21 women die in the UK each week of cervical cancer and the disease is the second most common cancer in women aged between 15 and 44 in Europe. Surely that would make you think twice about delaying a routine cervical smear test?

A new campaign has been launched to tell women that they can take steps to reduce their chances of developing cervical cancer by simply finding out more about the causes of cervical cancer and attending cervical screening.

According to ‘tellher’, the new cervical cancer public education campaign that launches today, women are not aware of the fact that cervical cancer is caused by a sexually transmitted virus called human papillomavirus. The ‘tellher’ campaign has been launched to inform women that abnormal cervical cells and cervical cancer can be treated effectively if caught in time. A simple cervical smear test can save a woman’s life but doctors are concerned by the drop in the number of young women turning up to be screened.

Unlike most cancers, cervical cancer is caused a sexually transmitted virus - human papillomavirus. In some women, this virus can affect the cells in the cervix, transforming them into abnormal cells that can become cancerous6. These cell changes can be detected early during a smear test, usually in plenty of time to treat the abnormal cervical cells before the cancer develops. But women need to accept invitations to attend for smear tests.

Shockingly last year only 69% of women aged between 25 and 29 invited for screening turned up compared to 80% the year before. Experts estimate around 80% of sexually active women will become infected with human papillomavirus at some point in their lives although not all types of the virus are cancerous. Local PCTs automatically send out invitations to all women over 25 reminding them to make an appointment for the potentially life saving smear test.

TV presenter Carol Smillie and GP, Dr Dawn Harper join us in the studio on Thursday 7th June at 15:00 to talk about the importance of being screened and the steps that can be taken to prevent the disease.

H: Hello and welcome to the Healthcare Show, brought to you by tellher.com, I’m Jane Constantinis. Now, shockingly, every week in the UK 21 women die from cervical cancer, it’s the second most common form of cancer in Europe among women aged between 15-44, the first of course being breast cancer. But the good news is it can be avoided. Now today sees the launch of a new campaign called Tell Her, which is aimed at educating young women about cervical cancer, and I’m joined in the studio today by Dr Dawn Harper and Carol Smillie to talk about the campaign and also to talk about cervical cancer. Thank you very much for coming in to talk to us. Carol, tell us first of all why you’ve become involved in this campaign?

C: Well I, contrary to what some people might think I haven’t actually ever had cervical cancer and I haven’t know anyone who has, so exactly why would I get involved? I have just spent the last 2 years touring with the Vagina Monologues, which was very enlightening and I really noticed in that time how much power there was to talk about subjects like this with women, like-minded women – you know we’ve all got one, we all know what happens when it goes wrong, what happens, and sharing experiences is a really powerful way to discuss it, so the Tellher.com website needs to encourage women to discuss their experiences, what they know, what they don’t know, rather than scaremongering, and this to me was the ideal vehicle or natural progression from the Vagina Monologues

H: Dawn is there a reticence among women to talk about these sorts of things, what’s your experience in practice?

D: I think women generally are better at talking about health issues than men, but I do think that our cervix is as the bottom of our health agenda if you like. We’re really good at checking our breasts, we’re increasingly aware of our hearth health and our bone health and that sort of thing, but actually I think there is an ignorance about cervical health and the ignorance is twofold really. Number one is people think they’re coming for a cancer smear, and they subconsciously or consciously thing that cancer is a disease of the elderly, therefore I don’t need to worry about it, I’m young. Now that’s just wrong, as you’ve just said, young women get cervical cancer. The other is that some people – women that know something about cervical cancer know that there is a sexual link, and there is a myth out there sadly that cervical cancer is a disease of the sexually promiscuous, and it’s not. It is transmitted sexually, it’s transmitted by a virus, human papilloma virus, but anyone who is having sex is at risk of contracting that virus. In fact 80% of British women have been in contact with that virus. You only need to have sex once to be at risk. So I think – they don’t come forward because they don’t think it’s relevant to them and they’re busy and they’ve got lots of other things going on, and let’s face it you know if you’ve got a husband and a few kids in the melting pot you’re right down at the bottom of your to-do list, you shouldn’t be. When the letter comes in come straight in and see us

H: I confess that I didn’t know about the sexual aspect of the disease. I’m going to ask you more questions about that at the moment, but I just want to remind you that of course this is an interactive show, so we do want your questions. If you want to ask Carol or Dawn anything then just put your question in the box below the screen and send it to us with your name and we’ll get through as many as we can during the course of the show. So do you think it’s because of this sexual undertone or overtone are all these misconceptions that people are reluctant, because fewer women are coming forward for their cervical smears, is that right?

D: They are and that is a worry. The main worry is that actually if you’re going to get a cancer, do you know what cervical cancer’s not a bad one to get because it takes such a long time to develop, so by simply giving up 5 minutes of your time every 3 years and coming in and having your smear, you can avoid getting the cancer, because as soon as we pick up those very early changes we can treat them, and once we’ve treated or removed those cells they’re not there to become cancerous in years to come, so it’s really really important. You don’t – probably the most important thing to say is you don’t know you’ve got it, you get no symptoms, you get no bleeding, you get no discharge, no pain, your husband or partner won’t know – the only way of knowing is to come and have your smear

H: And that is the thing that is so frightening about cancer generally isn’t it, the fact that you can be walking around. In fact that brings us very neatly onto our first question, which is from Tracy from Bath who wants to know what is the treatment for cervical cancer?

D: Rather depends – I suspect what Tracy probably means is what’s the treatment of an abnormal smear because there is the whole spectrum –

H: Well let’s just go back to the basics, talk us through that, you go for your smear test and then you get that letter saying something abnormal and panic sets in

D: You hope that it’s normal, if it’s not, in the vast majority of cases the abnormality is quite mild and you’ll just simply be asked to come back in 6 months not 3 years, and the reason we do that is because most changes actually just get better on their own, we don’t need to do anything. If the abnormality persists or gets a little bit worse, we would then progress to doing something called a colposcopy which is a glorified smear if you like. It’s usually done in the hospital rather than in your GP surgery, and it usually involves having your legs up in stirrups rather than just laying on the couch, but thereafter in terms of what you feel it doesn’t feel any different, but it just means that we can use a special telescope when we’re looking at the cervix, and remove any abnormal cells. Now if, and usually that’s enough for most people and if you’ve had a colposcopy you will be called back more frequently just because we’re very cautious about making sure that everything has been removed and that it’s all safe and healthy. If the abnormality is more extensive then sometimes we need to remove part of the cervix, and sadly if people present late and they’ve not had their smears and they’ve got full blown cancer, we’re talking about a hysterectomy, we’re talking about having everything down there removed, possibly radiotherapy, you know it’s a real tragedy. But the time frame from an abnormal smear to developing cervical cancer if you’re going to is years, so actually so much more reason for coming in and having smears done because you don’t need to get there

H: Because people are often frightened aren’t they to find out the bad news. You almost want to just – hope it will just go away. But if you’ve got, as you say this very big window of opportunity there’s no reason not to. Let’s take another question now. Janie from Edinburgh wants to know, you’ve touched on this and I’m sure we’ll have lots more questions about it – “cervical cancer is caused by a sexually transmitted disease, so why isn’t there more mention of it? People know about the risks of gonorrhea and Aids but so little’s known about cervical cancer.” Carol is that something you’d like to field? Tell us a bit more about how the campaign is tackling this?

C: Well the website is very good because it’s very user-friendly. We’re trying to use the fact that women talk to each other and are very good at talking to each other to get them to talk to each other about this. Log onto the website, have a look at the myths and the truths and you’d be surprised actually. There’s a little quiz in there, 10 questions with multiple choice answers, of which I got two wrong before I got involved – I’m now an expert! I am now an expert, but yes stupid things like if it’s sexually transmitted then surely if I use a condom I’ll be fine? I clicked yes – no. Apparently not

H: How can that be?

D: That’s not to say stop using condoms, because condoms do obviously protect against a lot, but –

C: Not this

D: HPV can be transmitted on skin-to-skin contact, and so it is perfectly possibly to contract the virus even though you’ve been using a condom, alright? So it gives some protection but not absolute protection, you’re not 100% safe

H: And would your partner have any symptoms?

D: None at all

H: And you wouldn’t either, so ok –

C: Boys get clean away, yet again!

H: Poppy from Herne Hill wants to know is there a cure for cervical cancer?

D: Well I think that’s probably exactly what we’re talking about – it is an entirely avoidable disease if you come early. The earlier it’s – any changes are picked up – the easier it is to treat and cure you

H: Now talking of early, let’s just talk a little bit about what sort of age women should start, you know, paying attention. Obviously they get called for their first smear – how does that all work?

D: In a way what we really need to do is respond to our requests from our surgery. The responsibility is taken away from women generally in that all you need to do is be registered with an NHS GP – in England if you are registered with an NHS surgery you will automatically be called after your 25th birthday. And all you need to do is to make sure you make that appointment, and I think the thing to do is to make it the day the envelope comes on the doorstep, because do you know what, we’re all busy, we’re all juggling and it can get lost underneath a mound of in-tray and it won’t happen, but actually we are terriers when it comes to cervical smears and you will get another letter, and another letter, and in my surgery you will eventually get a very stern one from me

H: Really?

D: Actually what I usually do is I say look, if you really don’t want to have a smear, would you just please make an appointment to come and see me and talk about it, and actually that’s an important message, there are a lot of misconceptions out there, a lot of people think it’s painful, they’ve heard horror stories and some people say some dreadful things, and often I find if I can actually get someone to come in and talk to me about it, by the time I’ve explained what it involves and why –

H: Talk us through now what is actually involved in having a smear test

D: What you do? Well –

C: Have you ever had a smear test?

H: Yes I have but you know – let’s get it out in the open

D: Right first thing to say is that if you’re a little bit hung up about it and you want a smear done by a lady, that is entirely reasonable, most practices now have a lady partner and in fact most practices now have trained nurses, so there’s no reason why you can’t have a lady to do your smear. It will take a 5 or 10 minute appointment. You literally, I mean usually I say wear a skirt because you don’t even have to get fully undressed, you just hitch your skirt up. You’ve got to remove your knickers, you lie on a couch, you’re covered over with a sheet or a blanket and a small instrument called a speculum is just inserted into the vagina and we literally just rub the edge of the cervix with a wooden spatula, it’s not painful, you don’t – it’s all over and done with in a few minutes, send it off to the lab. Very important that when you have your smear you check with the smear taker how you’re going to get your results. In my surgery we write to every woman, we write whether it’s normal or not. Some places only write if it’s abnormal, some places will ask you to leave a stamped addressed envelope so just make sure that you know, and generally it’ll take 2 or 3 weeks to come back, check what kind of time frame you’re on so that if you haven’t heard you can follow it up because it’s not completely fault-free, you know occasionally results will get lost and it’s important that you’ve got your result and you know what you’re doing next

H: I mean we’re all very good at going to the dentist, aren’t we and going for our eyes to be checked and so on –

C: It amazes me though because a) if you’ve had a baby, it is nothing. And b) if you haven’t had a baby you’ve probably had a bikini wax or a leg wax which quite frankly is excruciatingly painful, slightly embarrassing, very intimate and expensive, and you’re going to have to get it done again a few weeks later but you do it because you want to look good. So why would you spend the money and go through the pain to look good when you wouldn’t spend the time which is probably a fraction of the time to save your life potentially?

H: Absolutely. What can women do keep themselves safe? Is there anything they can do, apart from, obviously going for the regular smears?

D: I think going for the regular smears is the most important thing you can do. There is also evidence that if you smoke you’re more prone to the changes associated with HPV, so two things that you can really do to keep your cervix healthy is not to smoke and please always come in. Do you know so often I meet women who I eventually persuade to have a smear, and 9 times out of 10 I hear “is that it? Oh I would have come before if I’d known” and you just think if only people knew it really is such a minor thing to have done

H: And what is the source of their reluctance?

D: Fear of the unknown, sometimes. Sometimes fear of what the result might be. Sometimes you know some women have been told some terrible stories about how it’s dreadfully painful and there’s this great big thing that the doctor uses, and – please you know it’s absolutely not, and I have honestly “is that it?”

H: We’ve got a message in from Penny who just wants to go back to something you’ve touched on earlier, and that’s whether a condom will protect you from cervical cancer, she wants you to explain exactly why it doesn’t, and surely it’s completely different from any other sexually transmitted disease?

D: Different to most sexually transmitted diseases. In fact herpes is not totally protected by using a condom either, and that’s basically because the virus lives in the skin, it’s not transmitted in the ejaculate, ok, so if you’ve got a herpes sore on the end of your – on your partner’s penis and it’s covered by the condom then fine, but if the virus is actually in the skin elsewhere it can transmit, alright? That’s not to say – I’m not anti-condom at all, really important that people keep using condoms, but don’t be lulled into that false sense of security that because you’ve always used a condom you’re not at risk. You are I’m afraid still at risk

H: Ok we’ve got a very specific question from Susan here, she’s had an abnormal smear and was told she’s got CIN3 and has to go to the hospital – what does this mean? She’s obviously a bit concerned about it

D: And you know my firm goes every week with this sort of a call because the letter drops through the letterbox and you think – ahh, I’m going to write my will and am I going to see Christmas, of course she is. Very, very important that she goes to that appointment. What she will have is the colposcopy that I was talking about, and they will at that point, what they do is they paint the cervix with some special dye to look at the extent of the abnormal cells, because of course a smear will just say there are some abnormal cells here and this is the abnormality. What the doctor at the clinic will do is to have a look and see how extensive that is, and then decide what needs to be done. They may remove those cells at the time, depending on the extent she may need to have a bigger operation to remove some more things, so they will make the decision at the time, but she will have about a half hour appointment probably at the clinic to look into that. Very important that she goes and I see CIN3 reports all the time – she will be fine but she does need to keep her appointment

H: So the awful statistics that we had at the beginning of the show, 21 women die every week – did they – was it not caught in time, was it a problem with getting it diagnosed?

D: Cervical cancer is pretty much totally avoidable. Now what you – never say never or always in medicine, there is the occasional very aggressive form, but it is exceptionally rare and those deaths are pretty much all avoidable simply by coming and having smear tests when you’re called, as regularly as you’re called and not being frightened, and if you need treatment, go and have that treatment

H: Now Mary wants to know, she’s a bit embarrassed, perhaps Carol you can respond to this, she’s a bit embarrassed to talk to her daughter about such personal things, any advice? I know yours are a bit too young yet, but how are you going to approach that?

C: My daughter’s are 7 and 12, so the 12 year old’s probably coming up close to it, but it think you’d be surprised at how much kids do already know, I’ve certainly noticed with swearing and things- they know, they’ve seen it on television, they’ve heard it, they hear it in the playground and you’re kidding yourself if you think they don’t know it, but they have to have the facts for sure. As I say at 12 she’s only just getting sex education now and I will talk to her because she’s not sexually active yet, and if I had my way she never will be but equally I’m not naive enough to assume that will be the case

H: Short of locking her up

C: That’s the only chance I’ve got. But I think you pick your moment with these things. She doesn’t say how old her daughter is or if she has any other children, or even if this daughter – if she’s the eldest she may be more naïve. It’s when they’re the youngest they know it all, they’ve heard it all and they’ve made up the bits in between, so I think probably pick your moment or even go away with her somewhere or have a day shopping or whatever and try to bring the subject round to what she knows or what she’s heard at school, whose going out with who, that kind of thing. I mean it doesn’t say if she’s started periods or anything yet, we’re not even at that stage yet. She would die of embarrassment if she thought I was discussing this

H: Quite. Is it a good idea then to make it part of your general sex education, sort of chats to your daughters, or is that going to frighten them off?

D: Well I think actually Carol’s right, I think our youngsters today are much more sexually aware than I certainly ever was at the kind of ages we’re talking about and I think there’s a fine line – I mean what you don’t want to do is give them the green ticket to go out and play around and talking like that, but I do think you need to give them enough information –

H: Arm them

C: Without scaring them

D: Yes absolutely, and I think you can drip feed that information as well, and what you tell a 12 year old is quite different to maybe what you tell a 16 or a 17 year old and so there are grades of how you do it

H: And I suppose even just telling your daughters that you’re going for your smear test, not being at all embarrassed to say it’s the day of my appointment and if they ask what it is

C: And kind of making it like a girl thing, you know it’s not something we talk about with daddy, or your brothers or whatever, you know how I’m a bit grumpy every month, I’ll give you three reasons why that is before you get it and they do, they quite like that little sort of understanding, we know – but you know when we were kids we didn’t have this sort of Britney Spears type image of the music and the fashion, they are so much more sexually aware in terms of fashion, music, and it’s a natural progression – they’ll know more than – well I didn’t know anything

H: Do you think they really do know more or do you think it’s just image, and underneath they’re as naïve as ever?

C: If you watch the Teenage soap opera, if you’ve watched any of the American TV –

D: I Think they do and I have been horrified when I’ve heard them say things and I think they don’t understand that, and when you ask you –

H: They do

D: They really do know, and schools are much more proactive about sex education, which is good in the main but they are definitely I think, they’re bombarded with information, Internet, television –

C: I think your average 14 year old knows how not to get pregnant

H: Mine’s 2 ½ so I think probably a couple of years to go yet

D: Not yet

H: We’ve just got time for one final question, Ruth wants – has written in, her friend’s got cervical cancer and she should have gone for a smear which would have picked it up but she didn’t. She now tells every woman she meets to have a regular check, she thinks it’s important at any age, thanks. I suppose it’s exactly right, that’s what the campaign is all about

D: That says it all, that says it all, and you know you do meet women who didn’t go for their smear and have found themselves in this situation, it’s a tragedy

H: So what are you hoping to achieve with the campaign?

D: The opposite of that

C: Maximum coverage, talk to each other

H: Talk to each other, talk to our daughters

C: Well that lady wouldn’t even have known about it if it hadn’t been for her friend, she’d have carried on, I bet she’s told everyone now

H: Yes exactly. Good. Well very very good luck with it, thank you for coming in to talk about it

C: Pleasure. Tellher.com

H: Tellher.com, you can go there for more information, and advice and for the – you can do the quiz that Carol failed so miserably first time! Thanks very much for joining us, see you again. Bye bye.

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