Women dying from failure to do smear tests

Nearly half of the women diagnosed with cervical cancer between 1992 and 2002 had never undergone a smear test, which could have detected the problem early and led to effective treatment.

This fact has emerged from a new study, titled How Effective is Cervical Cancer Screening in Malta?, that confirms what pathologists have long suspected to be behind the unchanged rates of incidence and mortality of cervical cancer - the absence of a life-saving smear test in most cases.

A paper on the study, which involved the collaboration of surgical pathologist Albert Cilia Vincenti, Malta National Cancer Registry head Miriam Dalmas, and Roderick Busuttil from St Luke's Hospital Cytology Laboratory, has been submitted to the Maltese Medical Journal for publication.

Prof. Cilia Vincenti said the problem lay in the fact that Malta had no organised national cervical screening programme and all screening was opportunistic by nature.

Their paper recommends that a national study be carried out to find the number of women undergoing regular cervical screening.

This study, which should include all the public and private clinics and hospitals, would be used to assess the situation and propose changes to improve the uptake of screening.

Prof. Cilia Vincenti said their study was intended to establish why the annual average incidence of about 10 cases a year had remained steady over the years, despite the fact that the hospital and primary health care centres had been offering free cervical cytology screening services since 1978.

Just over half of the hospital files of patients diagnosed with invasive cervical cancer in the 10-year period under review had information on the person's smear history.

Of these, 44 per cent had never undergone any smear tests prior to the diagnosis of the invasive lesion, 46 per cent only had rare smears and just 10 per cent had regular smears.

The figures were close to those of a National Health Interview Survey conducted in 2002 among 2,213 women aged 16 years and over. Only 45.2 per cent reported having had a smear in the three years prior to the survey, with 41 per cent saying they had never had such a test in their life.

A parallel situation had emerged in the UK when after two decades (1960-1986) of British NHS cervical screening service, the mortality from cervical cancer, although not rising, was not going down either.

The British programme was remodelled in 1988 and an incentive was introduced for family doctors to screen at least 90 per cent of women aged between 20 to 65 - this resulted in a 34 per cent decrease in the incidence.

In the EU, where 12,800 women die each year from this disease, organised screening programmes are recommended at least every three years.

This new study, together with the NHIS data, show that this practice is not being observed in Malta.

The study actually questions the effectiveness of the current opportunistic screening programme.

Cervical cancer is the second most common cancer - and the third leading cause of cancer deaths - in women worldwide.

In Malta, cancer of the uterine cervix is the third most common cancer of the female genital organs - 132 new cases of cervical cancer and 49 deaths were reported between 1992 and 2002 (Malta National Cancer Registry, 2005).

"This may not sound like much, but with regular smear tests, this figure could be brought down to zero," Prof. Cilia Vincenti said.

Various strains of the human papilloma virus (HPV), a sexually transmitted infection, are responsible for the majority of cervical cancer cases.

Signs of an HPV infection may appear weeks, months, or years after the first infection, which is why it is important to have regular tests.

Prof. Cilia Vincenti stressed the importance of education and insisted that this was a potentially preventable disease if caught in time through regular screening.

He explained that many women were under the illusion that just because they led healthy lifestyles they were not at risk. This matter was tackled recently in the respected British medical journal The Lancet, under the heading Myths About Cancer Might Interfere With Screening Decisions.

This qualitative study in the US exposed widely held misconceptions from comments such as "nobody in my family had cancer, so I'm not worried about getting it", to "cancer is a death sentence" and "if I'm healthy, why would I get cancer".

The study identified some important targets for cancer "myth busting", starting from the need to clarify the meaning of genetic risk and the fact that cancer can happen to seemingly healthy, symptom-free people.

In the meantime, a regular smear test is a woman's only hope of detecting any abnormal activity.