Overview of
NHS Cervical Screening Programme
Cervical Screening QARC
Training School
October 2012

• 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

• 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
• 3 rd most common cancer in women
• Cervical screening saves approximately
4,500 lives a year

• 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!!!

• All women aged between 25-64
• Lesbian and bi-sexual women
• Immunosuppressed women
• Learning Disabilities
• Not sexually active
• 65+
• ???Opportunistic Sampling???

• 25 years 1 st invitation on or near 25 th 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

Why screen women only from age 25?
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.

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
___________________________________________________________________________________

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
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•
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Informed consent
Documentation
Care of Sample
Monitoring of results
Personal audit
Infection Control
PATIENT

• 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

(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

• 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!

SEC Cervical Screening QA Training School
SEC Cancer Screening QA Reference Centre
77a High Street
Battle
East Sussex
TN33 OAG
TEL: 01424 775965 Fax: 01323 438158
E-mail: esh-tr.secqarc@nhs.net

• Each Public Health Department has a Screening
Lead
• Responsible for Sample Taker numbers
• Monitors Inadequate rates for individual surgeries
• Monitors uptake

•
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

• 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