A cancer survivor is fighting against a change to cervical smear tests which she believes could result in fewer people having the potentially deadly disease caught early.
Katie Hirst, who lives in London, launched a petition after discovering a change to NHS smear tests was brought in last year which means they now only test for human papillomavirus (HPV) and no longer test for cell changes.
HPV is the name given to a common group of viruses – with ‘high risk’ types linked to the development of cancers, such as cervical cancer, anal cancer, genital cancers, and cancers of the head and neck.
When Katie was diagnosed with cervical cancer at the age of 24, a smear test showed she was HPV negative with abnormal cells. She fears that if her smear test only checked for HPV, her cancer may have remained undiagnosed.
Katie, 26, told Metro.co.uk: ‘What is worrying is that hardly anyone knows these changes came into place last year. I went for my first ever smear test in February 2019 after getting my letter asking me to go.
‘It was just before these changes came in. I was HPV negative but I had abnormal cells, yet I was diagnosed with cervical cancer just before I turned 25.
‘Luckily they caught it early, but if I’d had one of the new types of smear tests I would have been tested for HPV which would have been negative, and I would have been sent away for another three years.
‘By then [my cancer] may have been stage three or four.’
But gynaecologist Saurabh Phadnis told Metro.co.uk that more than 90% of cervical cancer cases are HPV-driven.
Katie, from Huddersfield, said she was diagnosed early so it meant she could avoid chemotherapy and had a trachelectomy instead – the removal of the cervix. This has left her able to still have children, though she cannot do so naturally.
She went into surgery not knowing if she would need a hysterectomy during the procedure. If surgeons discover a tumour that is too large, they may make a decision in theatre to remove more than just the cervix.
‘I know I am lucky it was caught so early, but I know myself and other women who were diagnosed with cervical cancer but were HPV negative,’ Katie said.
‘That’s why these smear test changes are scary – more people could go undiagnosed unless they get a private test, which are hundreds of pounds.’
Katie, now cancer free, said that after her petition ends she will continue to raise awareness of the changes under her campaign, What About Us.
She is calling for the testing age to be lowered as she was actually diagnosed before 25, when it is recommended women and those with a cervix have their first smear test.
Katie also urged women to be aware of any abnormal bleeding or unusual pain and get ‘any little change’ checked by their GP, even if their smear tests come back clear.
Dr Phadnis, a consultant gynaecologist and gynaecological oncologist at London Gynaecology explained that smear tests are not a test for cancer and the change to what they are tested for will not impact the large majority of people.
He said: ‘More than 90% of cervical cancer cases are HPV-driven.
‘A small proportion of patients have non-HPV cancer, and this patient was in that category. These particular cancers have more aggressive traits and a poorer prognosis.
‘It is important to remember that screening tests are not a test for cancer – it’s to check for HPV before it becomes cancerous, which takes a number of years.’
Dr Phadnis said the change to smear tests was made due to the introduction of the HPV vaccine and there needed to be a ‘reliable, safe and effective’ screening programme to check for presence of the virus.
There are more than 100 strains of HPV, but the vaccine – first introduced in 2008 – only protects against up to nine strains which cause 75% of cancers, so a smear test checks for any type of HPV.
The change in the screening process does not reduce the workload for doctors, Dr Phadnis added.
‘It actually increases the workload, as if HPV is present we then have to send the samples off separately to check for cell abnormalities,’ he said.
Dr Phadnis said he ‘understood’ Katie’s concerns and said it was a ‘challenge’, but stressed most of the 10% of cancers unrelated to HPV would not be picked up by previous screening tests anyway, as they are rare or may exist in areas that are not checked by a smear.
‘I would encourage women to attend their screening programmes when they are old enough for a smear, and look out for unusual symptoms like bleeding after intercourse, or changes to vaginal discharge. If you do, go to your GP for further investigation,’ he added.
Mika Simmons, filmmaker and founder of The Happy Vagina project and podcast, which looks to promote open discussion and education around women’s gynaecological health, echoed his thoughts.
‘As with everything, I feel this is a question of education. I know some women are concerned about this new way of testing and I am extremely thankful that we live in a country which provides platforms to express our thoughts and keep those in power accountable,’ she said.
‘However, the current research has shown that, this new way of testing – looking for HPV first instead of cell change – is a better, more effective way of looking at samples.
‘It’s estimated it could save thousands of missed diagnoses. It’s is of paramount importance that women understand what the change means and feel comfortable with their results.
Symptoms of cervical cancer
According to the NHS website, the symptoms of cervical cancer may not always be obvious, and sometimes there may be no symptoms at all.
It urges women to attend all cervical screening appointments every three years.
In most cases abnormal vaginal bleeding is the first noticeable symptom of cervical cancer, which includes bleeding during or after sex, between periods or after the menopause.
Other symptoms of cervical cancer may include pain and discomfort during sex, unusual or unpleasant vaginal discharge, and pain in your lower back or pelvis.
The NHS recommends anyone with symptoms visits a GP for advice and possible further investigation.
‘Jo’s Cervical Cancer Trust are doing great, groundbreaking work in this space and if any woman is concerned about what this new testing process means for them, I would highly recommend their website as a safe place to find answers to their questions.’
Public Health England says the new test is ‘more sensitive’ and combined with the HPV vaccine ‘has the potential to completely eliminate cervical cancer’.
Professor Peter Johnson, national clinical director for cancer, said: ‘Screening is one of the most effective ways of protecting against cervical cancer and there is no doubt this new way of testing will save lives.
‘It is vitally important that all eligible people attend for their screening appointments, to keep themselves safe.
‘Combined with the success of the HPV vaccine for both boys and girls, we hope that cervical cancer can be eliminated altogether by the NHS in England.
‘The chances of surviving cancer are at a record high, but there is always more we can do, as we continue to deliver our long term plan.’
Professor Johnson added that cervical cancer often causes no symptoms during the early stages of the disease, which is why it is ‘especially important that people attend their tests and that those who are eligible get vaccinated against HPV’.
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