NHS Cervical Screening Programme
NHS Cervical Screening Programme |
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If you have been invited for screening, or have been for screening and have any questions about the result, you should contact the name and address shown on your invitation letter or result letter. If you are worried about a specific problem, or otherwise worried about the risks of cancer, then you should talk to your GP. What is cervical screening?Cervical screening is not a test for cancer. It is a method of preventing cancer by detecting and treating early abnormalities which, if left untreated, could lead to cancer in a woman's cervix (the neck of the womb). The first stage in cervical screening is taking a sample using Liquid based Cytology (LBC). A sample of cells is taken from the cervix for analysis. A doctor or nurse inserts an instrument (a speculum) to open the woman's vagina and uses a spatula to sweep around the cervix. Most women consider the procedure to be only mildly uncomfortable. Early detection and treatment can prevent 75 per cent of cancers developing but like other screening tests, it is not perfect. It may not always detect early cell changes that could lead to cancer. What is LBC?Liquid based cytology (LBC) is a new way of preparing cervical samples for examination in the laboratory. The sample is collected in a similar way to the conventional smear, using a special device which brushes cells from the neck of the womb. Rather than smearing the sample onto a microscope slide as happens with the conventional smear, the head of the brush, where the cells are lodged, is broken off into a small glass vial containing preservative fluid, or rinsed directly into the preservative fluid. The sample is sent to the laboratory where it is spun and treated to remove obscuring material, for example mucus or pus, and a random sample of the remaining cells is taken. A thin layer of the cells is deposited onto a slide. The slide is examined in the usual way under a microscope by a cytologist. Possible future developmentsComputer assisted detection of cervical abnormalities is a possibility for the future. HPV vaccination will be introduced into the national immunisation programme in September 2008, for girls aged 12-13 across the UK. Then, starting in autumn 2009, a two year catch up campaign will vaccinate all girls up to 18 years of age. This catch up campaign will offer to vaccinate:
By the end of the catch up campaign, all girls under 18 will have been offered the HPV vaccine. When the HPV vaccination programme begins in 2008, women over the age of 18 will not be vaccinated as it would not be cost effective in preventing cervical cancer. This is because as soon as a woman becomes sexually active, she is at risk of infection with the virus. It will be many years before the vaccination programme has an effect upon cervical cancer incidence so women are advised to continue accepting their invitations for cervical screening. What does the NHS Cervical Screening Programme do?The programme aims to reduce the number of women who develop invasive cervical cancer (incidence) and the number of women who die from it (mortality). It does this by regularly screening all women at risk so that conditions which might otherwise develop into invasive cancer can be identified and treated. Who is eligible for cervical screening?All women between the ages of 25 and 64 are eligible for a free cervical screening test every three to five years. In the light of evidence published in 20031 the NHS Cervical Screening Programme now offers screening at different intervals depending on age. This means that women are provided with a more targeted and effective screening programme. The new intervals are:
The NHS call and recall system invites women who are registered with a GP. It also keeps track of any follow-up investigation, and, if all is well, recalls the woman for screening in three or five years time. It is therefore important that all women ensure their GP has their correct name and address details and inform them if these change. Women who have not had a recent test may be offered one when they attend their GP or family planning clinic on another matter. Women should receive their first invitation for routine screening at 25. Why are women under 25 and women over 65 not invited?Cervical cancer is rare in women under 20. Teenagers' bodies, particularly the cervix, are still developing, which means young women may get an abnormal result when there is nothing wrong. This could lead to unnecessary treatment so screening young women might do more harm than good. Under the age of 25 years, invasive cancer is extremely rare, but changes in the cervix are common. Although lesions treated in very young women may prevent cancers from developing many years later, the evidence1 suggests that screening could start at age 25. Lesions that are destined to progress will still be screen-detectable and those that would regress will no longer be a source of anxiety. Younger women will not have to undergo unnecessary investigations and treatments. Any woman under 25 who is concerned about her risk of developing cervical cancer or her sexual health generally, should contact her GP or Genito-Urinary Medicine (GUM) clinic. Women aged 65 and over who have had three consecutive negative results are taken out of the call recall system. The natural history and progression of cervical cancer means it is highly unlikely that such women will go on to develop the disease. Women aged 65 and over who have never had a test are entitled to one. What about women who are not sexually active?The NHS Cervical Screening Programme invites all women between the ages of 25 and 64 for cervical screening. But if a woman has never been sexually active with a man, then the research evidence shows that her chance of developing cervical cancer is very low indeed. We do not say no risk, only very low risk. In these circumstances, a woman might choose to decline the invitation for cervical screening on this occasion. If a woman is not currently sexually active but has had male partners in the past, then we would recommend that she continues screening. When was the NHS Cervical Screening Programme set up?Cervical screening began in Britain in the mid-1960s. By the mid-1980s, although many women were having regular smear tests, there was concern that those at greatest risk were not being tested, and that those who had positive results were not being followed up and treated effectively. The NHS Cervical Screening Programme was set up in 1988 when the Department of Health instructed all health authorities to introduce computerised call-recall systems and to meet certain quality standards. How many women are screened?The programme screens almost four million women in England each year. Of the women in the target age group most were tested following an invitation and the rest were screened opportunistically at the suggestion of the sample taker or of the woman herself. For clinical reasons some women have more than one test during the course of a year and nearly four and a half million samples are examined by pathology laboratories every year. Click here for the latest statistics on the NHS Cervical Screening Programme. How is the programme organised?More than 100,000 people are involved in cervical screening. They include the doctors and nurses who take the samples in GP surgeries and community clinics, the laboratory staff who review them and the people who run the computer systems. Who does what in the NHS Cervical Screening Programme?The national office of the NHS Cancer Screening Programmes, based in Sheffield, is responsible for improving the overall performance of the programme. Set up in 1994, its priorities are to:
Every Primary Care Trust (PCT) has a nominated person responsible for its cervical screening programme and implementing the national guidelines. Regional directors of public health are responsible for the quality assurance network in their region. How much does the programme cost and how is it funded?Cervical screening - including the cost of treating cervical abnormalities - has been estimated to cost around £157 million a year in England. Primary Care Trusts commission cervical screening from the overall allocation they receive from the Department of Health. Is cervical screening effective?Whilst cervical screening cannot be 100 per cent effective, cervical screening programmes have been shown to reduce the incidence of cancer in a population of women. For example: Percentage of Cancer Preventable(Protection offered by a single negative smear)
Coverage of the target populationThe effectiveness of the programme can also be judged by coverage. This is the percentage of women in the target age group (25 to 64) who have been screened in the last five years. If overall coverage of 80 per cent can be achieved, the evidence suggests that a reduction in death rates of around 95 per cent is possible in the long term. In 2006/7 the coverage of eligible women was 79.2 per cent2 Oral contraceptives and cervical cancerFurther evidence suggests that long-term use of combined oral contraceptives or progestogen-only injectable contraceptives is associated with a small increased risk of cervical cancer. The level of risk returns to that for never-users within 10 years of stopping use. 1P Sasieni, J Adams and J Cuzick, Benefits of cervical screening at different ages: evidence from the UK audit of screening histories, British Journal of Cancer, July 2003 |
Cervical screening programme index What happens at a Diethylstilbestrol (DES) exposed women Who does what in the NHS Cervical Screening Programme Frequently Asked Questions (FAQs) |
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