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What is the right age for cervical cancer screening?

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1: Sasieni P, Castañon A, Cuzick J. What is the right age for cervical cancer screening? Womens Health (Lond). 2010 Jan;6(1):1-4. doi: 10.2217/whe.09.69. PubMed PMID: 20088724.

The question as to what the right age is for beginning cervical screening has received much attention in recent months following the tragic death of Jade Goody from cervical cancer at the age of 28 years, and the consequential campaigning by national newspapers for the age at which women are first invited to screening in England to be lowered from 25 to 20 years. Far less attention has been given to the age at which cervical screening could reasonably stop, although it is an equally important question.

Decisions regarding when to screen are complex and require a careful balancing of the benefits and harms of screening, as well as the costs. Such balancing is inherently difficult because it is impossible to say how many anxious women or how many premature births balance out one cancer. There is no completely correct answer to the question ‘what is the right age for cervical screening?’, but there are some clearly wrong answers. The precise ages at which women are invited for screening is not fully evidence-based. Nevertheless, the reason behind such policy decisions should be rational and transparent.

When considering the benefits and harms of screening, it is useful to consider what would happen to 10,000 people participating in screening. Investigating relative risks alone is insufficient since it does not take into account how common (or rare) the cancer is for a particular group. Consider three possible scenarios involving 10,000 women. For one scenario, there is no screening and 100 women get cancer; in another scenario, there is 3-yearly screening and ten cancers; and in a third scenario, there is 5-yearly screening and 20 cancers. Comparing 3- yearly with 5-yearly screening, one might say that 3-yearly screening halves the risk of cervical cancer. The added benefit, however, is ten cancers prevented, and, compared with no screening, this is an additional reduction of 10%…

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