UK doctors and health professionals are alarmed at the sharp fall in the number of women coming forward for routine cervical smear tests. They say it could lead to an increase in deaths from cervical cancer.

Since a nationwide screening programme was introduced in 1988, the mortality of cervical cancer has reduced from 6,000 to 1,000 a year.

It is possible that the screening programme has been so successful that women have lost the awareness of its importance. The number of deaths are much lower, so the perception could be that the problem is not so great.

Compared with 2004/2005 where nearly 80 per cent of women from 25 to 29 attended a smear test on receipt of an invitation, only 69 per cent of the 660,000 women invited in 2005/2006 underwent the procedure. The 30 to 34 age group shows a similar reduction.

Julia Patnick, Director of NHS cancer screening programmes told the press that preliminary investigations suggest that women are failing to take up the invitations because they are embarassed or because the procedure is painful or intrusive. It is not clear why women today should feel more embarassed than they did 10 or 20 years ago.

Cervical smear tests are an early detector of abnormal findings which can, when investigated, reveal pre-cancerous cells. And the group most likely to have abnormal findings is the 25 to 29 age group. This fall in attendance suggests that as many as 2,000 women with potentially abnormal findings are going undetected, and the knock on effect if this trend continues could well be an increase in the cervical cancer mortality.

Recent research on cervical cancer cases in Europe shows that the number of cases is coming down in countries with routine screening programmes and rising in those that do not screen routinely.

Could it be that the "cost-benefit" balance that a young woman thinks about when she opens that smear test invitation and decides whether to go along or not is tipping the wrong way? The benefit is perceived to be small because of the low awareness of the risks, and so the cost is now perceived to be higher: the unpleasantness of the procedure, and finding time in a busy, working life, to go and wait in a doctor's surgery.

Perhaps, once public health programmes become successful, they still need to invest in keeping awareness levels high, just to hold on to the gains.

Information on Cervical Cancer Screening (Cancer Research UK).

: Catharine Paddock
Writer: blog