NHS cervical screening rates are at a 21 year low – how can healthcare professionals better support women to attend?

This week is Cervical Cancer Prevention Week, led on social media by Jo’s Cervical Cancer Trust and their lipstick-smearing #SmearForSmear campaign. Following criticism in previous years, the campaign this year focuses on the very real fears and anxieties many women have around going for their smear test.

Cervical cancer is the most common cancer in women aged 35 and under, and around 3,000 women will be diagnosed with cervical cancer every year in the UK. Virtually all cases are caused by a high-risk form of the virus HPV – itself a very common virus, which 80 per cent of adults will be infected with at some point in their lives, but which usually clears without any issues.

Cervical screening (or smear) tests are currently the best protection against cervical cancer, since they can detect abnormal cells at a pre-cancerous stage – but it’s also invasive, uncomfortable, and for some women even traumatic.

NHS stats published in November show cervical screening attendance is at its lowest in 21 years, and research published this week by Jo’s Trust found that young women who delay or don’t go for their smear tests feel scared (71%) and vulnerable (75%) at the thought of going. While embarrassment remains high (81%), a worrying two thirds (67%) say they would not feel in control at the prospect of a test.

The charity is concerned that over two thirds (68%) of the 2,005 25-35 year olds questioned say they wouldn’t tell their nurse their smear test worries, with almost half admitting they regularly delay or don’t take up their invitation. Worries about making a fuss (27%), fear of being judged (18%) or thinking their concerns are too silly or small (16%) mean women may instead be avoiding a potentially life-saving test.

Clearly, smear fears are complex – and that’s without mentioning the women and trans men for whom additional obstacles include past experiences of sexual violence, sexuality or gender identity, disability, anxiety disorders, and distressing past experiences.

The Evening Standard this week reported on a 100,000 signature-strong petition, started by 30-year-old disabled woman Fiona Anderson, who has muscular dystrophy, calling on the NHS to improve access to smear tests for women with disabilities.

According to the Standard: “Despite receiving her first cervical cancer letter in 2014, Fiona Anderson has “never had a smear test” because her GP practice does not have a hoist, something she suggests is the case at the majority of healthcare centres.”

And, as campaigner Kate Orson has previously written for Hysterical Women, many women are put off attending after experiencing devastating pain, sexual dysfunction and other side effects from the LLETZ procedure, which is used to burn off abnormal cells detected by the smear test.

What’s more clear than ever is that the onus should not be on individual women to suck it up and ‘get over’ whatever ‘silly embarrassment’ their concerns may previously have been dismissed as. There is so much more that the NHS – at a policy and front line level – can do to support women with this difficult but potentially life-saving procedure.

Ultimately, women need to feel in control of their smear test, and know that their concerns, however big or small they may seem, will be taken seriously. At the moment, for many women, that simply isn’t happening.

Launching the charity’s annual #SmearForSmear campaign Robert Music, Chief Executive of Jo’s Cervical Cancer Trust, said: “Smear tests provide the best protection against cervical cancer yet we know they aren’t always easy. We want women to feel comfortable talking to their nurse and asking questions. It’s not making a fuss and there are many ways to make the test easier. Please don’t let your fears stop you booking a test.”

When asked what has caused them to delay or miss a test, three quarters (72%) said embarrassment or a stranger examining an intimate area (69%). Fear it will hurt (58%), not knowing how to talk to a stranger about intimate body parts (44%), and not knowing what will happen during the test (37%) were also given as reasons by high numbers of women.

Robert continued: “Our research has again highlighted the urgent need for making the programme more patient-focused. We want to see self-sampling being made available as well as more flexible locations for women to attend. It’s vital women have more control otherwise we will see attendance continue to fall and diagnoses of this often-preventable cancer increase.”