Meeting of the Parliament 22 January 2019
I, too, thank Monica Lennon for bringing this important issue to the chamber tonight, during cervical cancer prevention week. It is fair to say that we all agree on the importance of getting regular health checks; screening for cervical cancer is no different in that regard. We are aware that the uptake of screening—the smear test—has fallen dramatically in Scotland in recent years. Around 73 per cent of women in Scotland currently access screening, but that figure is consistently lower than the figure for uptake in Northern Ireland and Wales, which is a little higher, at around 77 per cent.
I was really concerned to note that Lothian region has the second lowest uptake rate in the country. As Miles Briggs noted, the rates are closely linked to age, but they are also linked to socioeconomic factors. Young women have the lowest levels of uptake, and uptake is particularly low among women who live in areas of greatest deprivation. It is vital that we increase uptake across all regions and backgrounds, because cervical screening saves around 5,000 lives a year and prevents up to eight out of 10 cervical cancers.
Research by Jo’s Cervical Cancer Trust reveals some of the issues that have affected uptake. The availability of GP appointments can vary widely between areas; almost one in 10 women were offered only times that they could not make when they last tried to book an appointment; and around 7 per cent of those who were questioned by the trust were told that no appointments were available when they called to ask for one—sometimes they put it off at that moment and never got around to making that appointment.
Workplace demands are also a barrier for many women, with a fifth finding it a struggle to fit an appointment around their job. More than a tenth of those who were surveyed by Jo’s Cervical Cancer Trust said that they would be more likely to book an appointment if they did not need to use their annual leave to attend.
Another barrier is the decline in the provision of screenings at sexual health centres. A higher-than-average number of abnormal results come from tests taken at those clinics, so they are of great importance to ensuring that worrying changes are noticed at the earliest opportunity. In Scotland, provision of screenings at sexual health clinics varies widely, with only five tests in Forth Valley in 2017 but more than 4,000 screenings in Greater Glasgow and Clyde.
Lack of mobility is another barrier that is faced by women, particularly those who are housebound, as a GP visit for a screening is not always possible. Emma Harper spoke about a potential pilot, which I would warmly welcome. Elaine Smith spoke about the thought of attending a screening being particularly difficult or traumatic for women who have experienced sexual violence. The procedure itself, or having to discuss the process with a GP, can be a challenging barrier to overcome. I highlight specialist clinics, such as the My Body Back Project’s clinic in Glasgow, and urge the Government to make additional funding available for those oversubscribed services.
Having accessible information on cervical screenings in a range of languages is also vital. We need to be smarter about how we communicate with women about attending regular screenings. The more women-focused and responsive appointment systems can be, the better the chance of reversing the decline in uptake. Nationwide text or email campaigns could reach new audiences; indeed, reminders to attend a screening have been popping up on Twitter timelines. More innovation like that is needed, especially because there are gaps in the data on who is not attending. Better data—for example, collecting HPV vaccination status alongside smear results—would allow for more targeted activity and save money and resources in the long term.
With regard to the call for self-sampling pilots, better data systems could improve the reliability of the pilots’ results, too, and overcome some of the barriers around getting time to attend a surgery. Eighty per cent of women who were surveyed by Jo’s Cervical Cancer Trust said that they would prefer to do an alternative screening themselves at home—and the figure rises to 88 per cent among those who have put off getting an appointment. Taking the test into their own hands could empower women who have experienced sexual violence.
We need to look at how to incentivise GPs to help boost uptake rates—some actions that are taken by GPs are already incentivised. Much can be done to address the decline. We need to be better at collecting data if we are to fully understand why some women struggle to attend—and why some are loth to do so. Developing the reliability of self-tests at home should also be prioritised as a way to help the most vulnerable women.
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