A third of those eligible not taking up cervical screening
Around 4.6 million women have not come forward for their latest cervical screening, figures from NHS England show. This comes after the NHS sent out a record number of invites in 2021/22 – over 5 million which was up by 10.5% on pre-pandemic levels. Jo's Trust (2023) state that screening coverage across the UK is at its lowest level in 20 years.
In the UK, around 3200 women are diagnosed with cervical cancer every year, with 2 women a day dying from the disease (Jo's Trust, 2023). Screening involves taking a small sample of cells from the cervix and looking for high-risk human papillomavirus (HPV) that could develop into cervical cancer if left untreated.
Barriers to screening
National Clinical Director for Cancer, Professor Peter Johnson, highlighted the barriers to screening: ‘There are lots of reasons why somebody might not want to come forward – embarrassment, inconvenience, or uncertainty.’
A recent report from Jo's Trust (2023) – surveying 848 individuals working in cervical cancer and prevention – found that workforce pressures in primary care, and limited options of where and how to access screening, have been highlighted as significant challenges. Developing a more accessible test, providing more screening out of hours, and providing screening at more locations, were all suggested as possible steps for improving accessibility and uptake (Jo's Trust, 2023). According to Jo's Trust (2023) 80% of women in full-time work struggle to get a convenient appointment, with some resorting to using annual leave to attend.
Self-sampling
The NHS is currently trialling self-screening for cervical cancer at home, and the results of the pilot will inform whether it should be rolled out nationally. Jo's Trust (2023) found that 70.3% of survey respondents named HPV self-sampling as one of the biggest opportunities to eliminate cervical cancer in the UK. In Sweden, the Netherlands and Australia, self-sampling has led to higher participation among non-attenders compared to other initiatives.
HPV vaccine coverage yet to return to pre-pandemic levels
The UK Health Security Agency (UKHSA, 2022) has also released figures showing that coverage of the HPV vaccine in year 8 and year 9 pupils is yet to return to pre-pandemic levels. HPV vaccine coverage decreased by 7% in year 8 girls and 8.7% in year 8 boys in 2021 to 2022 when compared to the previous academic year.
The UKHSA is urging those who missed out on the vaccine to contact a health professional. Dr Vanessa Saliba, Consultant Epidemiologist at UKHSA, said: ‘Children and young people who have missed out on their HPV vaccinations should contact their school nurse, school immunisation team or GP surgery to arrange a catch-up – they remain eligible until their 25th birthday.’
A study published in The Lancet in 2021 found that cervical cancer rates were 87% lower in women who had been eligible for HPV vaccination when they were aged 12–13 years, compared to similar women born a few years earlier who had not been eligible for vaccination, clearly showing the programme is preventing cervical cancers (Falcaro et al, 2021).
Screening still required in those vaccinated
Those who have been vaccinated should still attend a cervical screening appointment when invited because the HPV vaccine does not protect against all strains of HPV (UKHSA, 2023).
Half a million missed out of blood pressure lowering medicines during the pandemic
Almost 500 000 people missed out on starting medication to lower their blood pressure during the COVID-19 pandemic, research supported by the British Heart Foundation has shown (Dale et al, 2023). Researchers say that thousands of people could suffer an avoidable heart attack or stroke due to these delays.
Fewer people taking blood pressure and cholesterol lowering medication
Using data on routinely dispensed prescriptions in England, Scotland and Wales, researchers found that 491 306 fewer people than expected started taking blood pressure lowering medication between March 2020 and the end of July 2021.
‘Measures to prevent infection spread were necessary and undoubtedly saved lives. The NHS has already taken important and positive steps towards identifying people with high blood pressure as early as possible,’ said lead author Professor Reecha Sofat, Associate Director at the BHF Data Science Centre, Breckenridge Chair of Clinical Pharmacology at the University of Liverpool. ‘However, we need this focus to be sustained in the long-term to prevent any increase in heart attacks and strokes which will add to a healthcare system already under extreme pressure.’, Professoor Sofat added.
By the first half of 2021, on average, 27 070 fewer people started taking blood pressure lowering medication each month compared with 2019. In the same period, they found that 16 744 fewer people started taking medication to reduce levels of fat or cholesterol in their blood each month. This decline was predicted to result in 13 662 additional CVD events, including 2281 cases of myocardial infarction and 3474 cases of stroke, should individuals remain untreated over their lifecourse.
Detecting risk factors early is key
‘Despite the incredible work done by NHS staff, our data show that we're still not identifying people with cardiovascular risk factors at the same rate as we were before the pandemic,’ added Professor Sofat. ‘Detecting these risk factors early and beginning medication where appropriate is crucial to manage them, helping more people to avoid a preventable heart attack or stroke so they can live in good health for longer.’
Dr Sonya Babu-Narayan, Associate Medical Director of the British Heart Foundation and consultant cardiologist, said: ‘Yet again we're seeing clear evidence of the major disruption to healthcare people in the UK experienced during the COVID-19 pandemic. But it's not too late to limit the damage. These findings demonstrate how getting heart healthcare back on track can curb the additional strain that untreated risk factors such as high blood pressure would otherwise place on the NHS.’