Why can't women have cervical screening until they are 25?

In 2003 the Advisory Committee on Cervical Cancer Screening (ACCS), an independent, ministerially appointed committee, advised the NHS Cervical Screening Programme to raise the starting age for cervical screening from 20 to 25.1 The reason for the change was that cervical screening does more harm than good in younger women.2 In March 2009, the ACCS held an extraordinary meeting to review the evidence relating to risks and benefits of cervical screening in women under 25. Members voted unanimously to keep the age at which screening commences at 25.3 The International Agency for Research on Cancer also recommends that women should not commence cervical screening before the age of 25.4

Cervical cancer is linked to persistent infection with the human papillomavirus (HPV). This is a very common, symptomless virus, which can cause minor abnormalities in the cells of the cervix. In the great majority of women, the immune system clears the infection and the abnormalities go away naturally. However, in a small number of women the HPV infection persists.5 In a few rare cases the abnormalities it causes can develop into something more serious, and if they are not caught and treated, they may eventually turn into a cancer.6,7

Cervical abnormalities associated with HPV infection are very common in women under 25, but are rarer in older women. Abnormalities in young women go away by themselves in the great majority of cases.6,7 Therefore, the consequence of screening younger women is that many would test positive for abnormalities and would subsequently be sent for unnecessary treatment to remove the affected cells. This treatment may increase the likelihood of a woman having a pre-term delivery if she goes on to have children 8,9,10,11 and the whole process can cause significant anxiety. Cervical cancer is extremely rare in women under the age of 25 with just 2.6 cases per 100,000 women.12 Therefore, the harms of screening women under the age of 25 are currently thought to outweigh the benefits.2

Screening is not appropriate for women who have symptoms, and conducting a cervical screening test may delay the proper diagnostic process in such cases. If you have symptoms, such as bleeding between periods or after sex, please consult your GP straight away.

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1 See Written ministerial statement and Minutes of the Advisory Committee [PDF 86Kb] on Cervical Screening's meeting on reviewing the age to begin screening.
2 Sasieni P, Casta˝ˇn A, Cuzick J. Effectiveness of cervical screening with age: population based case-control study of prospectively recorded data. BMJ, 2009; 339. http://www.bmj.com/content/339/bmj.b2968.
3 Minutes of an extraordinary meeting of the ACCS to re-examine current policy on cervical screening for women aged 20-24 years taking account of any new evidence and to make recommendations to the National Cancer Director and Ministers, 19 May 2009.
4: IARC handbooks of cancer prevention volume 10: cervix cancer screening. Lyon: IARC Press, 2005.
5 Bosch FX and Iftner T. The aetiology of cervical cancer (NHSCSP publication no 22). Sheffield: NHS Cancer Screening Programmes, 2005.
6 Nobbenhuis MA et al. Cytological regression and clearance of high-risk human papillomavirus in women with an abnormal cervical smear. Lancet 2001; 358(9295): 1782-3.
7 Castle PE et al. Evidence for frequent regression of cervical intraepithelial neoplasia-grade 2. Obstet Gynecol 2009; 113(1): 18-25.
8 Poon LC et al. Large loop excision of transformation zone and cervical length in the prediction of spontaneous preterm delivery. BJOG, May 2012, 119(6):692-8
9 Kyrgiou M et al. Obstetric outcomes after conservative treatment for intraepithelial or early invasive cervical lesions: systematic review and meta-analysis. Lancet 2006; 367(9509): 489-98.
10 Jakobsson M et al. Preterm delivery after surgical treatment for cervical intraepithelial neoplasia. Obstet Gynecol 2007; 109(2 Pt 1): 309-13.
11 Noehr B et al. 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. Am J Obstet Gynecol 2009; 201(1): 33.e1-6.
12 Cancer Statistics Registrations, England (Series MB1) No 40, 2009. Office for National Statistics.