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/ % of eligible women were recorded as being tested within 5 years of their previous adequate test 3 rd 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 Lesbian and bi-sexual women Immunosuppressed women Learning Disabilities Not sexually active 65+ ???Opportunistic Sampling???

Screening Frequency 25 years 1 st invitation on or near 25 th birthday yearly 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 Publicationsandstatistics/ Publications/PublicationsPolicy AndGuidance/DH_113478

20-24 Year olds With Abnormal Vaginal Bleeding ___________________________________________________________________________________

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 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

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 School SEC Cancer Screening QA Reference Centre 77a High Street Battle East Sussex TN33 OAG TEL: Fax:

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: / West Sussex: Viv Mussell or Moira Jones: or Brighton: Trish Kennard: / Kent & Medway: Paula Mclachlan: or Julie Tippett Surrey: Victoria Heald:

Resources NHS Cancer Screening Programmes National Electronic Library Specialist Screening Library - National Screening Committee - PCT intranet Screening newsletter Jo’s Trust