While the reasons behind these difficult decisions are understandable, there are worries about the impact that cancelling thousands of non-essential appointments and treatments will have on people’s health in the future.
Cervical screening has been paused in Scotland, Wales and Northern Ireland, and in many cases postponed in England, while colposcopies for low-risk smear results have also been cancelled. So what does this mean for the long-term health of women and people with cervixes?
Cervical cancer develops in a cervix (the entrance to the womb from the vagina) and mainly affects sexually active women between 30 and 45. According to data from 2015-2017, there are around 3,200 new cases a year, which is more than eight diagnoses a day. When caught early, it is one of the few cancers that is often curable, making screenings like smear tests an essential part of health treatment. This is why the NHS cervical screening programme invites all women from the age of 25 to 64 to attend cervical screening, with women aged 25 to 49 offered screenings every three years. If the screenings detect abnormal cells they will be followed up with a colposcopy to gather further information.
Because of the COVID-19 pandemic, cervical screenings have been suspended in Scotland, Wales and Northern Ireland. In England, while cervical screening hasn’t officially stopped, it is extremely unlikely that if you are due to have your screening, the appointment will go ahead as clinics are following the ‘urgent only’ in-person guidelines, for the safety of patients and practice staff.
Things are a bit more complicated for colposcopies. According to Karen Hobbs, information service coordinator at the leading charity for gynaecological cancers, Eve Appeal: "There are several reasons why someone might be referred for a colposcopy. For example, persistent HPV infection (with negative cytology – no abnormal cells), low-high grade cell changes, or a problem taking the sample at the GP surgery." She goes on to say that there is no across-the-board cancellation of colposcopies: at the moment, you will still be seen if your cervical screening result showed high grade/severe abnormalities. "If your screening showed mild (low grade) cell changes, then the current guidelines are that your colposcopy will be deferred by up to three months. Cases of persistent HPV but negative cytology and problems taking the sample at your GP clinic are looking at postponing by up to six months."
These delays and cancellations are being made known to women up and down the country, as has been the case for Nina, 30, and Hannah, 25. Nina was due for a six-month follow-up after some abnormal tests last year, while Hannah was waiting on a colposcopy following her first cervical smear in January. Initially, Hannah’s colposcopy was scheduled for her birthday but she rearranged it for 25th April. It has now been moved to 5th June.
Karen tells R29 that it is "considered safe to postpone cervical screening appointments by a few months and colposcopy appointments by three to six months depending on the reason for referral." However, as cervical cancer is the only one of the five gynae cancers that has a screening programme – and a successful one at that – she says that knowing the programme is essentially out of action for the time being is "understandable but disappointing". The Eve Appeal’s mission is for fewer people to be diagnosed with a gynae cancer, she says, and prevention and early detection are key.
Both Nina and Hannah say they understand but can't help feeling frustrated. "I have a latent sense of anxiety in the back of my head about missing appointments for an extended period of time," says Nina. "But I also feel quite selfish because clearly the NHS has much bigger concerns right now." She anticipates further anxiety in the future as there will likely be a bottleneck of people seeking ‘non-essential’ treatment. "I am lucky in that I do not have an emergency issue, but I wonder about how long the backlog will take to clear once this is over."
For Hannah, the frustration is more with herself for not prioritising her health when she could. "The rearrangement has made me feel quite anxious at times. When I originally got the results asking for a colposcopy, I was quite calm because I’d heard the same thing happen to quite a few friends or friends of friends on their first smear test," she says. "I feel extremely stupid for not prioritising my health over a nice meal when I had the chance to just get it done! I am feeling slightly concerned that there could be something going on that I’m not aware of which could get pushed back further and further because of the current situation."
While the anxiety of not knowing about potential problems is understandable, the Eve Appeal emphasises that cervical smears are (normally) routine and not a test for cervical cancer in and of itself. "It’s a test to see if there is any high-risk HPV present and abnormal cells that could potentially develop into cervical cancer in the future if left untreated, so it’s not a case of we [in the UK] are suddenly not testing people for cancer."
Most results will come back clear and even when they don’t, high-risk HPV can take 10 or more years to cause cervical abnormalities (although most cases of HPV will clear by themselves). "Delaying screening appointments for a short while/a few months is unlikely to have an impact on the number of cervical cancer cases," Karen reassures. However, there is always the risk that delays will mean a small number of people have a delayed diagnosis – with that in mind, you should be mindful of the symptoms of cervical cancer and report any to your GP who will refer you to hospital regardless of the pandemic situation. The main symptom to keep an eye out for is abnormal vaginal bleeding such as between periods, after sex, or after the menopause; other symptoms include unusual discharge, pelvic pain or pain during sex.
But while the physical impact may be projected to be small, the Eve Appeal is seeing a significant impact on mental health. "We’re definitely seeing a huge spike in anxiety and stress caused by the deferral of screening and colposcopy appointments. Our Ask Eve service receives daily messages from people who are feeling sick with worry, unable to focus, experiencing unmanageable stress because their appointment has been cancelled."
If you were due a cervical screening and haven’t yet heard about delays, you should mentally prepare for it to be cancelled. If you are based in England then theoretically there is still a chance it could go ahead – the best option is to check in with your GP surgery.
Unfortunately, like many problems and anxieties we face currently, access to cervical screenings, except in serious cases, is out of our control right now. Working on dealing with anxiety during this time is tough; if you are seeking specialist advice or comfort around gynae cancer and cervical screenings, you can get in touch with Ask Eve and have a chat with Tracie (the Eve Appeal’s gynae nurse specialist) or Karen, who works on the Ask Eve team.
Karen understands the frustration of having to 'wait and see'. "It’s difficult enough to wait for a Sainsbury’s delivery slot, so waiting for an appointment that could affect your health can be all-consuming and really hard to cope with. I came to work for the Eve Appeal and run the Ask Eve service because of my own cervical cancer diagnosis. I know how hard and stressful waiting for results/information/appointments can be, so please get in touch with us."
Ask Eve is a free, confidential, expert information service that can be contacted via email@example.com or 0808 802 0019. Check out the website eveappeal.org.uk or @eveappeal on social media for lots of gynae health info.