WHY SO LOW?
Cervical screening take ups in the UK are at a 20-year low, with Brighton and Hove having the weakest rates in the south-east. This year marks the 10th anniversary of Jade Goody’s death, and this month promoted Cervical Cancer Prevention Week from Monday 21 January to Sunday 27 January 2019.
Dear Miss Taylor, we are writing to invite you to make an appointment for NHS cervical screening.’ I add ‘call doctors’ to that day’s to-do list and dutifully tap the consultation date into my phone’s calendar.
A month on, I awkwardly lay back – legs akimbo – prattling on about the weather, as my cervix is checked for abnormal cells with what looks like a Wetherspoons cocktail stirrer. Just a week prior to my appointment, it’s been reported that only 71.4 per cent of GP-registered smear test invitees in the UK are attending screenings.
To be clear, cervical screening is not a test for cancer. It’s to detect cell changes and highlight irregularities which could prevent cervical cancer at a possible later stage. These nasty rogue-cowboy cells that medical professionals are searching for can hang out on the insides of people who are rich, poor, black, white or purple. Even regularly chugging kale juice whilst doing sunrise yogalates and having absolutely no symptoms won’t keep you out of the danger zone.
At 24 and the glowing picture-of-health, my friend Milly* was emotionally crushed to receive abnormal results from her first smear test. She nearly strangled herself with worry over ‘what could have been’ if the potentially rabid cells weren’t caught at such an early stage. Afterwards, Milly went for a cervical biopsy (colposcopy) and then laser therapy to remove the pre-cancerous cells. Although uncomfortable and a bit of an inconvenience, the jolting experience hasn’t deterred her from future appointments. “It’s done the absolute opposite,” she said. “I’m very aware of the difference it can make. I’d never miss it. Because as horrible and invasive the treatment was, I can bet that treating cervical cancer would be a million times worse.”
Chillingly, cervical cancer is the most common cancer for women under 35. It’s diagnosed in more than 3,200 UK patients each year and annually claims 900 of those lives according to 2018 NHS statistics.
People aged 25-29 years old are the worst group for going to smear test appointments. With one out of three in this bracket having skipped screening services, it’s the equivalent of half the complete Sugababes line-up not getting checked out at all.
But why are the cervical screening rates dropping year on year? What is it that’s stopping people from facing the swab and a speculum for a few seconds if it could slash the odds of saving their life from cervical cancer further down the line?
“I think sadly it’s education. I think people don’t understand the severity of contracting cervical cancer,” sighs Wendy, the motherly practice nurse who administered my test.
It’s very easy for an immensely privileged white woman like me to not be phased by smear screening. The gynaecological stars have been aligned in my favour since day dot. From growing up in a predominantly female household; to attending an all-girls school, which meant that hiking tights up to your armpits whilst loudly debating the merits of tampons versus pads before lessons were simply regular Tuesday chatter.
Wendy points out that reproductive health is still very much a taboo issue with some in the Asian communities and can be a shameful topic to talk about even to family or friends. “It should be taught in schools and explained – because nowadays lots of the girls have the HPV vaccine – so at that time it would be a really good way of getting the message across,” she says.
Wendy adds: “I also think discussing it [cervical screening] amongst peers as well would be encouraging. And having accessibility to later appointment times which we actually have in Horley. We’re open until 8 o’clock on a Monday so we do have evening smears.”
I ran a casual poll on my Instagram stories to gauge if those following me on the internet are going to cervical screenings. Surprisingly, 18 per cent of respondents replied ‘Yes’ when asked ‘Have you ever chosen not to have a smear test even if you’ve been invited?’. The reason that cropped up the most as to why friends, and friends of friends, didn’t go to a test was finding convenient slices of time.
“Hard to make appointments during appropriate times,” said one. “Shamefully too busy.” messaged another. “Keep meaning to go – and I still fully intend to.” “Results are only offered via mail (no online/text) which is difficult while transient.” Echoing Wendy’s sentiment about being able to actually get a favourable slot seems to be a blocker for even the smallish group of people I surveyed.
So far, flexible access to appointments and education on the importance and awareness of the role smear testing plays in vital cancer prevention are two kinks that need to be ironed out. But the ugliest head to this health-Hydra in tackling the not-so-sexy stuff about our sexy parts are psychological concerns.
Results from Jo’s Cervical Cancer Trust charity indicates a third to half of the 2000 people with a cervix they questioned shows embarrassment about their bodies as to why they aren’t taking up tests.
“I’ve had three children and still find it embarrassing to go get it done! Postponed mine at least once before going for it,” pinged a chat bubble from Sally* in her late twenties. When asked about why she was initially hesitant Sally said “I think it’s the whole ‘Had a baby. It looks weird down there/it’s changed’ since having the boys.”
Wendy vigorously nods when I read out the statistic on embarrassment: “I think there can be a potential mental barrier. But you hear people that are always happy to give the horrendous times when they’ve had a bad appointment or any sort of examination. And they can be quite negative and embellish it. Whereas people very rarely go ‘Oh it wasn’t that bad’. So again talking amongst peers, going online, having a Google – there are lots of things on YouTube you can look at. You can always bring people with you, a friend, a chaperone. It’s always been open in allowing that.”
However, as well-meaning as it for many to smudge their lipstick, snap a selfie and Boudica-cry “Have no fear, go get a smear!” it’s not always that straight forward. For survivors of sexual assault and medical or genital trauma (perhaps suffering the lot), the thought of trusting even a kindly Wendy-type within the current standard screening set-up can be completely outside the very realms of possibility. This means some people have not been checked out for decades. The reliving of past terror and distress has not routinely been part of the “You-Go-Girl!” cervical-health marketing campaigns so far, and as a collective, survivors have often been glossed over in discussions on moving the needle forward.
In my lifetime, this is the second conversation ripple I can recall about cervical cancer in the public consciousness. The first was Big Brother alumni and an original by-product of reality TV stardom, Jade Goody who died a decade ago this March at 27 years old, my age. Whether or not you liked her, it was impossible not to be touched by Jade’s heart-wrenching war with terminal cervical cancer. The haunting Hello! magazine images of Jade bald and beaming in a wedding dress, taken a mere month before she passed, served as a bleak reminder of how any life can be snatched away on the flip of a coin.
Dubbed the ‘Jade Goody Effect’, her cancer played out in public prompted an extra 500,000 people turning up to get swabbed that year. Wendy said that after Jade died, her practice saw an influx of approximately 4,600 patients for cervical screening over a couple of months, now she says it has almost halved.
There is an inkling of positive light at the end of this grim tale, as piercing bright waves of celebrity noise are starting to bring smear testing back to the forefront again with help from Rebekah Vardy and Michelle Keegan. In November 2018 both posted photos and vlogs on their social media channels sharing their most recent dalliance with the cocktail stirrer. Pearl-clutching trolls aside, the response reminded followers to schedule in their own examinations. The narrative of experiences around screenings has broadened too, with Jo’s Cancer Trust inclusively addressing [warning: link to piece] how to approach smear tests after sexual violence and growing awareness for organisations such as the MyBodyBackProject.
From a civilian level, the best way to fight this beast is to attend screening consultations if you are able and know what the cervical cancer symptoms are. Other avenues are to research and read about every aspect of the issue. Donate to specialist clinics for abuse survivors, trans people, non-binary, cervical cancer-fighting charities, or fundraise. Offer to go with someone who is feeling wobbly at the thought of a swab. Most importantly, talk bravely and openly about smear testing with friends, family and loved ones – you never know, you may save a life.
*Names have been changed to protect identities.