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Cervical cancer prevention week: aiming to increase smear testing in older women

Dr Anita Lim

For Cervical Cancer Prevention Week, one researcher describes how a clinical trial, which recruited participants exclusively from North Thames GP practices, could point the way to increasing cervical cancer screening uptake in older women.

Dr Anita Lim, of King's College London, gives the story behind the SHOW2 trial, as well as some more detail on the results.

Most women would tell you a smear test is never the most pleasant experience.

We know that speculum use, in particular, has been one of the barriers for women going for their smear test, especially after the menopause. The speculum is the device used to hold the vaginal walls open during a smear test. Hormonal changes around the onset of menopause can make smear tests become uncomfortable for many women and could become a major factor in reluctance to go for a test.

This is a big problem. In the UK, women aged 65 and over account for around half of cervical cancer deaths and 20% of new cases, according to Cancer Research UK. Most of these arise in women inadequately screened when they are aged from 50-64 years and highlights the importance of ensuring more women in this age group come for screening.

In the SHOW 2 trial, women from that age range who were overdue their screen either received standard care, in which they were sent the usual smear test reminder letters, or the intervention arm of the trial, which was a letter offering them the choice of having a sample taken by a doctor or nurse without using a speculum, or a self-sampling kit.

In the study, nearly 800 women were randomised from 10 GP practices in the boroughs of Tower Hamlets, City and Hackney. It was shown that offering non-speculum and self-sampling led to a significant increase in screening uptake - 17% higher than uptake in women who received usual care. Increased uptake was seen across all ethnic backgrounds.

Of those screened in the intervention arm, 23% chose to have a non-speculum clinician sample, 36% chose a self-sample, and 42% chose to have a conventional (speculum) sample.

We are particularly grateful to Noclor, who helped us identify sites for the study.

We hope research like this could help more women in the future have this potentially life-saving test by providing speculum-free alternatives for cervical screening.

The views and opinions expressed in this blog are those of the authors and do not necessarily reflect those of the NIHR or the Department of Health and Social Care.