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New Developments In the Cervical Screening Programme

New Developments In the Cervical Screening Programme. What's New In Cervical Screening. The impact of the previous changes to the programme Two week turnaround for results Pathology workforce review HPV Vaccination HPV Testing Ceasing of Reporting infections on Cervical Screening results

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New Developments In the Cervical Screening Programme

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  1. New Developments In the Cervical Screening Programme

  2. What's New In Cervical Screening • The impact of the previous changes to the programme • Two week turnaround for results • Pathology workforce review • HPV Vaccination • HPV Testing • Ceasing of Reporting infections on Cervical Screening results • Changes to the recall status of women having vault samples

  3. Recommendations for the England

  4. Changes to the Cervical Screening Programme • The Age Range For Screening • National Audit of Cervical Cancers • Liquid Based Cytology implementation • Large reductions in inadequate rates?

  5. Cancer Reform Strategy • The cervical screening programme will ensure that all women receive the results of their screening tests within two weeks by 2010

  6. Reduction of Cancer Screening Waiting Times • Better use of information Technology • More advanced Biomedical Scientist Practitioners in Cervical Cytology • Reconfiguring laboratories to make them more efficient • North West Specialist commissioning Report • Larger call/recall agencies to reduce turnaround times to allow better facilities to improve coverage such as telephone help lines

  7. Two Week Turnaround • Limit processing of samples to only those women eligible within the national standards • Implement an electronic link from the laboratory to the call/recall office • Despatch results letters by first class post on Monday Tuesday and Wednesday mornings • Workforce redesign- training of advanced practitioners • Merge workload from small laboratories

  8. Coverage by age, England 1999 & 2005, North West 2005

  9. Be Cervix Savvy

  10. Achievements in the Cervical Screening Programme • The NHS Cervical Programme saves up to 4,500 lives in England ever year • In 2006/07 3.4 million women were screened and laboratories examined 3.7 million samples • In 2006/07 over 40,000 women had high grade abnormalities detected and treated through the programme

  11. Classification of HPV Genotypes 100 + Different Genotypes Cutaneous Mucosal – (Anogenital types) Non-genital Skin warts – 1,2,3,4 Low Risk 6,11,42,43,44 High Risk 16,18,31,33,35,39,45, 51,52,56,58,59,68

  12. Human Papilloma Virus (HPV) • HPV is a necessary cause of cervical cancer • 99.7% of cervical cancers contain HPV DNA • Persistent infection with high-risk or oncogenic sub-types • High-risk subtypes associated with high-grade pre-invasive and invasive disease - 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68 • Low-risk subtypes associated with genital warts and low-grade cytological abnormalities – 6, 11, 40, 42, 43, 44

  13. HPV Transmission • Intimate contact • Studies have shown that infection in virgins was rare although any type of non-penetrative sexual contact was associated with an increased risk • Condoms have only a degree of protection due to HPV field effect all over genitalia therefore condoms are not comprehensive or complete in protecting.

  14. HPV Transmission • HPV is almost a normal consequence of having sex • 80% of the population have had HPV at some point in their lives • In most women HPV will cause no long term harm and be eradicated by their immune system

  15. Public Awareness of HPV • Research shows little evidence of HPV Awareness • Sample takers have a role in giving informed choice • The association between knowledge of HPV and feelings of stigma, shame and anxiety

  16. Consent to Cancer Screening • New publication series No:4 January 2008 • Women should be informed of the benefits and disadvantages of the test. • Women should be informed of the procedure by the sample taker who must also be able to accurately and honestly answer any questions she may have.

  17. Informed choice As a general principle , women should understand the limitations and consequences of screening or of not having screening, and should make an informed decision about whether or not to accept the invitation to participate in the programme.

  18. HPV SENTINEL SITES • HPV TESTING • HPV Triage • Sites in Manchester, Liverpool, Bristol, Norwich, and Sheffield and London • Samples will be tested for high risk HPV following a borderline or mild dyskaryosis result.

  19. What is HPV Triage? • All cervical samples with first BNC or mild dyskaryosis test result will be tested for high risk HPV to distinguish between women who need referral to colposcopy and women who can be safely returned to routine recall. • Women who test positive for high risk HPV will be referred to colposcopy. Women who are HPV negative will be returned to routine recall.

  20. HPV Triage

  21. Test of Cure Protocol(Follow up of treated CIN) • HPV testing will be used following treatment for all grades of CIN. • If cytology positive: • Managed as per current guidelines • No HPV test

  22. Test of cure continued • If cytology negative: • HPV test • Women who are cytology negative and HPV negative will proceed to a three year recall period – avoiding the need for 10 years of annual tests. • If HPV positive patient managed as per current guidelines i.e. 3 x neg for L/G or 10 x neg for H/G abnormalities

  23. HPV Vaccines – potential impact • Reduce high grade CIN and invasive cancer by approximately 70-80% • Reduce low grade CIN by 25-30% • Still have significant volume of disease present but implications will be different • Assumes 100% compliance with full vaccination schedule • Would need to continue screening to cover other oncotypes – by HPV testing • May see shift in genotypes after period of vaccination • Duration of effectiveness and protection unknown • Will not eliminate need for cytology in the unvaccinated or in those who test HPV positive

  24. Infection Reporting on Cervical Screening • Debate regarding if this is appropriate • Good versus harm • Informed Consent • Infections incorrect term as many are comensals • Consequences of these reports not realised by laboratory staff • Cervical Screening is not an appropriate test • High false positives for TV

  25. Changes to Recall Status for Women having Vault Samples • Letter produced from John Tidy (Chair Of National Colposcopy Professional Advisory Group) advising ‘ with effect from 1/4/08 it has been decided that due to problems with the recall of women for vault cytology it would be best managed by ceasing the recall of these patients from the national screening programme.

  26. Issues to be agreed • Women who undergo a Sub total hysterectomy will still require screening and therefore need to be identified. • Ensuring that the correct information is sent to Primary Care Clinician from the gynaecologists following patient discharge • Identifying who will be undertaking the vault smears in the future. • Ensure appropriately trained staff are undertaking the vault sample taking • Identifying responsibilities for failsafe

  27. North West Cervical Screening QA Regional Guidance for Good Practice in Primary Care • Available on the QA website: www.nwcsqarc.org.uk

  28. Any Questions?

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