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Chamber and committees

Meeting date: Tuesday, January 22, 2019

Meeting of the Parliament 22 January 2019

Agenda: Time for Reflection, Topical Question Time, City Deals and Regional Economic Partnerships, Decision Time, Cervical Screening Uptake, Correction


Cervical Screening Uptake

The Deputy Presiding Officer (Linda Fabiani)

The final item of business is a members’ business debate on motion S5M-15194, in the name of Monica Lennon, on cervical screening uptake statistics. The debate will be concluded without any question being put.

Motion debated,

That the Parliament notes the latest cervical screening uptake statistics, released in September 2018, which show that uptake is falling, with more than one in four women not taking up their invitation; understands that cervical screening is the best protection against cervical cancer and that falling screening attendance means that there will be more diagnoses that could have been prevented; commends the preventative work of the HPV Immunisation Programme in Scotland, which it understands has seen high uptakes of the HPV vaccine among S1 to S3 girls since 2008; supports Cervical Cancer Prevention Week, which runs from 21 to 27 January 2019, and notes calls for more to be done to remove barriers to screening and to make it easily accessible in the Central Scotland region and across the country.


Monica Lennon (Central Scotland) (Lab)

This is cervical cancer prevention week, and I am grateful to members who supported my motion to allow this debate to take place.

There is actually a lot to be positive about when it comes to cancer of the cervix. Why? Because it can largely be prevented through the human papilloma virus vaccination, which is given to girls—and soon to boys—in Scotland and through cervical screening, which is also known as a smear test.

Tonight, with thanks to the fantastic campaigning and research led by Jo’s Cervical Cancer Trust, we will talk about cervical screening, and I hope that we will focus on what more we can do in Scotland to make cervical cancer a disease of the past.

This debate is critical, because not enough women are attending their smear tests—I know that is an issue that the Minister for Public Health, Sport and Wellbeing is taking very seriously.

Let us face it: no one likes having a smear test. Like too many women in Scotland, I have ignored reminder letters and missed my smear test in the past. It can be uncomfortable and many of us feel embarrassed to talk about it, never mind go to the appointment.

The latest round of statistics reveals that the number of women not attending their regular screening is increasing; in fact, attendance is at an all-time low. Despite our nationwide cervical screening programme, which offers the test to women between the ages of 25 and 64, about one in four women do not attend their regular appointment. Uptake is even lower among younger women, despite the fact that cervical cancer is the most common cancer for women under the age of 35. Only 62 per cent of women aged between 25 and 29 attend their regular appointment, yet not attending smear test appointments is one of the biggest risk factors for developing cervical cancer.

According to new research by Jo’s Cervical Cancer Trust, young women do not go for their smear tests, because they feel embarrassed, scared or vulnerable—eight out of 10 admit that they are embarrassed. Difficulty in getting a suitable appointment time or time off work are also factors.

We have to remove the fear of the unknown and the worry around smear tests. This week, high-profile celebrities, campaigners and even politicians are sharing a lipstick-smeared selfie on #smearforsmear. After I shared mine on Twitter yesterday, a close friend told me that that is just what I look like on a normal night out—a claim that I strongly reject. The WhatsApp discussion with my girlfriends that followed that remark proved to me that it is good for women to talk about our health fears and that a little bit of light-hearted humour can perhaps help with that.

Katy Johnston, from BBC’s “The Social”, recently filmed her experience of going for a smear test. As she says in the video:

“Realistically, this is two minutes of your life—a little bit of awkwardness, sure, embarrassment—but it could stop cells in their tracks before they become cancer.”

Katy has endometriosis and got over her initial fear of the test, but we must recognise that it is not an easy procedure for all women. The my body back project, based at the Sandyford clinic in Glasgow, provides a dedicated smear testing service for women who have experienced sexual violence. There are so many lessons to be learned from that project. We need vital trauma-informed services as standard across the country.

Jo’s Cervical Cancer Trust told me about Nicola, from Scotland, who was diagnosed with cervical cancer in 2015. Let her words sink in:

“I was diagnosed with stage 1b2 cervical cancer at age 35 after putting off my smear test for over a year. It was 6 weeks before I was due to get married overseas. I was devastated. The word ‘Cancer’ seemed to take over my whole life and the thought that I might not be around to see my two children grow up terrified me. I postponed my treatment for a few weeks until after my wedding, because I thought, if something were to go wrong then at least I could leave my husband, children and family with wonderful memories of our wedding and holiday together. A radical hysterectomy means I can no longer have children and I went into early menopause. The physical and psychological impact of cancer will never go away but I look forward to the day that no one is diagnosed with cervical cancer.”

What can we do to get the word out that cervical cancer can be prevented, so that other women in Scotland do not have the same experience as Nicola’s?

First, the Scottish Government and Jo’s Cervical Cancer Trust deserve enormous credit for previous initiatives. The nip it in the bud campaign ran last year and is exactly the type of awareness work that we need more of. The HPV vaccination programme also deserves massive credit.

Jo’s Cervical Cancer Trust has been calling for Scotland to continue to lead the way by running a pilot of self-sampling, which could have a hugely positive effect on screening levels. I was pleased to read reports today that the national health service in Scotland will pilot a scheme of self-sampling for women who have routinely not kept their regular appointments, and I look forward to seeing its results.

More could be done by health boards to monitor general practices with a low uptake and to increase the availability of screening appointments. Samantha, one of my constituents in Hamilton, waited more than two months for an appointment—clearly, that is not acceptable. Another wise woman, Lesley from Edinburgh, had this to say:

“Imagine we didn’t get smear tests under the NHS—we’d all be campaigning to get them for free. It’s a few minutes at the nurse, who has probably seen a lot worse than your lady garden and it’s so important and life-saving.”

In a novel initiative by a Glasgow beauty salon, Debbie Porter offers free waxing services to women to encourage them to book their smear test. As reported on Glasgow Live recently, Debbie posted to her clients on Facebook:

“Being a wax specialist, I see many of you girls who admit you haven’t been for a smear or are too scared to do so, yet, you have me wax you for 20 minutes.”

Debbie has a point.

There are many reasons why women put off their smear tests, but there is one overriding reason why they should not: the test protects against cervical cancer and can save lives.

I thank all the women who have shared their experiences and thoughts with me and, of course, Jo’s Cervical Cancer Trust—a number of whose volunteers and board members are in the gallery tonight—for all the amazing work that they do. Presiding Officer, minister, colleagues, if we match our shared ambition with action, we can consign cervical cancer to the history books.


Emma Harper (South Scotland) (SNP)

I congratulate Monica Lennon on bringing this important debate to the chamber, which gives us the opportunity to raise awareness of the latest cervical cancer screening uptake statistics. Given that cervical cancer prevention week runs this week, from 21 to 27 January, it is timely that we have the opportunity to raise awareness about this extremely important subject.

I remind the chamber of my background as a registered nurse. Much of my experience involved working in the operating room to support gynaecologists in their work following positive results, which required less invasive action compared with the more invasive surgery that was required for women who did not attend for screening at all.

As the motion outlines, the latest statistics show that cervical screening rates are falling in Scotland. All women aged 25 to 64 are invited for cervical screening—those between 25 and 49 are invited every three years and those between 50 and 64 are invited every five years. I was shocked to read that one in four women is not taking up their invitation for what is, as we know, a relatively simple test. Approximately 6,000 women across Dumfries and Galloway in my South Scotland region have not responded to their invitation to attend their GP surgery or sexual health clinic or to see a practice nurse. It is important to acknowledge that cervical screening is the best protection against cervical cancer and that attending screening appointments will mean that there will be increased diagnosis. As with many diseases and conditions, early diagnosis is key to effective early treatment.

I will use my time to highlight some of the unique work that is being developed by my former medical colleagues, including researchers in NHS Dumfries and Galloway. Last year, I met Doctors Heather Currie, William Forson, Gwen Baxter and Jim Lawrence to discuss their proposed research on self-testing for cervical screening. As recently as last Friday, I caught up with Dr Forson for an update, and I am pleased that the self-test pilot scheme has gained approval from the ethics committee and will roll out soon across NHS Dumfries and Galloway.

The team has developed a self-test swab to gather samples, which meets the required criteria for testing for the human papilloma virus. I know that we do not like to have props in the chamber, but I am holding up a uni-swab sample packet; it has a wee cotton bud-type swab and PCR media solution. The goal is for the current process to be followed; instead of cytology samples being done, the HPV cotton bud swab would be used and that would be replicated in current places for obtaining cell samples. Ultimately, the aim of the research is to offer the non-attenders—those 6,000 non-attenders, who are known as defaulters—the opportunity to attend and the opportunity to self-test in their own homes. The self-test swab kit costs less than £2.

Research has shown that the self-test kit has been proven to work in other study populations—I know of one in Africa and one in Canada, and it is also being tested in the Netherlands. It could be applied here in Scotland to help to attract the non-attenders to take up cervical screening and simultaneously work to address the barriers to attending, such as cold speculums, exposure, discomfort, embarrassment and lack of knowledge. Often the challenges are to do with work-life constraints, including transport to and from work or home to places for samples to be obtained. Women can be quite challenged in finding the time to get to their appointments. I am one of them; I have been a defaulter, but I am now taking proactive steps to get myself to my nurse practitioner.

I am aware that some health professionals across Scotland are a bit put off being screened, because they often know those who carry out the screening, who are their colleagues and friends. As I mentioned, other countries such as the Netherlands are trying the self-testing approach, and I look forward to hearing the results.

I encourage the Scottish Government to closely explore and engage in the outcomes of the self-test research and, if it works, to look at the option of rolling out a self-test cervical screen kit across the whole of Scotland.

Cervical cancer is the most common cancer in women aged 25 to 35 in Scotland and the rest of the UK. In Scotland, around six women every week are diagnosed with cervical cancer. Cervical screening saves around 5,000 lives every year in the UK and prevents eight out of 10 cervical cancers from developing or spreading. It is crucial to encourage women to attend and be screened.

I am aware of innovative work from various businesses across Scotland—Monica Lennon mentioned one such business. There is another one in Dumfries called the Salon Bellissimo, which offers women money off waxing and other treatments if they are going to have a cervical screening test.

I encourage everyone to attend when they are invited for their cervical screening test.


Miles Briggs (Lothian) (Con)

I congratulate and thank Monica Lennon for holding this debate on the important issue of screening uptake for cervical cancer. I thank the organisations that provided us with briefings ahead of the debate, including Jo’s Cervical Cancer Trust.

Cervical cancer screening rates are important because screening saves lives, preventing eight out of 10 cervical cancers from developing. I hope that today we can collectively send out the message that screening saves lives and that, each year, the lives of hundreds of Scottish women can be saved if they go to their screening.

In Scotland, approximately six women every week are diagnosed with cervical cancer—six women every week. There is the potential to reduce that number if we can increase uptake rates for cervical screening. Uptake of cervical screening is lowest among younger women, as has already been outlined. That is particularly concerning for many of us, as cervical cancer is the most common cancer in women under the age of 35 in Scotland and across the UK.

A survey that was carried out by Jo’s Cervical Cancer Trust asked 2,005 women aged between 25 and 35 about why they would delay or not go for a screening test. The survey, as we have heard, found that a lot of it was about embarrassment. Of the young women who delay or do not go for a screening test, 71 per cent felt scared, 75 per cent felt vulnerable, 81 per cent said that they were embarrassed and 67 per cent responded that they felt that they no control over the screening and the test.

The survey was incredibly important in order to find out what would make women delay or not take up the invitation of a test. Twenty-seven per cent said that they were concerned about making a fuss, 18 per cent were afraid of being judged and 18 per cent said that their concerns were too small or silly to go for the screening. Almost half of the women who were surveyed said that they regularly delay or do not take up the invitation of a test. If the uptake of cervical screening is to be improved and the concerns of women that have been outlined are to be addressed, we need to see progress.

This week is a great time to have the debate. Jo’s Cervical Cancer Trust has launched its #smearforsmear social media campaign to raise awareness of what a smear test is for and why it is important, and to provide support and advice to women who are going for a test, to make it feel less daunting. As well as providing support and advice, the campaign aims to act as a reminder to women to book their test if they have been meaning to go but have put it off. With busy lives, people often do put off such things, but that is something that we should look to change.

Men also have a role to play. Ali Maxwell, who is the son of Jo Maxwell, after whom the charity is named, has said that men should play a role in understanding the importance of the tests and encouraging our mothers, daughters, sisters, partners and friends to take the test. Too often, we have similar debates in which we encourage women to remind men, but this is an opportunity to show how men can play a role in helping to address some of the fears around smears.

The survey revealed that 72 per cent of women delayed or missed the test because, as has already been mentioned, of the embarrassment of a stranger examining intimate areas and 44 per cent did not know how to talk to a stranger about it. It is therefore important that public information campaigns are able to really tackle the issues. As members have outlined, many people who work in the health professions worry that they might have to see other health professionals. Therefore, it is important to look at how we can reassure people.

Last week, the cross-party group on cancer published our inquiry into the Scottish Government’s cancer strategy and highlighted some progress. We saw progress in relation to public information campaigns through the flower campaign, which I hope that the Government will repeat in future.

We still face significant challenges around cervical cancer, with incidence rates having increased by 19.1 per cent over the past decade. I would like to hear from the minister this evening about what work is being undertaken to develop reminders for women, and to further look at how we can use technology for screening reminders, such as an email or an automated text message, in addition to the letter that women receive from their local health board.

We should all work to address the barriers that are preventing women from accessing screening. Campaigns such as #smearforsmear can make a huge difference in improving uptake rates for cervical screening and reducing the number of women in Scotland and across the UK who are diagnosed with cervical cancer every year.


Elaine Smith (Central Scotland) (Lab)

I am grateful to Monica Lennon for bringing the debate to the chamber during cervical cancer prevention week. I believe that there is some discussion about how to pronounce cervical, but I will stick with the west coast way. However we pronounce it, it is vitally important for women’s health that women take up the invitation to go for a cervical smear test, so it is worrying that the number of women who are doing so is in decline. That needs to be addressed as a priority and may require another Government public health campaign to raise awareness of the benefits of the smear test and to provide reassurance.

As we know, a campaign is being run by Jo’s Cervical Cancer Trust, which is a UK-wide charity that was set up by James Maxwell in memory of his wife Jo, who died from cervical cancer. It provides high-quality information and support to help prevent cancer and to reduce the impact on those who are affected by cervical cancer and abnormalities, and it campaigns for excellence in treatment and prevention.

Last year, the be cervix savvy roadshow toured the country and provided information and support about screening and cancer to local communities, including communities in Scotland. The purpose of the roadshow was to ensure that more people know what cervical screening is and what to expect at the test; understand the test’s role in preventing cancer; learn about cancer and how to spot the symptoms; and know who can have the HPV vaccine and why. I visited the roadshow bus last year when it was in Coatbridge. It was kept very busy, with lots of women, and some men accompanying them, coming to find out more.

As has been mentioned—and as, I think, women in the chamber will know—what can stop women attending is more likely to be the fear of the smear test and a possible bad result than a negative experience of the test itself. In order to encourage women to attend their appointments, it is important to ensure that they know that while the test is certainly not comfortable, it should not be painful. It is also crucial that there is discussion of the outcome, if a bad result is achieved. As Monica Lennon pointed out, there should be a particular focus on the excellent chances of treating cervical cancer if it is caught quickly.

Jo’s Cervical Cancer Trust can help with information and advice about the test. It gives useful tips, such as ensuring that the test is carried out by a woman doctor or nurse, if that makes a woman feel more comfortable about attending their appointment. The only time that I have had a bad experience of the test, which was when I was quite young, was when it was carried out by a male doctor. I always try to ensure that I see a female doctor or nurse.

The trust highlights issues that women who are survivors of sexual abuse might have with screening, on which it provides specific advice and support. A further area of the website provides helpful advice for women with learning disabilities.

The trust’s current campaign is underpinned by new research that shows that, as we have heard, young women who delay the test or do not attend it can feel scared, vulnerable or embarrassed at the thought of having the test. Two thirds say that they would not feel in control during the test, so it is important to show them ways that they can be in control. Addressing those issues would undoubtedly help to boost screening numbers.

The idea of invasive screening can be particularly off-putting for young women. More research into ways of conducting less invasive screening would be extremely welcome. I was interested to hear Emma Harper talk about new research that is taking place into screening.

Emma Harper

The member mentioned those who have been on the receiving end of sexual violence. Does she think that a self-test approach might be a way of supporting women?

Elaine Smith

It could certainly be an option. All options that make women feel comfortable about taking the test should be explored.

We should also consider out-of-hours provision, and persuading employers to be more sympathetic to letting women have time off work to go for the test.

I notice that I am over my time, but I want to mention an issue that is not given enough thought, which is that health screening, for example for breast or cervical cancer, is not available to many women who are homeless. Women who are living on the streets or in hostel accommodation or women’s refuges may not receive appointment letters or have a GP. They might have no idea how to go about getting a screening. Screening might be—and probably is—the least of their worries, but the issue is one that, as a society, we should all be concerned about. I will be interested to hear the minister talk about how it could be addressed.

Once again, I thank Monica Lennon for bringing this important women’s health issue to the chamber—and I thank the Presiding Officer for the bit of extra time.


Alison Johnstone (Lothian) (Green)

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.


Rona Mackay (Strathkelvin and Bearsden) (SNP)

I add my thanks to Monica Lennon for bringing this important debate to the chamber. The speeches that we have heard have driven home just how vital it is to highlight the issue. Some fantastic points have been raised.

Cervical cancer is the 14th most common cancer in females in the UK, accounting for around 2 per cent of all new cancer cases. Almost all cases of cervical cancer are caused by a common virus called human papillomavirus, or HPV. Cervical cancer screening is a great NHS success story. It has been available all my adult life and can pick up any abnormalities at an early stage, which allows painless treatment that prevents cancer. All women aged 25 and 64 are invited to attend cervical screening, and I can honestly say that I do not think I have ever missed receiving a reminder. The system works, and it saves 5,000 women’s lives a year throughout the UK.

In 2017-18, 378,382 cervical screening tests were processed in Scotland. For the past 10 years, the HPV vaccine has been offered to girls from secondary 1 to S3 in Scottish secondary schools, which is a fantastic public health initiative. The immunisation helps to protect against the types of HPV that cause 75 per cent of the cases of cervical cancer.

As we have heard, according to the report by Jo’s Cervical Cancer Trust, 72.8 per cent of eligible women in Scotland aged 25 to 64 were recorded as having been screened yet, alarmingly, in Glasgow just 56 per cent of young women attended screening.

In Scotland, cervical cancer is the most common cancer in women aged between 25 and 35. As we have heard, research shows that, for most women who do not attend, the reason is that they are scared or embarrassed. We must reach out to young people and stress how important it is that they take the test. The test is to prevent cancer, not to find it.

I agree with Monica Lennon on trauma-informed screening and with Emma Harper on the self-test screening, which is positive news.

The test can be uncomfortable, but it takes less than two minutes—and that may be the most important two minutes a person can spend.

The take-up of screening is poorest among younger women and increases with age to peak at 50 to 54. In addition, the take-up of screening is highest among women from the least-deprived areas and falls with increasing deprivation. That is really worrying, as Alison Johnstone mentioned. Elaine Smith made a vital point about homeless and marginalised women not being screened, which is an issue that needs to be addressed.

Any abnormality will be picked up and dealt with. In 2017-18, only around 1 per cent of tests showed high-grade abnormality, with 7.2 per cent showing low-grade abnormality and almost 92 per cent being clear.

The take-up of cervical screening is higher in HPV-vaccinated women of all ages than in non-vaccinated women. That may be due to immunised women being more aware of the risks involved thanks to their education during the immunisation programme. Education is a key part of getting the message across. My hope is that screening becomes the norm for women and girls, just like going for dental check-ups or eye examinations—no big deal, just something that we have to do.

Let us get the message out loud and clear to women and girls: the test is too important to miss; it will give you peace of mind that everything is okay and, more important, it could save your life.


Annie Wells (Glasgow) (Con)

I thank Monica Lennon for bringing the debate to Parliament during cervical cancer prevention week.

Put simply, cervical screening saves lives. Despite that, however, one in four women is not taking up their invitation for a cervical screening, putting themselves at risk of having undetected cervical cancer. It is key that we try to understand why screening attendance is falling, what the barriers are to women getting the test done and how we can ensure that every woman has the information and opportunities that they need to access cervical screening. Bearing in mind that screening is a free health test that is available to every woman in Scotland, it is essential that we acknowledge the barriers and factors that are preventing women from taking up their invitation.

As we have heard, the test can be uncomfortable and slightly embarrassing for many women. It is one of those tick-box exercises that, if put off among a list of countless other things to do, may have no immediate or obvious repercussions. A survey of more than 2,000 women by Jo’s Cervical Cancer Trust found that a third of young women were too embarrassed to go to their test because of their body shape.

For some women, it is much more difficult to go, possibly because they have had a bad experience at a test or an experience of sexual violence. That is why I was encouraged to hear from Emma Harper about the piloting of self-tests, which I welcome. It is paramount that women are given the information to allow them to overcome those barriers.

If women feel embarrassed about having the test done, they need to be informed—through a public campaign or social media—that they can specify that they want a female nurse, that they need only undress from the waist down and that, for most people, the test is not painful at all.

When reading around the topic, I was encouraged to see celebrities posting on social media about their own smear test experiences. Ten years ago, Jade Goody sadly lost her life to cervical cancer, after which cervical screening rates rose thanks to extensive media coverage and her work to raise awareness.

However, 10 years later, numbers have dipped. Most alarming, in Scotland, the biggest fall in cervical screening take-up is among 25 to 29-year-olds, with more than one in three not taking up their invitation. As cynical as we sometimes might be about social media, the power to raise awareness among that group is great. There are many great campaigns out there that young women and men can join to spread the word among their friendship groups. As we have heard, the #smearforsmear campaign encourages people to share smeared lipstick selfies along with tips and words of support during cervical cancer prevention week.

Innovation is also key. In my hometown of Glasgow, I have had the pleasure of meeting representatives from Jo’s Cervical Cancer Trust at the be cervix savvy roadshow, once on Buchanan Street and once in George Square as part of its mobile unit service. It was easy to see how information could be easily shared in such prime locations.

Like Monica Lennon, I was pleased to see in the local press last week the initiative of a Glasgow beautician who is offering a free wax treatment to anyone who has a confirmed smear test appointment.

I again thank Monica Lennon for bringing the debate to the chamber during cervical cancer prevention week. We cannot allow the take-up of cervical screening to slip any further or we run the risk of seeing a rise in diagnosis rates of what is often a preventable cancer. There is no quick fix to turn around the situation, but I hope that, by working together and raising awareness, we can save lives.


The Minister for Mental Health (Clare Haughey)

I thank members who have contributed to the debate today, and Monica Lennon for bringing it to the chamber.

Cervical screening is unique. Not only can it detect cancer early, but it can prevent cervical cancer before it begins. The screening test detects precancerous cell changes that are mainly caused by the human papilloma virus, which 80 per cent of us will get at some point in our lifetimes, and treatment as a result of screening prevents eight out of 10 cervical cancers from developing.

There is no doubt, therefore, that the cervical screening programme saves lives: it is the best protection against cervical cancer. As a woman who has been for a smear test, I believe that we must do all that we can to encourage eligible women to take up their cervical screening invitation. I agree with members that it is disappointing that uptake rates for cervical screening continue to decline. Latest figures show that just 72.8 per cent of eligible women attend screening in Scotland. That is down from 73.4 per cent in 2017 and about 80 per cent 10 years ago. The trend is not unique to Scotland; it is mirrored across the UK.

In my Rutherglen constituency, the most recent uptake data range from a high of 84.7 per cent to a low of 62.4 per cent. Uptake of screening was highest among women from the least-deprived areas and fell with increasing deprivation levels.

What is putting women off getting tested? Evidence shows that there are a number of barriers, from complex emotional obstacles such as fear, body shame and embarrassment to practical barriers such as struggling to attend an appointment due to work commitments or childcare. New research from Jo’s Cervical Cancer Trust and the Scottish Government shows that two thirds of Scottish women are unaware that not attending cervical screening is the biggest risk factor for developing cervical cancer. Awareness raising is therefore very important, but we must also recognise that uptake is lowest in our least-affluent communities.

The Scottish Government’s cancer strategy is investing up to £5 million in our NHS national cancer screening programmes, including cervical screening, in order to improve outcomes. The funds are supporting innovative projects, working to tackle inequalities and encouraging participation in screening programmes in communities from which individuals are least likely to take part.

So far, we have committed more than £2.7 million to support 25 projects. Cervical cancer prevention week gives us the opportunity to recognise and celebrate the good work that is currently being undertaken to tackle inequalities of access and to raise awareness of cervical screening in Scotland.

The Scottish Government warmly welcomes the input of Jo’s Cervical Cancer Trust to the Scottish cervical screening programme, and we work closely with the trust to encourage women—especially women in hard-to-reach groups—to attend for screening. Under the cancer strategy, Jo’s Cervical Cancer Trust has received funding for a Glasgow outreach service that targets specific groups in which there are significant health inequalities and a higher rate of non-attendance. It works with local general practices, sexual health clinics, community groups and volunteers to improve access to, and uptake of, cervical screening. Last year, Jo’s ran its first ever Scottish “Be cervix savvy” roadshow, which visited high streets and retail parks around Scotland. It increased awareness by addressing public knowledge of cervical screening and cancer. I was pleased to learn that two community workers from my constituency were trained as volunteers and joined the roadshow when it travelled to Lanarkshire.

The Scottish Government’s cancer strategy supports Clyde Gateway—Scotland’s biggest and most ambitious regeneration programme company—in tackling inequalities in access to screening. The Clyde project includes the creation of additional monthly cervical screening clinics. That gives women the choice of a more convenient appointment time, which increases flexibility and accessibility.

Elaine Smith

Do any of the projects that have been mentioned work with women who are homeless?

Clare Haughey

I was going to address that point further on in my speech. I will do that, if that is all right with Elaine Smith.

The Clyde project has developed a community health pathway in the community of Burnhill in Rutherglen, which is the second most deprived community in South Lanarkshire. Through engagement with residents on the street, door to door and via local activity groups, the project has consulted 337 local residents.

Those are a few of the excellent projects that are currently under way. I have only just touched the surface.

It is vital that we continue to explore how screening can be more effective at reaching those who are in the greatest need. We will bring together all the learning that we have gathered from the projects into a cohesive and co-ordinated strategy to reduce screening inequalities.

We are complementing that work with our “Flower” cervical screening awareness campaign, which started running in cinemas yesterday and will be run across digital platforms from 28 January. The campaign targets 25 to 35-year-old women, who are less likely to attend. The campaign encourages women to take up their screening invitations and recommends that women who missed their last appointment—or who have never been screened—contact their general practitioner. I thank all the people who undertake vital work to raise awareness of the importance of cervical screening.

Finally, I will mention our cervical cancer vaccination programme, which we introduced in 2008. Since we introduced the programme, uptake rates have remained high and continue to exceed 80 per cent. The programme has been evaluated since it began and already shows encouraging and positive signs that the rate of cervical cancer that is caused by the HPV virus will reduce in the future. However, the vaccine does not protect against all cervical cancers. Therefore, regular screening is still important and will continue to be an essential part of our armoury for many years to come. We must continue the work to get that message out to young women.

I will address a couple of the issues that members raised during the debate. Emma Harper spoke about self-screening. Dumfries and Galloway NHS Board is carrying out a small-scale pilot in its area. We are looking at the possibility of a national pilot. The UK National Screening Committee is looking at the evidence for self-sampling, and we are awaiting its advice before proceeding further with that.

Miles Briggs and Alison Johnstone asked me about the potential of digital communications to encourage people to take up the invitation for screening. As part of the work under the cancer strategy, we will use learning—including digital and other technology—to develop future communication plans.

Elaine Smith asked me about homelessness. Through the cancer strategy, there are a number of projects in which we are looking at how screening services can be improved for hard-to-reach groups—which, of course, include women and men who are homeless, people with learning disabilities and people with mental health issues.

We who are here tonight share the same ambition—to make cervical screening accessible to all women across Scotland, regardless of where they live, by understanding and reducing the barriers that women face.

We all have a role in sharing the potentially life-saving messages about cervical screening with all the women in our lives. Together, let us nip cervical cancer in the bud.

Meeting closed at 17:49.