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22nd May 2015

Screening – stay on the radar

cancer concept, pink ribbon in the hands

Screening – stay on the radar

There is evidence that, despite Government initiatives to improve uptake, women with learning disabilities are less likely to be screened for breast and cervical cancer.

Gentlemen readers may wish to zone out now, but try to stick with it!

Ladies will groan and wince at the arrival of The Letter from your surgery reminding you that its time to go for your smear test, or that you are requested to attend the mammography wagon. Although we know that this is essential in being well and recognising any early signs of cancer, it’s not a pleasant way to spend a morning, and I have yet to meet anyone who doesn’t dread it.

Inequality in screening uptake

A research project in 2012 confirmed that for people with learning disabilities, the uptake of these regular screening appointments lags a significant way behind that of the population as a whole. Cervical screening rates had improved over the ten-year period of the study, but breast screening had declined.

I reflected that I had never supported anyone I worked with to attend a screening appointment, which was odd, as I have worked in various provisions over a 30-year period, so during this time there must have been people that were eligible. So I wondered if any readers out there had the same lack of experience and how many service users were missing out on this vital screening.

Breast screening

Breast cancer screening is offered to all women from 47 to 73 years of age, every three years. It involves a trip to a special, usually mobile screening centre, where rather undignified (but happily swift) photography of the breasts takes place. This is something that women with intellectual disabilities would find challenging without significant support. It requires the patient to be still, to be able to understand and respond to the screener’s instructions and to be able to respond to questions about self-examination and lifestyle.

There is a great resource out there of easy-read and video information to help explain the process to service users, so it need not be difficult to assist someone to participate. For those with profound and multiple disabilities the screening method might not be achievable, so it is vital that you support these clients in regular examination of the breasts and seek advice if any abnormalities or concerns arise. Again, lots of information exists to help you with this.

Smear tests

Cervical screening is offered to the female population from 25 to 49 every three years, then every five years from 50 to 64 years of age. This involves a trip to the nurse, either at the GP surgery or a clinic. The examination (for those who don’t know!) involves a swab of the cervix, achieved through a short internal examination. This can be uncomfortable, embarrassing and frightening. For women who are not sexually active, it can be even more so.

Sensitivity around this examination is not surprising, and for women who have never been sexually active it may be something that a risk assessment could support non-attendance. Its intimacy can make people want to avoid it, but this should be worked through as the benefits are clear. Again, a wealth of information exists to help women understand the process and the reasons for it.

So – if you support women with learning disability , of the ages where they are eligible for screening, check that their address details at the surgery are correct and that the GP knows they are in your care, so they can copy you in on any invitations. For those who are more independent and have not recently attended screening, help them to recognise the letters and understand the process.

Here’s some help:

Cancer Research UK - Cervical screening for people with learning disability

Jo’s Cervical Cancer Trust – The Smear Test Film

Beyond Words – empowering people through pictures

Improving Health and Lives: Learning Disabilities Observatory - Making Reasonable Adjustments to Cancer Screening

*All information is correct at the time of publishing. Use of this material is subject to your acceptance of our terms and conditions.

Ginny Tyler

Learning Disabilities Specialist

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