Transcript Slide 1

THE NHS CERVICAL
SCREENING PROGRAMME
(NHSCSP)
Cervical Sample Taker Training
2015
Aims of the NHS
Cervical Screening Programme

To reduce the incidence of and mortality from
cervical cancer
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This is achieved by offering regular screening to all
women at risk so that conditions which might
otherwise develop into invasive cancer can be
identified and treated
History of cervical screening
in the UK
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Cervical screening began in the mid-1960s
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The NHSCSP was set up in 1988 with the
introduction of computerised call and recall
systems
Screening programmes
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Condition must be an important health problem
Natural history of disease must be understood
Acceptable test
Eligible population known
Good coverage
Agreed policy on management
Effective treatment
Good quality assurance
Economically balanced
Natural History of Disease
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Pre-malignant condition
can be detected
Cervical Intraepithelial
Neoplasia (CIN)
CIN1, CIN2, CIN3
Low and High grade
dyskaryosis
CIN is NOT cancer
Risk factors for cervical cancer
Factors that increase risk include:
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persistent infection with high risk types of the
human papillomavirus (STI)
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Any activity that increases the woman’s chance
of catching HPV…examples?
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Smoking
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immunosuppressive disorders, including HIV
infection
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not attending for screening
Risk factors for cervical cancer (cont.)
Factors that reduce risk include:
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regular attendance for screening
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regular condom use
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total hysterectomy for other reasons
Eligible women
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Those aged 25-64 who have a cervix
Women under age 25
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Cervical cancer is rare
Increased rates of borderline changes
Risk of over-treatment
Screening would do more harm than good
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Evidence reviewed in 2009
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Still considered robust
Symptoms should not be ignored
Age-specific incidence rates and number of cases of cervical cancer diagnosed by five
year age group, England 2008
350
20
Total Cases
18
Rate
16
No. Cases
250
14
12
200
10
150
8
6
100
4
50
2
0
0
20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84
Age Group
85+
Age-specific rate per 100,000 felmale population
300
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Some cases of cervical
cancer in this age
group have had
delayed diagnosis
because symptoms not
investigated
appropriately.
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New guidance
published in 2009
Women over 65
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Will be removed from routine recall
Unnecessary additional tests may be
rejected
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Test will be accepted if:
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Follow up for abnormal sample (remains on
recall system)
If woman has never had a cervical sample
taken
How often to attend for screening?
Age group (years)
Frequency of screening
25
First invitation
25–49
3 yearly
50–64
5 yearly
65+
Only screen those on follow-up for an abnormal
result, or women who have never been
screened
Unscheduled tests - interval
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Laboratory will accept a sample 3 months in advance of it
being due but no sooner
Symptoms do NOT warrant earlier repeat
Vaginal Bleeding
Vaginal Discharge
Contraception/HRT
Pregnancy or postnatal services
Genital warts
Multiple sexual partners
Smokers
Family history of cervical cancer
These do NOT
warrant taking a
cervical sample if it is
not due
Additional samples may be taken if:
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HIV positive (annual)
Renal failure (possibly one additional test)
These women will be under care of a
gynaecologist for any additional samples or
specialist centre
Unscheduled Tests – General Rule
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If a woman has not received a letter from the
PCSA inviting her for a cervical screening
test:
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DO NOT TAKE A SAMPLE!
Ceasing recall
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Women over 65 should cease recall
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Women who have had a TOTAL hysterectomy
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Women who have had radiotherapy for cervical cancer
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Patients informed choice
Informed choice
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All women must be given the opportunity to make an
informed choice about whether or not to attend for
cervical screening
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If woman refuses test she will be sent another
invitation in 3/5 years
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Refusal does not necessarily mean ceasing from
recall
Cervical Screening - Coverage
% coverage (less than 5 years
since last adequate test)
85
80
75
70
65
2002
2003
2004
2005
2006
2007
2008
2006 data as at 10th August 2006
© Data prior to 2005, re-used w ith the permission of the Department of Health
2009
2010
2011
Non-attendance – why?
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Fear
Worry about result
Embarrassment
Lack of understanding
Language barriers
Previous experiences
Unable to get convenient appointment
It wont happen to me…
I didn’t realise I was at risk…
Aims of the NHS
Cervical Screening Programme

To reduce the incidence of and mortality from
cervical cancer

This is achieved by offering regular screening to all
women at risk so that conditions which might
otherwise develop into invasive cancer can be
identified and treated
Cervical Cancer in England 1988-2008
18
Trends in incidence and mortality, England 1988 to 2008
ASIR and ASMR per 100,000 female population
16
England - Incidence
England - Mortality
14
12
10
8
6
4
2
0
Year