Jade Goody, Britain’s brash reality TV celebrity, is still sparking controversy and discussion even while she’s dying.
Goody’s personal tragedy has done more to highlight the importance of regular smear tests and the risks of casual sex and smoking than perhaps anything else in the UK. When she found out—very publicly—that at the young age of 27 she is unlikely to survive the cervical cancer that has metastasized to her bowel, liver and groin, the rate of women seeking Pap smears in Britain soared by 21 percent.
So what’s to think about? Well…
Is HPV Getting Worse?
International focus on Jade Goody’s case threw up some unpleasant statistics.
Smear tests detect pre-cancerous changes, called CINS, as well as actual cancer. CINS are caused by persistent cases of HPV (human papillomavirus), a very common STD that normally resolves itself. However, in Britain the incidence of cases of the highest grade of pre-cancerous change, CIN3, in 20-24 year-olds has risen from 15.8 percent of all cases in 1999 to 19.3 percent of all cases in 2004.
This seems to suggest that any or all of the following are true:
· HPV incidence and virulence is worsening.
· Young women’s immune systems—healthy immune systems are the reason that most HPV cases clear up on their own—are weakening. Britain’s diet has notoriously deteriorated in the past decade, while the prevalence of smoking in the UK is greater in the 20-24 year old age group than in any other, and girls are now more likely to smoke than boys. Smoking increases the chance of an HPV infection becoming persistent by up to 27 times.
· Girls are having more unprotected sex with more partners at a much earlier age.
Bottom line: Regardless of whether you think Gardasil’s a good thing or not, take HPV seriously. Consider that it may be worsening (one of the fears about Gardasil is that it may create fiercer replacement diseases) and take the necessary steps to protect yourself.
Screening Age Row
And then there’s the NHS row. According to the Journal of Family Planning and Reproductive Health Care, researchers are upset with the 2004 NHS (Britain’s National Health Service) decision to quit offering Pap smears to women younger than 25 in England (women in the rest of Britain can still have the test at 20).
The NHS says that it is following guidelines set by the International Agency for Research on Cancer because cervical cancer in under-25s is extremely rare, but changes in the cervix are very common. Screening at 20 could therefore result in unnecessary, frightening, and potentially harmful interventions.
But Professor John Shepherd, a cervical cancer specialist and spokesman for the Royal College of Obstetricians and Gynaecologists, notes that some ten percent of cases are found in women under 30, and believes that younger women should be screened. Experts also note that fewer women come for the test when they start later, perhaps because it has not become a regular part of their adult life; they’re also concerned that women who have had the Cervarix vaccination will think they are fully protected and ignore the necessity for smear tests. Would Jade Goody be looking at a happier outcome had she gone for a Pap smear at 20 or even 25?
Bottom line: The American Cancer Society currently recommends starting regular screenings by three years after becoming sexually active, or by the age of 21, whichever comes first. Do it, whether or not you’ve had the Gardasil shot. Or, if the NHS/IGR guidelines make sense to you, discuss them with your doctor and, at the very outside, get the test by age 25.