The Cervical Screening Programme is widely known to save thousands of lives every year. It is the best protection against cervical cancer, detecting high-risk human papillomavirus (HPV) and cell changes which can then be monitored or treated to prevent progression to cancer. Like all screening tests, it is not foolproof and cannot prevent every diagnosis. Furthermore, with cervical screening attendance low across much of the UK, exacerbated in many parts by the current pandemic, symptom awareness remains vital.
Symptom awareness in the under 25s
September was Gynaecological Cancer Awareness Month and we at Jo's Cervical Cancer Trust launched new research into cervical cancer symptom awareness among women aged 18 years and over. Worryingly, only 2 in 5 of those surveyed knew what the symptoms are. The lowest level of awareness was in the under 25 age group – those not yet eligible for cervical screening.
In many cancers, the signs and symptoms can be common things that may not cause alarm bells, and cervical cancer is no exception. The most common symptom is unusual vaginal bleeding (ie, in between regular periods, after sex, post-menopausal). Post-menopausal bleeding should always be a cause for concern. However, bleeding between regular periods and after sex can happen often, and for a variety of reasons, which are usually harmless – but not always.
This was reflected in one of our most concerning findings – over half of the 18–24 year old age group we surveyed believe that unusual vaginal bleeding is not something to worry about. This belief could be preventing many from reporting this symptom. During the pandemic, cancer referral rates fell by 60% at the height of lockdown. We cannot allow this to happen again. It is important that patients know they should seek help for symptoms and are supported to do so.
Virtual appointment anxiety is a barrier to younger women
We found a hesitance about virtual appointments also contributes to, especially younger, women not seeking help. One in five of the youngest age group stated that they would not contact their GP if it were over the phone or video call, with anxiety being just one of the reasons they would not do so.
Ensuring appropriate referrals
The appropriate pathway for those presenting with abnormal bleeding is to rule out other conditions and offer a pelvic examination, as well as visually checking the cervix for abnormalities. Cervical screening is not the appropriate test, as it is for asymptomatic patients and is not a diagnostic test.
For nurses working in general practice, ensuring this pathway is followed can ensure appropriate referrals happen as soon as possible. Cervical screening could in fact delay a potential diagnosis, due to the time taken to arrange appointments and wait for results, whereas an urgent referral could speed up the detection of cervical cancer.
Our research showed that those who had experienced unusual vaginal bleeding have experienced varying care. Cervical screening was often offered and only 30% of 18–24 year olds were given an examination, compared to 57% of those over 55 years.
Other common symptoms of cervical cancer are a change to vaginal discharge (particularly if it smells unpleasant), pain or discomfort during sex, and an unexplained pain in the lower back or pelvis that lasts for a long time.
Practice nurses are instrumental in detecting cervical cancer at an early and treatable stage, especially in women under the age for cervical screening, by taking concerns seriously when patients present with vaginal bleeding and following the correct pathway.
Box 1.Jo's Cervical Cancer Trust's top tips
- Ensuring that a visual check of the cervix and a pelvic examination is offered to patients who are experiencing symptoms of cervical cancer, regardless of whether they are up to date with cervical screening or not
- Identifying opportunities to increase symptom awareness when counselling patients, especially among those under 25 years
- Consider how your practice's communications could help raise awareness of the signs and symptoms of cervical cancer; contact Jo's Cervical Cancer Trust for posters or social media content: jostrust.org.uk/talk-symptoms