Cervical_cancer_screening Flashcards
What is the main aim of cervical cancer screening?
The main aim of cervical screening is to detect pre-malignant changes rather than to detect cancer.
How many deaths per year is the cervical cancer screening program estimated to prevent in the UK?
The cervical cancer screening program is estimated to prevent 1,000-4,000 deaths per year.
What percentage of cervical cancer cases are adenocarcinomas, which are frequently undetected by screening?
Cervical adenocarcinomas account for around 15% of cases.
What was the method of examining smears for many years before HPV testing?
The smears were examined for signs of dyskaryosis which may indicate cervical intraepithelial neoplasia.
How has the cervical screening program evolved with the introduction of HPV testing?
Patients with mild dyskaryosis could be further risk-stratified, and those who were HPV negative could be treated as having normal results.
What is the current method of testing in the cervical screening program?
The NHS has moved to an HPV first system, where a sample is tested for high-risk strains of human papillomavirus (hrHPV) first and cytological examination is only performed if this is positive.
Who is screened and how often?
A smear test is offered to all women between the ages of 25-64 years. 25-49 years: 3-yearly screening. 50-64 years: 5-yearly screening.
Is cervical screening offered to women over 64 years old?
Cervical screening cannot be offered to women over 64, unlike breast screening where patients can self-refer once past screening age.
How often is cervical screening offered in Scotland?
In Scotland, it is offered from 25-64 every 5 years.
When is cervical screening in pregnancy usually performed?
Cervical screening in pregnancy is usually delayed until 3 months post-partum unless missed screening or previous abnormal smears.
What should women who have never been sexually active consider regarding cervical screening?
Women who have never been sexually active have a very low risk of developing cervical cancer and may wish to opt out of screening.
When is the best time to take a cervical smear according to NHS advice?
The best time to take a cervical smear is around mid-cycle, although there is limited evidence to support this.
summarise cervical screening
Cervical cancer screening
The UK has a well-established cervical cancer screening program which is estimated to prevent 1,000-4,000 deaths per year. The main aim of cervical screening is to detect pre-malignant changes rather than to detect cancer. It should be noted that cervical adenocarcinomas, which account for around 15% of cases, are frequently undetected by screening
The programme has undergone a significant evolution in recent years. For many years the smears were examined for signs of dyskaryosis which may indicate cervical intraepithelial neoplasia - management was based solely on the degree of dyskaryosis. The introduction of HPV testing allowed patients with mild dyskaryosis to be further risk-stratified, i.e. as HPV is such a strong risk factor patients who were HPV negative could be treated as having normal results.
The NHS has now moved to an HPV first system, i.e. a sample is tested for high-risk strains of human papillomavirus (hrHPV) first and cytological examination is only performed if this is positive.
Who is screened and how often?
A smear test is offered to all women between the ages of 25-64 years
25-49 years: 3-yearly screening
50-64 years: 5-yearly screening
cervical screening cannot be offered to women over 64 (unlike breast screening, where patients can self-refer once past screening age)
in Scotland, it is offered from 25-64 every 5 years
Special situations
cervical screening in pregnancy is usually delayed until 3 months post-partum unless missed screening or previous abnormal smears.
women who have never been sexually active have a very low risk of developing cervical cancer therefore they may wish to opt out of screening
It is said that the best time to take a cervical smear is around mid-cycle. Whilst there is limited evidence to support this it is still the current advice given out by the NHS.
A 30-year-old woman is 24 weeks pregnant and she receives a letter about her routine cervical smear. She asks her GP if she should make an appointment for her smear. All her smears in the past have been negative. What should the GP advise?
Reschedule the smear to occur at least 12 weeks post-delivery
Take the smear now
This smear can be missed, she will be re-entered for routine screening in 3 years
Perform a speculum exam to visualise the cervix for abnormalities
Seek advice of an obstetric consultant
Reschedule the smear to occur at least 12 weeks post-delivery
NICE guidelines suggest that a woman who has been called for routine screening wait until 12 weeks post-partum for her cervical smear. If a smear has been abnormal in the past and a woman becomes pregnant then specialist advice should be sought. If a previous smear has been abnormal, a cervical smear can be performed mid-trimester as long as there is not a contra-indication, such as a low lying placenta.
Cervical screening is important and women should be encouraged to engage in routine screening.
A 36-year-old woman who used to inject heroin has recently been diagnosed HIV positive. She is offered a cervical smear during one of her first visits to the HIV clinic. How should she be followed-up as part of the cervical screening program?
Attend colposcopy annually
6 monthly cervical cytology
Cervical cytology every three years (normal screening program)
Annual cervical cytology
Attend colposcopy every three years
Annual cervical cytology
Women who are HIV positive are at an increased risk of cervical intra-epithelial neoplasia (CIN) and cervical cancer due to a decreased immune response and decreased clearance of the human papilloma virus. (1) HIV positive women who have low-grade lesions (CIN1) do not clear these lesions and these can progress to high-grade CIN or cervical cancer. Even those women who are effectively treated with antiretrovirals have a high risk of abnormal cytology and an increased risk of false-negative cytology. (1)
Women with HIV should be offered cervical cytology at diagnosis.. Cervical cytology should then be offered annually for screening.
- NICE Clinical Knowledge Summaries. [Internet]. Cervical screening. 2015. http://cks.nice.org.uk/cervical-screening (accessed March 2016).
