Cervical cancer screening shouldn’t start until 25

By Kirsten McCaffery, University of Sydney; Alexandra Barratt, University of Sydney, and Jane Williams, University of Sydney

Women in England, Scotland, Wales and Northern Ireland will all soon be advised to start screening for cervical cancer at 25 years, and those aged between 50 and 64 years to screen every five years rather than every three. And a review of the Australian National Cervical Screening Program is considering whether it should make the same recommendations.

The Australian review is considering evidence on the screening starting age and the interval between Pap smears, as well as different screening technologies such as Liquid Based Cytology (LBC) and primary HPV testing. It coincides the with major changes in similar programs in the United Kingdom based on recommendations by the UK National Screening Committee (NSC).

The policy change was made in England in 2003 and Northern Ireland in 2010. And following a recent review, the protocol has been recommended for extension to both Scotland and Wales.

The changes are based on evidence that screening women under 25 offers little benefit. In fact, screening this age group arguably causes “more harm than good” with little or no health benefit, and potential physical, psychological, and economic harms. Cervical cancer is extremely rare in young women and the efficacy of screening drops as age decreases.

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The ethics of over-diagnosis: risk and responsibility in medicine

Stacy Carter, University of Sydney

OVERDIAGNOSIS EPIDEMIC – Today, Stacy Carter presents a philosophical view of over-diagnosis and what can be done to change how things stand.

Recently a friend told me a story about her dad. Fit and well, he had a PSA test during a general medical check-up. The PSA test is controversial: many, including its inventor, say it should never be used to screen for cancer.

My friend’s dad’s PSA test started him on a path to prostate cancer diagnosis and surgery. The surgery made him incontinent. Humiliated by accidents, he couldn’t be far from a toilet so could no longer coach soccer or go on his daily long walk with friends. He became socially isolated and sedentary. He put on weight. And he developed diabetes.

Now his health is worse, but it’s not only his health that has been affected. Other aspects of his well-being – attachment to his friends and the ability to live the life he wants – have been undermined. His story is, sadly, not unusual, except for one thing.

The hospital where he was treated called him in to apologise for operating unnecessarily and harming him. Both he and his clinicians concede he was over-diagnosed (the disease would not have produced symptoms or shortened his life) and over-treated (he received treatment he didn’t need.)

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