Cervical Screening: Improving Uptake Dr susanna Unsworth Women’s health gp – angel hill surgery, bury st edmunds

Cervical Cancer Every day in the UK 9 women are diagnosed with cervical cancer Every day in the UK 3 women will die from the disease Cervical cancer is the most common cancer in women under 35 years Cervical screening prevents up to 75% of all cervical cancers

NHS Cervical Screening Programme (NHSCSP) Introduced in 1988 Current programme 25-49 years – 3 yearly recall 50-64 years – 5 yearly recall (ending when most recent result negative, with normal recall and next date falls after 65th birthday) Uptake rates 1989 – 40% 2008/9 – 79.8% - ‘Jade Goody’ effect – extra 400,000 tests Currently at its lowest rate for 20 years!

Why are women not attending? Almost 3.7 million women missed their screening appointment in the last 5 years – this is 1 in 4 women. WHY?

Why are women not attending? Knowledge about the test Fear of the test Access to Appointments

Knowledge about the test Unaware of screening programme Women from ethnic minority groups Women with learning disabilities Not recognising they are at risk Older single/divorced women Understanding the role of HPV (human papillomavirus) HPV Primary Screening Unaware of symptoms of concern Abnormal bleeding/discharge, pain on intercourse

Fear of the test Younger women not knowing what to expect Social media, horror stories Previous experience Fear of the result HPV positive result – ‘have I got an STI?’ Pain following the menopause Vaginal atrophy

Access to appointments Difficulty getting appointment at surgery Inconvenient times, cancellation Lack of employment flexibility to attend Day time appointments, nurse running late Other responsibilities eg childcare No female sample takers Particularly ethnic minority groups

What are we doing at Angel Hill? All new women registering are contacted by practice nurse Monthly review of non-attending women with a letter inviting them Text reminders of appointments Variable appointment times with nurses Jo’s Trust Posters in all waiting areas Where possible, screening done opportunistically Educated practice nurses Women’s Health Specialist GP – Me!

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