongst this age group."

Dr. Susan Sherman, senior lecturer in Psychology at Keele University and lead author of the BMJ report, said: "The review published in the BMJ suggests that older women not getting themselves screened to prevent cervical cancer has become a significant contributor to the number contracting the disease. Despite all the attention on younger women – in part due to the Jade Goody effect – 20 per cent of new diagnoses and nearly 50 per cent of cervical cancer deaths occur in women over the age of 64. We need to change the perception of cervical cancer so it is thought of just like breast and bowel cancer – that it can affect women well into old age.

"Encouragingly we found that women with three negative tests for cervical cancer between 50 and 64 are considerably less likely to get the disease in the next 20 years. So regular screenings have the potential to catch the disease early and reduce the victims of cervical cancer dramatically. Jo's Cervical Cancer Trust has also backed this up with its own investigation and during Cervical Screening Awareness Week from 15 -21 June we want to encourage more older women to get themselves screened for cervical cancer."

ENDS

NOTES TO EDITORS

About Jo's Cervical Cancer Trust

• Jo's Cervical Cancer Trust (www.jostrust.org.uk) is the UK's only charity dedicated to supporting women and their families affected by cervical cancer and cervical abnormalities. The charity also campaigns to increase awareness of the disease and bring down numbers diagnosed through promoting the cervical screening and HPV vaccination programmes. The charity's national helpline is on 0808 802 8000.

*About HPV (Human Papillomavirus)

• Anyone who has ever been sexually active is at risk of contracting HPV
• Around 13 high-risk types of HPV are responsible for causing cervical cancers
• Within the high-risk group, types 16 and 18 are the most prevalent, causing over 70 per cent of cervical cancers
• An HPV infection causes changes to the cells of the cervix, creating abnormalities; it affects the DNA in the cells, meaning any new cells created will also be abnormal. HPV attacks the basal cells of the cervix (these are specific cells found in skin that reproduce new skin cells) [3]. These abnormalities can result in the production of damaged and disorganised cervical cells that cannot function correctly.
• Four out of five (80 per cent) women are infected with genital HPV at some point in their lives without ever knowing they have been infected because HPV is usually cleared (without treatment) by the body's immune system, with 80 per cent of cells healing within two years.
• However, a small percentage of women do not clear the infection and it can remain 'dormant' (inactive) or persistent in their bodies, sometimes for many years. If your immune system doesn't clear the infection and/or the abnormal cells are not removed or monitored, the DNA of the HPV virus can join with the DNA of the epithelial cells, creating cancer cells. This is why cervical screening and HPV vaccination are important in helping to spot abnormalities and prevent cancer.
• Research has shown that changes in abnormalities do not usually escalate quickly and it can take between 5 to 20 years for a cancer to develop.
• **A self-sampling kit is designed for women to use themselves in the privacy of their own home, or if they so wish, at a medical centre.The kit will test for the presence of high risk HPV types that could cause cervical cancer.

Cervical cancer and abnormalities

• In the UK 8 women daily are diagnosed with cervical cancer and 3 women will lose their lives
• Over 300,000 women a year are told they may have a cervical abnormality that could require treatment

Tips on screening:

• If you are using vaginal oestrogen cream for menopause symptoms, do not apply it on the day of your screening
• Do not douche or use a tampon for at least two days before your screening.
• The more relaxed you are, the less discomfort you will feel. However if you feel any discomfort let the nurse know.
• You can ask for a different sized speculum (the instrument used to open the vagina). Women experiencing vaginal dryness can also ask the nurse to use a lubricant or they may use vaginal moisturisers before attending
• If you have any concerns you can see the nurse first to discuss any issues before returning for the actual test once the concerns have been addressed.
• If vaginal pessaries have been prescribed to treat an infection then postpone your screening for at least a week after the treatment has finished.
• If your problems continue and a smear test can't be performed you can also be referred directly to a colposcopy clinic.