Each year in Canada, approximately 1,408 are diagnosed with cervical cancer. Cervical cancer is the 3rd most common female cancer for women aged between 14 and 44 years old in Canada [1]. The number of young women diagnosed will be reducing over the next ten years due to the HPV vaccination program which offers the vaccine to girls under 18 years of age. This program was introduced in 2008 and will help to prevent the majority of cervical cancers [2].

Those young women who are diagnosed with cervical cancer under the age of 25 often experience typical symptoms prior to diagnosis.

Symptoms of cervical cancer

The most common symptom is:

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

Other symptoms include:

  • Unusual and/or unpleasant 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 does not require a cervical screening test but will need to be examined by her GP and should undergo a direct examination of the cervix in order to rule out the very small chance that a cancer is present.

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 ectropion or cervical erosion, changes in hormones due to the contraceptive pill or benign cervical polyps or a sexually transmitted infection such as Chlamydia. The guidelines explain to GPs about the types of questions they need to ask to establish if the symptoms could be related to cervical cancer. A pelvic exam can be done by a GP.

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 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 recent survey 80% of women said they would see a doctor for a cold that lasted more than 3 weeks, compared to only 50% if they bled outside of a period [3]. However, your GP will not be embarrassed and they are used to talking about these subjects. Because abnormal bleeding can be a symptom of cervical cancer it is vital you seek some advice from your GP. If you want to you can also take a relative or a friend with you who can support you during your appointment with the GP.

You might also find it helpful to take the Department of Health guidance along with you to discuss with your GP.

Why does cervical screening start at 25?

According to the most recent research, abnormal cervical cells are caused by high risk infection with HPV and are very common in women under 25. They are less common in older women.

A high risk HPV infection has no symptoms so for most women they will be infected and not even know. Whilst a woman has high risk HPV, the infection can cause cells of the cervix to become abnormal (these abnormalities are sometimes called pre-cancerous changes). 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]. Some women are unable to clear high risk HPV and the abnormal cervical cells caused by this infection could with time turn into cervical cancer.

Because high risk HPV infections are common in young women, screening young women means that there would be a high number of women receiving a positive result indicating that they have abnormal cervical cells that would require further investigation. 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. But medical experts do not currently have a way to understand which women will be able to clear their abnormalities and which could go on to have cancer. However, they do know that if a woman is older than 25 and abnormal cells have not cleared up on their own, there is a greater need to offer treatment.

So if young women are more likely to have abnormal cells this means these women will be more likely to be sent for treatment to remove the abnormal cells following a screening test.

Treatment for cervical abnormalities has been shown to increase the risk of preterm labour and cause unnecessary anxiety for the woman. [5, 6, 7, and 8].

Diagnosis and treatment for cervical abnormalities has been shown to cause significant psychological trauma and, considering the majority of young women will clear these abnormalities without treatment, it means screening and subsequent treatment for abnormalities could cause more harm than the benefits of screening can provide.

Additionally cervical screening has been shown not to be very effective in young women. In countries where screening started at 20, rates of cervical cancer in women under 25 are not significantly different to countries that start screening at 25 [9].

The International Agency for Research on Cancer also recommends that women should not start cervical screening before the age of 25.

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 GP if you are bleeding outside of your period or after sex.
  3. Cervical screening (the smear test) is not recommended for women under 25.

References

  1. Cancer Research UK - http://www.cancerresearchuk.org/cancer-info/cancerstats/types/cervix/inc.... Accessed 10.09.14
  2. 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.
  3. Jo's Cervical Cancer Trust - http://www.jostrust.org.uk/news/articles/2013/01/21/third-more-women-lik.... Accessed 10.09.14.
  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), 486-96.
  5. Poon LC et al., 2012. Large loop excision of transformation zone and cervical length in the prediction of spontaneous preterm delivery. BJOG 119(6), 692-8
  6. 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), 489-98.
  7. Jakobsson M et al., 2007. Preterm delivery after surgical treatment for cervical intraepithelial neoplasia. Obstetrics Gynecology 109 (2 Pt 1), 309-13.
  8. 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 & Gynecology 201(1), 33.e1-6.
  9. 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.

"Not Eligible for Cervical Screening - Under 25." Jo's Cervical Cancer Trust. N.p., 19 Aug. 2013. Web. 02 Mar. 2015.