Not eligible for cervical screening – under 25

Three women under 25

In the UK cervical screening is offered from the age of 25 and finishes at 64. Cervical screening is designed to look for cervical abnormalities and not cancer.

Why does cervical screening start at 25?

Cervical cancer is very rare in women under 25. Each year in the UK around 65 women out of the 3,207 women diagnosed with cervical cancer are under the age of 25, which means that approximately two out of every 100 women diagnosed are under 25 [1]. Additionally, cervical screening has been shown to be not very effective in young women. In countries where screening starts at 20, rates of cervical cancer in women under 25 are not significantly different than in countries that start screening at 25 [2].

The number of young women diagnosed is likely to reduce even further over the next ten years due to the human papillomavius (HPV) vaccination programme, which routinely offers the vaccine to girls aged 11–13 in Scotland and 12–13 in the rest of the UK. This programme was introduced in 2008 and will help to prevent over 70% of cervical cancers [3].

Infection with high risk HPV has been shown to be very common in women under 25, but less common in older women.

There are no obvious symptoms associated with high risk HPV infections, so most women who are infected won't even know. When a woman has high risk HPV, the infection may cause the cells of the cervix to become abnormal, but for most women these cervical abnormalities will clear up by themselves as the body's own immune system gets rid of the HPV infection [4]. However, some women are unable to clear high risk HPV and the abnormal cervical cells caused by a persistent infection could, with time, turn into cervical cancer.

Since high risk HPV infections are common in women under 25, it is likely that if these younger women went for cervical screening a high percentage of them would test positive for cervical abnormalities. If high grade changes were found these women would be advised to have the cells removed, as this is the current standard treatment practice in the UK. However, most women with high risk HPV will clear the infection within 12 to 18 months and then the cervical abnormalities will go back to normal.

Currently medical experts don't have a way of telling which women will be able to clear their HPV infections and the cervical abnormalities associated with them and which could go on to have cancer. However, they do know that if a woman is older than 25 and her abnormal cells have not cleared up on their own then there is a greater need to offer treatment.

Previously, the research suggested that having treatment for cervical abnormalities increased the risk of giving birth before 37 weeks of pregnancy, which is called preterm labour [5][6][7][8][9]. More recent research has looked at this risk for women who have large loop excision of the transformation zone (LLETZ) to treat their abnormalities [10][11]. LLETZ is the most common treatment option for women with cervical abnormalities.

During LLETZ a small wire loop and an electrical current is used to cut away the affected area of tissue, which is called an excision, and it seals the wound at the same time. The depth of the excision depends on how large the area of abnormalities is. The research shows that if the LLETZ excision is less than 10 mm deep, the risk of preterm labour is not significantly higher [10][11].

However, excisions that are deeper than 10 mm or repeated LLETZ procedures are shown to significantly increase the risk of preterm labour [11]. This is because deeper excisions remove more of the cervix, which reduces its ability to perform its function during pregnancy – which is to help keep the foetus in the uterus until birth. Each woman's cervix is different; some are shorter than others, which means that there are no definitive rules about the effect LLETZ treatment might have on future pregnancy.

A diagnosis of and treatment for cervical abnormalities can cause significant anxiety for many women and since the majority of young women will clear abnormalities without treatment, screening, detecting and treating changes in women under 25 would cause more harm than benefit.

The International Agency for Research on Cancer also recommends that women should not start cervical screening before the age of 25. In 2012, the UK National Screening Committee, an independent, ministerial appointed committee, advised the NHS Cervical Screening Programme that screening under 25 does more harm than good and recommended that there is a consistent screening age across the whole of the UK. Scotland has now changed its screening age in line with England, Northern Ireland and Wales.

Symptoms of cervical cancer

Women who are diagnosed with cervical cancer often experience typical symptoms prior to diagnosis.

The most common symptom is:

  • Abnormal vaginal bleeding in between periods, and/or during or after sex. 

Other symptoms include:

  • Unusual vaginal discharge 
  • Discomfort or pain during sex
  • Lower back pain.

Abnormal vaginal bleeding is quite common and is usually not serious. If a woman is experiencing symptoms such as abnormal bleeding she will need to be examined by her practice nurse or GP and should undergo a direct vaginal examination, including the cervix, in order to rule out the very small chance that a cancer is present.

There are guidelines for young women (aged 20–24) who are experiencing abnormal bleeding. This guidance, published by the Department of Health in England in 2010, states that women experiencing vaginal bleeding after sex and in between periods require a pelvic examination. Vaginal bleeding is extremely common and can be caused by a range of different problems, including changes to the cervix (neck of the womb) called cervical ectropion or cervical erosion, hormonal changes due to the combined contraceptive pill or benign cervical polyps, or sexually transmitted infections such as Chlamydia. The guidelines explain the types of questions that practice nurses and GPs need to ask in order to establish if the symptoms could be related to cervical cancer. A pelvic exam can be done by a trained practice nurse or GP.

You can download the full Department of Health Clinical Guidance for the assessment of young women aged 20-24 with abnormal vaginal bleeding here.

If you are experiencing any of these symptoms or are concerned about any new symptom, it is important that you make an appointment to see your practice nurse or GP as soon as possible. Some women find it embarrassing to talk about gynaecological problems. If you feel like this, you are not alone. In a survey conducted by Jo's Cervical Cancer Trust in 2013, 80% of women said they would see a doctor for a cold that lasted more than three weeks, whereas only 50% said that they would if they bled outside of a period [12]. However, your practice nurse or GP will not be embarrassed and they are used to talking about these subjects. Since abnormal bleeding can be a symptom of cervical cancer it is vital you seek some advice from your practice nurse or GP. If you want, you can also take a relative or a friend with you who can support you during your appointment.

You might also find it helpful to take the Department of Health guidance along with you to discuss with your health care professional at your appointment.

Summary

  1. Cervical cancer is very rare in women under 25 
  2. Abnormal vaginal bleeding can be a symptom of cervical cancer – there are guidelines in place for the under 25s with abnormal bleeding. You should see your practice nurse or GP if you are bleeding outside of your period, during or after sex 
  3. Cervical screening is not recommended for women under 25.

If you want to talk to someone about cervical screening or symptoms you can call our Helpline on 0808 802 8000.

More links on this subject

 


References

  1. Cancer Research UK. Cervical cancer incidence statistics. www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/cervical-cancer/incidence#age. Accessed: 04.09.15
  2. Landy et al., 2014. Benefits and harms of cervical screening from age 20 years compared with screening from age 25 years. British Journal of Cancer 110, 1841–1846.
  3. Meshera D et al., 2013. Reduction in HPV16/18 prevalence in sexually active young women following the introduction of HPV immunisation in England. Vaccine 32 (1), 26–32.
  4. Kim JW et al., 2012. Factors affecting the clearance of high risk human papillomavirus infection and the progression of cervical intraepithelial neoplasia. Journal of International Medical Research 40 (2), 486–496. 
  5. National Institute for Health and Care Excellence, 2013. Preterm labour and birth. www.nice.org.uk/guidance/gid-cgwave0660/documents/preterm-labour-and-birth-final-scope2. Accessed: 04.09.2015.
  6. Poon LC et al., 2012. Large loop excision of transformation zone and cervical length in the prediction of spontaneous preterm delivery. BJOG 119 (6), 692–698.
  7. Kyrgiou M et al., 2006. Obstetric outcomes after conservative treatment for intraepithelial or early invasive cervical lesions: systematic review and meta-analysis. Lancet 367 (9509), 489–498.
  8. Jakobsson M et al., 2007. Preterm delivery after surgical treatment for cervical intraepithelial neoplasia. Obstetrics and Gynecology 109 (2 Pt 1), 309–313.
  9. Noehr B et al., 2009. Loop electrosurgical excision of the cervix and subsequent risk for spontaneous preterm delivery: a population-based study of singleton deliveries during a 9-year period. American Journal of Obstetrics and Gynecology 201 (1), 33.e1–33.6. 
  10. Castanon A et al., 2012. Risk of preterm birth after treatment for cervical intraepithelial neoplasia among women attending colposcopy in England: retrospective-prospective cohort study. British Medical Journal 345, e5174.
  11. Castanon A et al, 2014. Risk of preterm delivery with increasing depth of excision for cervical intraepithelial neoplasia in England: nested case-control study. British Medical Journal 349, g6223.
  12. Jo's Cervical Cancer Trust. Third more women likely to visit a doctor with a cold than a symptom of cervical cancer. www.jostrust.org.uk/news/articles/2013/01/21/third-more-women-likely-to-visit-a-doctor-with-a-cold-than-a-symptom-of-cervical-cancer. Accessed: 04.09.15.

 

Date last updated: 
06 Jun 2016
Date due for review: 
04 Sep 2018

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