Cervical screening

Question 1

What is the frequency of cervical screening

Answer 1

Every 3 years from 25-49
Every 5 years from 50-64
No smear from 65, unless there was a previous abnormal result

Question 2

What are the next steps if smear is normal and they are HPV -ve

Answer 2

Continue with routine screening

Question 3

What are the next steps if smear is abnormal and they are HPV -ve

Answer 3

Refer for colposcopy

Question 4

What are the next steps if smear is normal and they are HPV +ve

Answer 4

Re-test at 12 months

Question 5

What are the next steps if smear is abnormal and they are HPV +ve

Answer 5

Refer for colposcopy

Question 6

What are the next steps if a smear comes back as inadequate

Answer 6

Recall at 3 months

Question 7

What are the next steps if a smear comes back as inadequate for the second time

Answer 7

Refer for colposcopy

Question 8

What are the next steps if after testing HPV +ve, the patient tests HPV -ve after 12 months

Answer 8

return to routine screening

Question 9

What are the next steps if after testing HPV +ve, the patient tests HPV +ve after 12 months but cytology remains normal

Answer 9

Repeat test 12 months later (24 months since first result)

Question 10

What are the next steps if after testing HPV +ve, the patient tests HPV +ve after 12 months, then HPV +ve after another 12 months (24m)

Answer 10

Refer for colposcopy

Question 11

In which women may cervical screening be omitted

Answer 11

Those without a cervix
Women who have never been sexually active (have very low risk of developing cervical cancer therefore they may wish to opt-out of screening)

Question 12

How is cervical screening carried out during pregnancy

Answer 12

cervical screening in pregnancy is usually delayed until 3 months post-partum unless missed screening or previous abnormal smears.

Question 13

Which women will have annual cervical cancer screening and why

Answer 13

Women at high risk of CIN/cervical cancer e.g. those with HIV

Question 14

What other investigation should be done for women >35yo with suspected cervical cancer

Answer 14

Endometrial biopsy

Question 15

What are the possible results from cervical cytology

Answer 15

1. Normal
2. Borderline nuclear changes HPV test → Urgent colposcopy <2w +ve colposcopy, -ve routine call
3. Mild dyskaryosis (CIN 1) → HPV test → Urgent colposcopy <2w +ve colposcopy, -ve routine call
4. Moderate dyskaryosis (CIN 2) → Urgent colposcopy <2w
5. Severe dyskaryosis (CIN 3) → Urgent colposcopy <2w
6. Invasive changes → Urgent colposcopy <2w

Question 16

What is colposcopy

Answer 16

Colposcopy = use of a microscope and bright light source to visualise the transformation zone
Use of:
- Acetic acid to highlight abnormal areas of protein coagulation
- Lugol’s iodine which is taken up by normal cells due to high glycogen content

Question 17

What are the benefits to the cervical screening programme

Answer 17

Programme is inexpensive, easy to administer, acceptable to patients and is valid/reliable/reproducible.
Prevents cervical cancer in those with HPV

Question 18

What are the risks of the cervical screening programme

Answer 18

The exam can be very uncomfortable and sometimes painful for women
Not 100% sensitive and specific
Colposcopy can cause infection and bleeding
Those who undergo LLETZ will have an increased risk of pre-term deliveries if they become pregnant in the future