Cervical cancer is often highly treatable when detected early, but failures in screening, diagnosis or follow-up care can allow the disease to progress unnecessarily.
For many patients, particularly those who have been having regular NHS screening tests, a cervical cancer diagnosis comes with questions about whether the condition could have been identified or treated sooner – and whether their outcome could have been different had that happened.
Cervical cancer is a cancer which mainly affects young women in their early 30s. Each year, 3,250 people are diagnosed with cervical cancer, according to The Eve Appeal. Thanks to advancements in both the cervical screening and HPV vaccination programmes, there has been an overall reduction in the disease in recent decades, with rates falling by a quarter since the 1990s.
However, there are still too many patients who are diagnosed with cervical cancer at a later stage when more invasive surgery like hysterectomies are needed.
For many patients, prevention fails not because they did anything wrong, but because the healthcare system did. Prevention depends on test results being accurately reported, symptoms being properly investigated, and abnormalities being acted upon without delay.
When cervical screening tests are missed or misinterpreted, symptoms are not taken seriously, or diagnosis and treatment are delayed, the consequences can be life-changing. Women in their 30s are facing the prospect of infertility and early menopause due to treatment of cervical cancer.
This blog explores how cervical cancer prevention works in the UK, when cervical cancer care errors leads to clinical negligence, and what your rights are legally when care falls below reasonable standards.
How Cervical Cancer Prevention Works in the UK
The message has always been that the earlier any type of cancer is caught the better a person’s chances of treatment and survival will be. Prevention relies heavily on adequate screening which can help detect some cancers at an early stage.
When caught in the pre-cancerous stages, cervical cancer is very treatable. For this to happen, it relies on several elements working together:
- The NHS Cervical Screening Programme
- Accurate analysis of smear test samples
- Clear communication of results
- Appropriate follow-up and recall
- Prompt referral when symptoms or abnormalities are identified
When these steps are followed correctly, cervical cancer can often be prevented altogether or diagnosed at a much earlier stage, leading to better outcomes.
What is Cervical Screening?
Cervical screening – or a smear test – is used to prevent cervical cancer, not diagnose it. It is a quick internal test where a sample is taken from the cervix to check for the common skin-dwelling human papillomavirus (HPV). It can also be used to check for any cell changes or abnormal cells in the cervix that could later develop into cancer if left untreated.
Abnormalities are almost always (99.7 percent) caused by high-risk HPV. There are around 200 types of low and high-risk HPV viruses and 80 percent of people will get one in their lifetime. Most will have no problems as the body is able to clear HPV itself. But persistent infection is what causes cells in the cervix to change.
While 13 types of HPV are linked to cancer, HPV detection doesn’t automatically mean you will develop cancer. Cervical cancer is slow developing and can take between ten and 20 years for HPV to cause cell changes. Symptoms rarely occur for many years, often when it has metastasised (spread to other parts of the body). This is why screening is imperative.
Currently all women or people with a cervix who are registered with a GP and aged between 25-64 are automatically invited for regular smear tests every five years.
There will always be two camps when it comes to screening invitations landing on the door mat: those who read it and forget about it (or choose to ignore it), and those who book an appointment straight away. Those in the former camp who put it off may do so out of the fear of the unknown, feeling embarrassed to ‘bare all’ to a nurse, or having had a bad experience in the past.
Of course, attending screening is a patient’s choice. However, some patients may not be able to make an informed choice for many reasons, often owing to anxiety or lack of understanding. Cervical cancer rates are around 65 percent higher in the most deprived areas of the population; around 520 cases of cervical cancer each year in England are linked with deprivation. For whatever reasons, lives are being put at risk by socioeconomic barriers to cancer screening.
When Cervical Screening Errors Undermine Prevention
For those who do attend their screening appointments, the majority will have a good experience throughout, considerate nursing care, followed by prompt and accurate laboratory analysis and reporting. However, there are cases of substandard medical care, advice or treatment.
Screening is not an infallible solution to cancer prevention, nor is it risk-free. Screening only prevents cervical cancer if results are correctly analysed, clearly reported and acted upon without delay.
Some patients may get an incorrect or misinterpreted result, such as a false positive or negative. This means they are either over-diagnosed and given unnecessary treatment or have a late diagnosis when their cancer has often advanced and sadly, curative treatment options have dwindled.
Other examples of screening-related failures seen in clinical negligence claims include:
- Abnormal results not being communicated to patients
- Failure to arrange repeat testing or colposcopy
- Patients not being recalled after abnormal findings
However, if undertaken correctly and without error or negligence, the benefits of having a smear test far outweigh the risks.
Missed Opportunities for Early Diagnosis
Even with screening in place, cervical cancer can still develop, particularly if symptoms are present and not investigated, or if a very aggressive cancer arises in between screening periods. If a patient has been having regular screening but is then diagnosed with late-stage cervical cancer then questions should always be asked. Patients can request a Cervical Screening Audit going back over all of their screening results.
Primary care plays a crucial role in cervical cancer prevention. GPs are often the first point of contact and are responsible for acting on abnormal screening results, investigating reported symptoms and making urgent referrals where appropriate
Prevention can often fail when symptoms are repeatedly overlooked by healthcare professionals. Cervical cancer generally affects younger women who are aged 30 to 35. Women of this age should feel confident in speaking to medical professionals about their bodies, but unfortunately, sometimes they may have their symptoms dismissed as ‘normal’ or attributed to things like their age, contraception use or hormonal changes.
Risk factors of cervical cancer also include smoking, immunosuppression drugs and recurrent sexually transmitted diseases. If GPs fail to take these into account, it could mean that patients slip through the cracks.
When symptoms and risk factors are overlooked, referrals are delayed or not made in line with NICE guidance, meaning investigations don’t happen and the cancer is left to spread or advance to a later stage. In some cases, earlier action could have reduced the extent of treatment required, preserved fertility and improved prognosis.
Symptoms of Cervical Cancer Include:
- Bleeding during or after sex – often the first symptom
- Bleeding between periods
- Post-menopausal bleeding
- Unexplained pelvic or lower back pain
- Pain and discomfort during sex
- Changes to vaginal discharge
Lost Results and Poor Follow-Up
Cervical cancer prevention is about more than screening alone. It depends on vigilance, communication and timely action at every stage of care.
Some cervical cancer cases involve no single clinical error, but rather systemic failures, such as lost or misreported smear test results, failures in follow-up systems and poor communication between departments.
These breakdowns can mean that abnormalities identified during screening are never acted upon, removing a key layer of protection.
Women with symptoms, HPV or cell changes aren’t referred for colposcopies which looks at the cervix under a microscope and takes a biopsy for investigation. This in turn often leads to delayed diagnosis of cervical, with women either suffering with symptoms for years or being unaware that they have cervical cancer until a later date.
When Delayed Diagnosis Affects Fertility and Treatment Options
One of the most devastating consequences of delayed cervical cancer diagnosis is the impact on fertility and reproductive health.
There are two main types of cervical cancer. The most common is squamous cell carcinoma which makes up between 80 and 90 percent of cases. It is mostly caused by HPV and affects the flat, skin-like cells covering the cervix's outer surface (the ectocervix).The second-most common type is adenocarcinoma which starts in the gland cells that produce mucus, usually found on the inside of the passage that runs from the cervix to the womb (endocervix).
Both types are treated in the same way. However, if investigations aren’t done in a timely manner, and diagnosis is delayed, it often means women face more invasive treatment. Cell changes can often be treated with LLETZ which uses a thin wire loop with an electrical current to remove the cells with changes directly from the cervix.
When cervical cancer is diagnosed at a later stage, even from stage 1 and early stage 2, patients often need to undergo surgery to remove the cervix, top of vagina and tissue around the womb. In some cases, a hysterectomy may be advised to take away the womb, fallopian tubes and ovaries to reduce the risk of the cancer returning or spreading.
These treatments put women into early menopause and reduce their chance of having children. With women now waiting longer to start a family, this news can be difficult to process. As too can it be for women who wanted to have more children in the future but have now had that choice taken away from them. However, a landmark ruling at UK Supreme Court ruled the NHS can be ordered to pay for surrogacy treatment abroad if a hospital’s negligence leaves a woman infertile.
Following surgery, it may also be recommended to undergo chemoradiotherapy and brachytherapy (internal radiotherapy via the vagina). Daily hospital visits can be both physically and mentally taxing for patients, especially when you know this could likely have been prevented had previous mistakes not been made.
At Medical Solicitors, our team have worked with people who have been affected by delayed or wrong diagnosis of cervical cancer. As well as avoidable hysterectomies, some of the other lasting effects they experienced include lymphadenopathy of the legs caused by a radical hysterectomy, permanent nerve damage during surgery to remove the womb, reduced life expectancy by almost four decades and worst of all, loss of life, often leaving behind a partner and children.
If you are diagnosed with abnormal cells or cervical cancer, you should discuss with your physician the treatment options available to you, the risks and benefits of each, and any side effects such as fertility issues. You can then make an informed decision about what treatment option you consent to.
What to Do If You Are Concerned About Cervical Cancer Care
Under the NHS Duty of Candour, patients have the right to be informed when something has gone wrong with their care. This includes being told about errors or delays, receiving an explanation and apology and being informed of the next steps.
Aside from the complaints process, upon diagnosis your gynaecology department should take it upon themselves to do a cervical cancer audit looking at all of your screening for the previous 10-year period. If they do not, you should ask for this and it should be reported to you.
If you have concerns about your treatment, you may wish to make an official complaint via the NHS Pals service. In some cases, this may answer your questions and settle the matter.
However, this can also prompt difficult reflections for some patients, particularly those who believe their cancer could have been detected earlier. They may wish to seek legal advice and pursue a medical negligence claim for compensation.
It is important to know that the success of a medical negligence claim is contingent on whether your it can be proven (by way of independent medico-legal expert evidence) that any delay or medical error affected the outcome. Simply put, would your cancer not have progressed to a more advanced stage had it been diagnosed earlier? Would your cancer have been easier to treat? Would you have had less invasive treatments?
Claimants have the responsibility to prove breach of duty of care which means they must prove their care fell below the reasonable standards. Many patients are unsure whether what they experienced was simply an unfortunate outcome or whether their care fell below an acceptable medical standard.
A specialist medical negligence law firm like Medical Solicitors can help by independently reviewing the circumstances of your care. This typically involves obtaining medical records, assessing whether NHS guidelines and accepted clinical standards were followed, and seeking expert medical opinion (often from multiple specialities, such as pathology and gynae-oncology). Importantly, this process is about establishing the facts, not assigning blame.
If negligent care is identified during our no obligation screening process, then one of our lawyers will explain your legal options clearly and sensitively, including whether a claim may be possible and what further evidence is needed, at which point we also offer a Conditional Fee Agreement (no win, no fee).
Seeking legal advice does not commit you to taking action. It can simply be a way to gain clarity, accountability and support after a very challenging experience. Even where no claim is ultimately pursued, many clients find reassurance in understanding what went wrong and receiving clear answers about their treatment.