• 7/15/2004
  • London, UK
  • Staff writers
  • Manchester News / and Lancet

Britain’s cervical screening program is helping save the lives of 5,000 women a year and has prevented a cancer epidemic, experts said today.
National screening for cervical cancer started in 1988 after deaths from the disease among women aged under 35 increased three-fold in the previous 30 years. Now researchers have estimated that the lives of 100,000 women born between 1951 and 1970 will be saved thanks to screening.

Writing in The Lancet, they said that 15 years ago the country was heading for a devastating outbreak of the disease. But since the introduction of screening, that trend has been reversed, at a cost per life saved of about £36,000.
The latest research compared falling death rates from cervical cancer since 1988 against the projected increase if screening had not been introduced.
Prof Julian Peto, who led the study for Cancer Research UK, said that changes in sexual behavior since the 1960s led to epidemic levels of sexually transmitted diseases. This meant that the HPV (human papillomavirus) infection – which can go on to cause cervical cancer – became more common among sexually active women.

Up to half of young women in Britain have been infected with a high-risk strain of HPV by the time they are 30. The virus usually clears up on its own, but if it persists if can lead to changes in the cells in the cervix which may lead to cancer if untreated. These early changes can be detected with screening and the abnormal cells removed, preventing cancer from developing. The researchers said the increased prevalence of HPV was presumably the main reason for the rapid increase in cervical cancer deaths in the 1960s to 1980s, but other factors could also play a part.

Patterns

These included age when a woman first had sex, the number of sexual partners, growing numbers of other sexual disease, smoking and contraceptive use. The sexual revolution of the 1960s led to the number of girls having sex before they were 16 rising from 1% of those born in 1931 to 24% of those born in 1974. The number of women who said they had had five or more sexual partners in 1990-91 was 11% of those aged 45-59, compared to 26% of those aged 25-34.

The researchers concluded: “Cervical cancer mortality projections … suggest that the introduction of effective national screening prevented an epidemic that would – without any screening – have culminated in British rates being among the highest in the world at all ages, with about 11,000 invasive cancers and 5,500 deaths per year in England and Wales by 2030.”
The experts added: “These estimates imply that about 1.5% of all British women now younger than 50 years – about one in 65 – would have died of cervical cancer before age 85 years if they had never been screened, and 3% would have developed the disease,” the researchers said. Prof Peto, based at the London School of Hygiene and Tropical Medicine, said: “The cervical screening program will prevent about 5,000 future deaths each year in Britain at a cost per life saved of less than £40,000, or about £2,000 per year of extra life. “Despite occasional but widely publicized failures the British cervical screening program is already remarkably successful and is still improving.”

Death rate

Before the screening program was introduced, the death rate from cervical cancer in British women aged under 35 was among the highest in the developed world – only Bulgaria, Hungary and Romania had higher rates than the UK. Julietta Patnick, director of the NHS Cancer Screening Programs, said: “I am delighted that these findings recognize the huge contribution that the cervical screening program has made to saving women’s lives. “We work hard to set the highest standards to ensure that women can access our world leading, high quality cervical screening program. As this research shows, regular screening is one of the best defenses against cervical cancer and so I urge all women to attend when invited.”

Professor Robert Souhami, director of policy and communication at Cancer Research UK, added: “Although HPV infection affects many young women, regular cervical screening is able to pick up abnormalities and treat them quickly before cancer develops. “This new study adds to the volume of work that shows how effective national screening programs have been and continue to be in the detection and consequent early treatment of cancer.

OCF Note

While this article addresses cervical cancer, the involvement of the HPV virus in the occurrence of oral cancers is well documented. It is now believed that for those non-smokers who have become victims of oral cancer, that sexual transmission of the virus is a major factor in the etiology of the disease. This study shows once again that a proper screening program, particularly one which is conducted on a regular basis, or performed opportunistically by dental and medical professionals would catch oral cancer at early, highly curable stages or even as precancerous lesions. The reluctance of the US medical primary care physicians and dental practitioners to engage aggressively in an early detection screening program is something that must be changed in this country if we are to make a reduction in the associated death rates of oral cancers. SEER numbers in the US indicate that approximately 66% of all oral cancers are diagnosed at late stages, when outcomes are worse, and mortality rates are higher. Routine screening and early detection saves lives. Now if only our primary care dental and medical providers would routinely engage in them….