Transcript Practicalities of Smear Taking

Overview of
NHS Cervical Screening Programme
Cervical Screening QARC
Training School
October 2012
Learning Outcomes
• Understand the NHS Cervical
Screening programme
• Understand the role and
responsibilities of the practice
nurse in cervical cytology screening
• Have insight into barriers that
prevent women attending for
screening
Key Statistics
• 3.35 million women were tested in
2010/2011
• 78.6% of eligible women were
recorded as being tested within 5
years of their previous adequate test
• 3rd most common cancer in women
• Cervical screening saves approximately
4,500 lives a year
Key Statistics
• The Annual review 2011 identifies the
NHS Cervical Screening Programme
(NHSCSP) can prevent 75% of cancers
in women who attend regularly.
• The Annual review highlighted that
fewer than 2 in 10,000 of women
screened showed evidence of invasive
cancer which is more or less the same
as last year.
Natural History of Cervical Cancer
• Human Papillomavirus Infection (HPV) is
directly linked to 99% Cervical Cancer
• > 100 types of HPV virus
• Two high-risk types, HPV 16 and 18, cause
over 70% of cervical cancers
• 2 types cause genital warts (6 + 11)
• Weakened immune system
• Smoking!!!
Eligibility for Screening
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All women aged between 25-64
Lesbian and bi-sexual women
Immunosuppressed women
Learning Disabilities
Not sexually active
65+
???Opportunistic Sampling???
Screening Frequency
• 25 years 1st invitation on or near 25th
birthday
• 25-49 3 yearly
• 50-64 5 yearly
• 65+ Only screen those who have not been
screened since age 50 or had recent abnormal
results
Why screen women only from age 25?
Cervical cancer is rare in women under 25 but
changes in the cervix are common. Screening
women from the age of 25 will reduce the
number of unnecessary investigations and
treatments in younger women and so reduce
anxiety.
Advisory Committee on Cervical Screening
Review of Screening women under 25 years
Guidance for Abnormal
Bleeding in Under 25s
• Published 3 March 2010
• Cascaded to GPs and practice
nurses
• Available at
http://www.dh.gov.uk/en/
Publicationsandstatistics/
Publications/PublicationsPolicy
AndGuidance/DH_113478
20-24 Year olds With Abnormal Vaginal Bleeding
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Issues with screening women under 25
• 1 in 3 cytology samples abnormal but cervical
cancer very rare, & will fall further with HPV
vaccination
• Long delays in diagnosis for those cases
• PCB common: 1 in 600 women aged 20-24; IMB
maybe 1%
• ? Up to 15,000 women aged 20-24 report
abnormal bleeding
• PCB is ‘cardinal symptom of cervical cancer’ at
this age, but IMB requires attention
Guidance on managing clinical symptoms
• Take history and offer immediate speculum
examination of cervix
• No cytology
• Can be done by practice nurse who is
experienced sample taker
• Suspected cancer  2WW referral to
colposcopy
• Abnormal but not cancer  refer to gynae or
GUM
• Normal cervix  swab and treat STIs or refer
to GUM
Responsibilities of the Sample
Taker
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Informed consent
Documentation
Care of Sample
Monitoring of results
Personal audit
Infection Control
PATIENT
Sample Results
• Out of the 3.3 million women who had adequate
results:
• 93.4% were normal
• 3.5% were Borderline
• 1.9% were Mild dyskaryosis
• 0.5% were moderate dyskaryosis
• 0.6% were severe dyskaryosis
• 0% were severe/?invasive cancer
• 0% ?Glandular neoplasia
Who’s Who?
• Who governs the screening
programme?
• What role does the PCT
have?
• What does Public Health do?
QA (Quality Assurance)
• SEC QARC Lead by a QA Director
and supported by professional QA
leads for each element of the
Programme
• Area covered – Kent, Surrey and
Sussex
• Contacts: Sample Taking Facilitator
– Debbie Pullinger- 01424 775965
QA - Objectives
• Assess each element of the Cervical
Screening Programme
• Maintain the database of sample
taker numbers
• 3 Yearly Visits to Colposcopy /
Laboratory / Call recall / PCT & Public
Health
• Provide Support & Advice!
QARC – Contact Details
SEC Cervical Screening QA Training School
SEC Cancer Screening QA Reference Centre
77a High Street
Battle
East Sussex
TN33 OAG
TEL: 01424 775965 Fax: 01323 438158
E-mail: [email protected]
PCT / Public Health
• Each Public Health Department has a Screening
Lead
• Responsible for Sample Taker numbers
• Monitors Inadequate rates for individual
surgeries
• Monitors uptake
PCT/Public Health Contact Details
ESDW/H&R PCT: Jenny Greenfield: 01273
336050 / 07881 501126
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• West Sussex: Viv Mussell or Moira Jones:
01243 770777 or 01243 815411
• Brighton: Trish Kennard: 01273 545383 /
07951 055807
• Kent & Medway: Paula Mclachlan: 01233
658417 or Julie Tippett 01233 658406
• Surrey: Victoria Heald: 0208 541 7782
Resources
• NHS Cancer Screening Programmes www.cancerscreening.nhs.uk
• National Electronic Library Specialist Screening
Library - http://rms.nelh.nhs.uk/screening
• National Screening Committee - www.nsc.nhs.uk
• PCT intranet
• Screening newsletter
• Jo’s Trust