Cervical Sample Taker Training 2015

THE NHS CERVICAL SCREENING PROGRAMME

(NHSCSP)

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

History of cervical screening in the UK

Cervical screening began in the mid-1960s

The NHSCSP was set up in 1988 with the introduction of computerised call and recall systems

Screening programmes

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

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:

persistent infection with high risk types of the human papillomavirus (STI)– Any activity that increases the woman’s chance

of catching HPV…examples?

Smoking

immunosuppressive disorders, including HIV infection

not attending for screening

Risk factors for cervical cancer (cont.)

Factors that reduce risk include:

regular attendance for screening

regular condom use

total hysterectomy for other reasons

Eligible women

Those aged 25-64 who have a cervix

Women under age 25

Cervical cancer is rare Increased rates of borderline changes Risk of over-treatment Screening would do more harm than good

Evidence reviewed in 2009– 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

0

2

4

6

8

10

12

14

16

18

20

0

50

100

150

200

250

300

350

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 85+

Age-specifi

c rate per 100,000 felmale populati

on

No.

Cas

es

Age Group

Total Cases

Rate

Some cases of cervical cancer in this age group have had delayed diagnosis because symptoms not investigated appropriately.

New guidance published in 2009

Women over 65 Will be removed from routine recall Unnecessary additional tests may be

rejected

Test will be accepted if:– 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

– 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:

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

If a woman has not received a letter from the PCSA inviting her for a cervical screening test:

– DO NOT TAKE A SAMPLE!

Ceasing recall

Women over 65 should cease recall

Women who have had a TOTAL hysterectomy

Women who have had radiotherapy for cervical cancer

Patients informed choice

Informed choice

All women must be given the opportunity to make an informed choice about whether or not to attend for cervical screening

If woman refuses test she will be sent another invitation in 3/5 years

Refusal does not necessarily mean ceasing from recall

Cervical Screening - Coverage

65

70

75

80

85

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

2006 data as at 10th August 2006

© Data prior to 2005, re-used w ith the permission of the Department of Health

% coverage (less than 5 years since last adequate test)

Non-attendance – why?

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

Trends in incidence and mortality, England 1988 to 2008

0

2

4

6

8

10

12

14

16

18

ASI

R a

nd A

SMR

per

100

,000

fem

ale

popu

lati

on

Year

England - IncidenceEngland - Mortality

Cervical Cancer in England 1988-2008