Presentation on theme: "Cervical Screening and HPV testing"— Presentation transcript:
1 Cervical Screening and HPV testing Dr Tracy OwenQuality Assurance Director, NICSP
2 Aim of screeningTo reduce mortality and morbidity associated with cervical cancerby identifying and treating pre-cancerous changesScreening can prevent 70% of cervical cancersLiquid based cytology – introduced 2007/08? Role of HPV testing in screening pathway - HPV detected in 99.7% of cervical cancers
3 Coverage rates by Trust NI coverage = 77.32% (2010/11)Coverage = % of eligible women with a screening result in last 5 years
5 Is there anything else that you can do to improve informed choice in your practice?
6 Reminder - policy change From Jan 2011AgeScreening interval25 – 49 yrs3 years50 – 64 yrs5 yearsEvidence based, endorsed by UK National Screening Committee,in line with WHO recommendations
7 What do we know about HPV? >100 types – only small number cause cervical cancer (HR-HPV)Transient infection very common - 8 in 10 people infected in lifetimePrevalence decreases with age (Manchester study)40% of 20-24yr olds with HR HPV, 5% of yr oldsCan’t be treated but can clear on its ownInfection persists in 20-30% of women
8 HPV – a complicated issue Women or their partners may have HPV for many years without knowing it99% of cervical cancers associated with persistent infection with high risk types of HPV (70% linked to HPV 16 or 18).Transmitted by close skin-to-skin contactCondoms help but don’t provide full protection
9 HPV testing and screening HR-HPV testing at two points in screening pathway - Triage and Test of CureImproved management of ‘low grade’ abnormalitiesIntroduced for smears taken from Monday 28 January 2013Applies to women in screening age range (25-64 yrs)HPV test is carried out on the same sample
10 HPV triage15-20% of women with borderline/mild changes have a significant abnormality that needs treatmentHR-HPV testing is effective in identifying which women may need treatmentAll borderline/mild samples are tested for HR-HPV (Triage)HR-HPV positive are referred immediately to colposcopyHR-HPV negative can be safely returned to routine recall
12 Benefits of triageReduces the need for multiple repeat tests – reduces anxiety & costColposcopy is focused on the women who are more likely to have significant diseaseWomen get to colposcopy soonerNegative predictive value of HR-HPV test is reported between 93.8 and 99.7%?reduced DNA rate at colposcopy
13 Repeat at 6 months – borderline result STANDARD PROTOCOLHPV TRIAGE PROTOCOLRoutine screenBorderline cytologyRepeat at 6 months – borderline resultCOLPOSCOPYRoutine screenBorderline cytology,HPV +veCOLPOSCOPY
14 Test of Cure (TOC)To assess women who have been treated for any grade of CIN for risk of having residual or recurrent diseaseWomen with normal cytology and negative for HR-HPV at follow up are at very low risk of residual diseaseHR-HPV test on women with normal, mild or borderline cytology result at 6 month follow up after treatment (excluded if treated for CGIN/invasive disease)If HR-HPV negative are returned to routine recallIf HR-HPV positive are referred back to colposcopy
15 Test of cure pathway Normal/Borderline/ Mild Dyskaryosis HR-HPV test 6 months post treatmentNormal/Borderline/Mild DyskaryosisHR-HPV testHR-HPV NegativeRoutine recall (3yrs)HR-HPV PositiveColposcopy referral
16 Benefits of TOCApprox 80% of treated women avoid annual cytology testsCost savings to primary care and laboratoryImproved service for women - shorter patient journey time with return to routine recall
17 STANDARD PROTOCOL HPV TOC PROTOCOL Colposcopy – CIN 3 detected LLETZ Annual follow up cytology for 10 yearsRETURNED TO ROUTINE RECALLColposcopy – CIN 3 detectedLLETZTest of cure at 6 months: HR-HPV negativeRETURNED TO ROUTINE RECALL
18 Information for smear takers Packs issued to all practices**ensure all smear takers in practice have seen this**
19 HPV testing will be done as appropriate on same sample – you do not need to request it Cytology and HPV result will be issued on same reportPatient consentBe prepared to answer patient questionsrisk of cancertransmission of HPV
20 Psychological impact of HPV infection Surprise and anxiety.Guilt and shame are closely linked to concerns about transmission and disclosure to future sexual partners.Providing clear and accurate information to women can considerably reduce the anxiety they experience and the possible stigma associated with HPV.Women should be assured that having sex just once exposes them to many subtypes of HPV and this exposure should be viewed as normal.
21 TerminologyWomen are frequently confused by the term ‘wart virus’. It is incorrect and should be avoided.Using the term ‘HPV positive’ can arouse concern and may be confused with ‘HIV positive’.Result letters should indicate that ‘high-risk HPV’ has been detected.
22 How do I protect myself against HPV? HPV infection cannot be treated, only CIN.Attend cervical screening regularly.Vaccination is now available to protect against 16, 18 subtypes.HPV vaccination will help to prevent HPV infection/CIN in the future.