Cervical Sample Taker Training 2015 THE NHS CERVICAL SCREENING PROGRAMME (NHSCSP)
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Transcript of Cervical Sample Taker Training 2015 THE NHS CERVICAL SCREENING PROGRAMME (NHSCSP)
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