Presentation on theme: "The NHS Cervical Screening Programme"— Presentation transcript:
1 The NHS Cervical Screening Programme Kath Bainbridge North West QA Primary Care Development Nurse
2 What We'll cover Aims and Outline of NHS Cervical Screening Programme Cervical Cancer causes and incidenceCoverageQuality AssuranceCall and RecallGP’s Responsibilities and QOFWomen in Special Circumstances
3 Aims of the NHS cervical screening programme To reduce the number of women who develop invasive cervical cancer and the number who die from it.Regular screening is offered so that conditions which might develop into cervical cancer can be identified and treated
4 The Cervical Screening Programme Started in 1960s1988 – All Health Authorities run a cervical screening programme for women aged 20-64, with call recall systemLiquid based cytology introducedLower age increased to 25
5 The Cervical Screening Programme National HPV vaccination programme introduced for 13 year old girlsHPV triage pilotedCytology laboratory services move to cover larger areasHPV Primary testing pilots
6 Elements of the Cervical Screening programme Sample TakingTransportation to LaboratoryLaboratory Screening ServiceCall and RecallColposcopy
7 Risk Factors for Cervical Cancer Infection with HPVCo-factors that modify the riskSmokingLong term oral contraceptives (> 5 years)5 + full term pregnanciesPrevious exposure to other STIs e.g. chlamydiaImmuno-suppressionNot being screened- HPV - >80 types- HPV16 & HPV18 (high risk types) found in >90% cancers- HPV6 & HPV11 genital warts (but no increase in cervical cancer)- Maj of sexually active women will have come into contact with high risk HPV, but immune system will get rid of infection- Smokers - twice as likely to develop Ca Cx. Perhaps because smoking assoc with high risk behaviour, or suppresses immune system. Stopping system helps clinical abnormalities to regress- Long term OCP increases cancer risk, but benefits outweigh risks- Late 1st preg lower risk. Risk rises with number of pregnancies- Many women who develop CA have never been screened, regular screening can prevent around 75% cases
8 Cervical Cancer Trends in incidence and mortality, England 1989 to 2010 Increase in 2009 is related to the death of Jade Goody – an increased number of previously unscreened young women attended for screening leading to an increased rate of diagnosis. Half a million extra attendances in 2008/ % more than expected – many of these in age age group attending late for screening.Between March 2009 and June 2009 a 58% increase in diagnosis in women age compared to 2008
9 Map of mortality by Cancer Network, 2006-2010 Incidence and mortality rates tend to be lowest in the south and east of England, and highest in the north and themidlands.There is evidence that cervical cancer survival is worse in women living in the most deprivedfifth of areas nationally compared with the least deprived fifth. This equates to a 6% gap inrelative survival one‐year after diagnosis and an 11% gap for five‐year relative survival.
10 Age-specific incidence rates and number of cases diagnosed by five year age group, England 2009 The age‐specific incidence rate peaks among women in their early 30s. Following a gradual reductionin the rate in women in their 40s, rates rise again in women in their 70s and 80s. As a result of thescreening programme many cervical cancers are detected in younger women, with around 60% ofcases occurring in women aged 25‐49. The cessation of screening when women reach 65 maycontribute to the rise in incidence rates after this age; although cervical screening can be veryproblematic in older women due to anatomical changes and the hormonal environment.
11 Age-specific relative survival, England 2007-2009 (one-year) and 2003-2005 (five-year) Survival following a diagnosis of cervical cancer has improved in England since the late1980s, from 83% to 88% for one‐year relative survival and from 64% to 70% for five‐yearrelative surThere is strong evidence that cervical cancer survival is worse in older women. For example, oneyearrelative survival in those aged 20‐39 is 96.6% compared with 51.9% in those aged 80 or older.Similarly, five year survival in those aged 20‐39 is 87.2% compared with 27.0% in those aged 80 andover.As with many cancers, this marked difference may, in part, be due to difficulties in treating thedisease in older women, particularly women with co‐morbidities. The cessation of screening inwomen over the age of 64 may also result in older women presenting later with their disease.Differences in tumour biology may also be a factor in poorer survival among older womenvival.
12 The Programme aims for 80% coverage Coverage is the proportion of women eligible for screening who have had a test with a recorded result at least once in the previous 5 years.Women are eligible between 24yrs and 6 months – 64 yrs.Screening frequency 3-5 yearlyIf 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.AIM for 80% coverage - maximises the impact of the programme and decrease incidence and mortality.Good progress over the past 30 years as the programme has been pulled together…Unfortunately now showing downward trend…
16 Quality of Cervical Screening Programme Overseen by NW QARCSystematic approach to performance monitoring and addressing underperformanceSample taker trainingSample taker databaseFailsafe mechanismsClear process for managing SUIAccess to quality colposcopy service
17 Clinical Issues in Cervical Screening Sample acceptance policyIncidents and significant eventsHigh Inadequate RatesSampling and accuracyPathway for abnormal bleeding in under 25’s
18 The cardinal symptom of cervical cancer in this age group is postcoital bleeding, but persistent intermenstrual bleeding, which is more common also requires attention.
20 Call and RecallCall and recall or Primary Care Support ServicesContact practice with Prior Notification List (PNL)Send invitation lettersNone Responder cardsOpen ExeterCeasingWill always give advice and information on requestcontact details: orPNL is sent to practices 8 weeks before test due date. - Practice have 4 weeks to complete and return.Options available: Invite. Postpone recall. Cease recall. No reply ?
21 GP Responsibilities Failsafe systems PNL’s and ceasing women Management of results and referralsQuality assurance re sample takers – qualifications and update trainingQOF – points, exception reporting
22 Failsafes CONSIDER PATIENT PATHWAY Housekeeping issues -identify patient , paperwork , labels , equipment expiry dates ..Transport- issuesWho registers all samples sent and checks all results received?What about non responders?Who checks abnormal results dealt with?Who checks histology results in newly hysterectomised patients?Who responds to failsafe queries from lab and deals with them and deals with critical incidents?What happens to TR or no address or don’t want correspondenceNon responders 3rd invite is from practice to chase up ??how to get 25 ‘s inWhat about giving urgent results if needs referral – who does it?
23 Employment and training issues. Practices should check staff :Trained to take cervical samplesHad an update in the previous 3 yearsFamiliar with Surepath LBC systemHave access to Manchester Cytology Laboratory Guidelines and The NHSCSP Good Practice Guide No 2 (2011)Manager has completed sample taker spread sheet and informs The CANE Area TeamThey are on the Sample Taker RegisterUndertake regular audit of sample taking and outcomes
24 Cervical screening QOF points IndicatorPointsAchievement thresholdsCS001. The contractor has a protocol that is in line with national guidance agreed with NHS CB for themanagement of cervical screening, which includes stafftraining, management of patient call/recall, exceptionreporting and the regular monitoring of inadequatesample rates7CS002. The percentage of women aged 25 or over and who have not attained the age of 65 whose notes record that a cervical screening test has been performed in the preceding 5 years1145-80%CS004. The contractor has a policy for auditing itscervical screening service and performs an audit ofinadequate cervical screening tests in relation toindividual sample-takers at least every 2 years2
25 Women in Special Circumstances Learning DisabilitiesPhysical disabilityTerminal illnessRadiotherapyFemale Genital MutilationPregnant/post natalMale to Female sex changeFemale to male sex changeLesbian and Bisexual womenImmuno- compromisedLearning Disabilities – understanding, do you know how to link with local disabilities nurses who may give support – Mental Capacity ActPhysical disability – may need a venue with a hoist, different positionTerminal patients are still offered screening but can choose to declineRadiotherapy – if for cervical cancer not appropriateFGM – Still at risk of cervical cancerPregnancy / post natal- avoid taking samples in pregnancy and not till 12 weeks post natalMale to female – no cervix – call and recall need to be notifiedFemale to male – not called as male name but still have cervix so onus on sample takerLesbian and Bisexual – still at risk as someone may have had a male partnerImmuno-compromised – renal transplant take before and if no CIN, normal recall – HIV – annual cytology
26 Vault Samples New guidance in 2009 (reinforced in 2011) Women who have had a total hysterectomy have no cervix therefore not eligible for recall in NHSCSPAll vault samples in the North West should be done in a colposcopy setting
27 The Future…… HPV Immunisation HPV Primary Screening pilots Evaluations in other countries for HPV Primary Testing are looking positive6736(13) /abstractWomen who have had a HPV vaccination?
28 Useful Websites www.cancerscreening.nhs.uk www.cancerresearchuk.org englandPresentation title - edit in Header and Footer