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

• 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

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.

Why screen women only from age 25?

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

• 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 SchoolSEC Cancer Screening QA Reference Centre77a High StreetBattleEast SussexTN33 OAGTEL: 01424 775965 Fax: 01323 438158E-mail: esh-tr.secqarc@nhs.net

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

• 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