4.6 million eligible patients are not up to date with cervical screening

This year’s Cervical Screening Awareness Week sees the proportion of women and people with a cervix that have never had cervical screening or are behind on their tests at a 10 year high. In the UK, cervical cancer is the 14th most common cancer amongst that group. Annually there are an estimated 3,200 new cases in the UK, translating to 9 diagnoses a day. Unfortunately, a quarter of those diagnosed die from the disease. Whilst cervical cancer is common, it is also highly preventable.

For Cervical Screening Awareness Week, we want to share a little of our insight and expertise in preventive healthcare to highlight how society can tackle cervical cancer together and reduce its impact by ensuring no one is left behind.

Cervical cancer is commonly caused by the human papillomavirus (HPV), with 99.8% of cases caused by the infection. If left untreated, overtime these abnormal cells can develop into cervical cancer. The disease is a highly preventable through regular screenings and vaccinations, with prevention and treatment coming a long way in the last 50 years.

Despite being a 99.8% of cervical cancer cases being preventable, the amount of people who haven’t had potentially life-saving cervical screenings is at the highest in a decade. Approximately 4.6 million of those eligible for screenings have never been screened or are not up to date with their tests.This comes despite the NHS sending over five million screening invites to patients in the last year - up 10.5% on pre-pandemic levels.

Additional data has shown that cervical cancer incidence is highest amongst those aged 30-34 in England and 65% higher in the most deprived areas compared to the least. At the same time, vaccination rates among teenagers are falling.

Figure 1: Cancer Research - Cervical Cancer (C53), Estimated Average Number of Excess Cases per Year and European Age-Standardised Incidence Rates per 100,000 Population, by Deprivation Quintile, England, 2013-2017

The latest research from leading cervical cancer charity, Jo’s Cervical Cancer Trust has shown that if screening rates don’t improve amongst unvaccinated women, there could be a 100% increase in cervical cancer deaths amongst 60-64 year olds by 2040.

So why is this happening? The report from Jo’s Cervical Cancer Trust has highlighted the challenges faced in eliminating cervical cancer for both the public and NHS.

Accessibility inequalities

Barriers to screening preceded the COVID-19 pandemic and still exist today. Their research found that those living in more deprived areas are less likely to attend screenings and vaccine uptake is lower in these areas, especially amongst some ethnic groups. Two-thirds who are physically disabled have been unable to attend appointments whilst almost half of sexual violence survivors didn’t attend and those in full-time work found it difficult to get a convenient appointment.

Anxieties about screening

Limited options where screening is performed, and workforce pressures were the biggest issues identified. People feel embarrassed and anxious about getting tested with many preferring not to have to visit their GP to be screened.

Lack of public understanding and awareness

There is a significant misunderstanding and knowledge gap about cervical screening with the public. Many don’t know what screening is for, whilst 1 in 5 in the UK mistakenly believe that cervical screening can detect ovarian cancer.

Additionally, vaccine hesitancy and limited public understanding around the HPV vaccine are a factor in why vaccine uptake has decreased within teenagers. From their research, Jo’s Cervical Cancer Trust found that only 55% of parents of soon-to-be eligible children were aware of HPV and the vaccination programme.

Lack of digitalisation

IT systems are not fit for purpose and are not robust enough to meet requirements. There’s a lack of access to quality data that will help targeted screening and vaccination programmes whilst lack of improvements to NHS IT infrastructure is hindering primary care workflows and communication they could have with patients.

What needs to be done?

We have reached a critical point with cervical cancer in the UK, but prevention and treatment of the disease; once diagnosed; has come a long way in the recent years.

Data from Cancer Research shows that incidence rates in the UK decreased by 25% between 1993 and 2018. Since early 1970 mortality rates have decreased by 75% whilst over the last decade, mortality rates have decreased by 18%. It is now estimated that 51% of those diagnosed with cervical cancer are now surviving beyond ten years. Yet more needs to be done.

This is a preventable disease that can be eradicated. With regular screenings for 24–64-year-olds and increasing vaccination uptake within teenagers we can achieve this.

Education around cervical cancer, screening and the HPV vaccine is essential. People, especially in more deprived areas don’t know enough about cervical cancer or are hesitant about attending appointments. It’s our duty to change that and raise awareness within these groups. National awareness campaigns and education about vaccination in schools will help reach more communities and increase knowledge about cervical cancer, whilst removing the stigma that surrounds it.

Many people face difficulties getting appointments, are embarrassed or don’t have access to screenings. Improving the flexibility of where screenings take place and making them more accessible will remove some barriers for so many. More appointments, screening out of hours, access to screening through other services like the sexual health clinic and the development of HPV self-sampling can help improve screening uptake.

Some patient’s details may not be up to date in the call and recall system. Others may only have one line of communication available. Without being able to communicate with patients effectively and regularly, we will continue to see women and people with a cervix falling through the gaps and getting a late diagnosis. By having different communication methods within practices call and recall system, you’re able to communicate with patients across the correct channels, whilst opening up the possibility to communicate with them across multiple channels.

These changes would not be as effective without improving the IT systems. Modern IT systems are required to be robust enough to deal with the demands of delivering effective screening and vaccination programmes. Automating patient communication and workflows should be a given so that it enables practices to effectively communicate with patients, maximise their reach and ease administrative workloads.

It’s clear that encouraging more people to both attend regular screenings and HPV vaccinations is vital for us to achieve the NHS’s ambition of diagnosing more cancers early and preventing them from ever occurring. Catching the disease early is the best strategy for preventing more deaths from cervical cancer. However, we cannot continue allowing so many people to fall through the cracks. If action isn’t taken, then we will be missing a huge opportunity to eradicate cervical cancer deaths in our lifetime.

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