The National Cervical Screening Programme Wednesday 17th April 2019

What we are going to discuss The Cervical Screening Programme Primary HPV Improving uptake in our local area Common Questions Don’t Fear the Smear Raising awareness around cervical screening Encouraging women to attend their cervical screening regularly The Cervical Screening Programme

NHS Screening ‘Screening is the process of identifying healthy people who may have an increased chance of a disease or condition.’ The sieve represents the screening test and most people pass through it. This means they have a low chance of having the condition screened for. The Cervical Screening Programme

The Cervical Screening Programme The Cervical Screening Programme was introduced in the UK in 1988 Cervical Screening (a smear test) checks the health of your cervix It's not a test for cancer, it's a test to help prevent cancer. During the screening appointment, a small sample of cells will be taken from your cervix. The sample is tested for changes to the cells of your cervix. Finding abnormal changes early means they can be monitored or treated so they do not get a chance to turn into cervical cancer. The Cervical Screening Programme

Who is eligible for Cervical Screening? If you have a cervix When you have received your invitation from the Cervical Screening Programme What age are you eligible for Cervical Screening: The Cervical Screening Programme

Your Cervical Screening Invitation and Leaflet Presentation title

Who is not eligible for Cervical Screening? If you do not have a cervix If you have had a Total Hysterectomy If you have had a Sub-Total Hysterectomy you STILL need to attend your cervical screening appointments If you have had radiotherapy of the cervix The Cervical Screening Programme

Important Facts You can book an appointment as soon as you get a letter. If you missed your last cervical screening, you do not need to wait for a letter to book an appointment. If you're 65 or older and have never been for cervical screening, or have not had cervical screening since the age of 50, you can ask your GP for a test. The Cervical Screening Programme

When Cervical screening is not recommended Under 25’s You will not be invited for routine cervical screening until you are 25 years old (receive your first invitation at 24 and half years old) Cervical cancer is very rare in people under 25 years Cervical screening in younger women under 25 might lead to having treatment that you do not need - abnormal cell changes often go back to normal in younger women Over 65’s You'll usually stop being invited for screening once you turn 65. You'll only be invited again if 1 of your last 3 tests was abnormal. The Cervical Screening Programme

Changes to the Cervical Screening Programme Cytology Screening Cervical Sample is taken Cervical sample sent to the laboratory Sample is cytology tested (looking for abnormal cells in the cervix) If abnormal cells are present, the sample is HPV tested- patient is referred to colposcopy if required If no abnormal cells are present , the sample is not HPV tested- patient receives a negative result letter and will be re invited in 3-5 years time (depending on age) Cytology, which looks for cell changes (abnormalities) first, is 70-80% reliable. This means using cytology as the first test means 7 or 8 in 10 cell changes. In 2013, 6 laboratories in England began Primary Human Papillomavirus (HPV) in the Cervical Screening Programme. The Cervical Screening Programme

Changes to the Cervical Screening Programme HPV Screening Cervical Sample is taken Cervical sample sent to the laboratory Sample is tested for HPV If HPV is found then the sample is checked for abnormal cells- patient is referred to colposcopy if required If the sample is HPV Negative- patient receives a negative result letter and will be re invited in 3-5 years time (depending on age) HPV primary testing, which tests for high-risk HPV first, is 90% to 95% reliable. This means using HPV testing as the first test means we find about 9 in 10 cell changes (abnormalities). It is a more accurate test than cytology, which is why the UK is switching to this method of testing. In 2016 the UK National Screening Committee recommended that primary HPV testing should replace the cytology test By the end of 2019 Primary HPV Screening will be rolled out across the NHS Cervical Screening Programme- Please note that GP practices in Suffolk already have changed to Primary HPV Screening. The Cervical Screening Programme

So what is the Human Papillomavirus (HPV) HPV is the name of a very common group of viruses. They do not cause any problems in most people, but some types can cause genital warts or cancer. There are more than 200 types of HPV, of which at least 13 are cancer-causing high risk (hrHPV) types. hrHPV is found in 99.7% of cervical cancer cases hrHPV types 16 and 18 are responsible for approximately 70% of cervical cancers. A persistent high-risk HPV infection can cause the cells of the cervix to change. These changes are called abnormalities. If abnormalities get worse, they may develop into cervical cancer. Presentation title

The Cervical Screening Programme

HPV Vaccine The HPV Vaccine for girls was introduced in 2008 The HPV Vaccine currently used protects against four types of HPV: 6,11,16 and 18. The first dose is routinely offered to girls aged 12 and 13 in school year 8 via the school immunisation team The second dose is normally offered 6 to 12 months after the first vaccine. Currently all girls can get the HPV vaccine free from the NHS from age 12 up to their 18th birthday. Girls who miss either of their HPV vaccine doses should speak to their school immunisation team or their GP surgery and make an appointment to get up-to-date as soon as possible. It's important to have both doses of the vaccine to be fully protected. The HPV Vaccine helps protect against Cervical Cancer September 2019 will be the first year that this is rolled out to boys. The Cervical Screening Programme

Cervical Screening National Coverage Ipswich and East Suffolk CCG National Target- 80% Date England Coverage Suffolk Coverage Ipswich and East Suffolk CCG Coverage 31st March 15 73.5% 74.5% 74.9% 31st March 16 72.7% 74.1% 74.4% 31st March 17 72.2% 73.6% 73.8% 31st March 18 71.6% 73.3% 74% The Cervical Screening Programme

Cervical Screening National Coverage West Suffolk CCG National Target- 80% Date England Coverage Suffolk Coverage West Suffolk CCG Coverage 31st March 15 73.5% 74.5% 75.5% 31st March 16 72.7% 74.1% 75.3% 31st March 17 72.2% 73.6% 74.9% 31st March 18 71.6% 73.3% 74.7% The Cervical Screening Programme

did not attend their cervical screening Key Facts National Cervical Screening Programme 2017-18 This means that 1.28 million eligible patients did not attend their cervical screening The Cervical Screening Programme

Key Facts Every year in the UK, around 3,000 women will be diagnosed with cervical cancer. Cervical cancer is the most common cancer in women aged 35 and under. The Cervical Screening Programme

Suffolk 31,401 patients missed their cervical screening appointment 1st April 2017- 31st March 2018 73.3% of the Suffolk eligible population attended their Cervical Screening 26.7% of the Suffolk population did NOT attend their cervical screening Eligible patients offered screening- 115,049 Patients that took up Cervical Screening- 83,648 patients 31,401 patients missed their cervical screening appointment Poster Text Messages GP Cervical Screening Packs Offer GP Visits to discuss Cervical Screening uptake and what individual practices can do to improve Cervical Screening uptake The Cervical Screening Programme

Suffolk County Council Poster Rest Room Poster Displayed in hairdressers and salons Distributed around Suffolk for 6- 12 months The Cervical Screening Programme

National Campaign The Cervical Screening Programme

COMMON QUESTIONS Where did I get the virus from? Anybody who has ever had any sexual contact has a risk of getting HPV. HPV can be passed on through: - Vaginal, anal and oral sex Touching in the genital area Sharing sex toys. Someone is at risk of getting HPV from their first sexual contact (this does not have to be penetrative sex) HPV can be present for a long time without knowing about it, so it is hard to know where HPV originated from Having HPV does not mean any partner has been unfaithful. The Cervical Screening Programme

Will my partner have HPV? COMMON QUESTIONS Will my partner have HPV? HPV is a common virus that 4 out of 5 (80%) of the population will have at some point during our lives. It is passed on through skin-to-skin contact. Is there a test for men? There is currently no HPV test for men, as a result would not help the management or treatment of any related condition The HPV Vaccine is being offered to boys as of September 2019 The HPV Vaccine is also being offered to Men who have Sex with Men (MSM) through Specialist Sexual Health Services and/or HIV Clinics The Cervical Screening Programme

COMMON QUESTIONS Why has HPV been detected when I have had the vaccination? The HPV vaccine doesn’t protect against all types of hrHPV. The vaccine covers the two most common hrHPV types, HPV 16 and 18. Together, these two types cause about 7 out of 10 cervical cancers. Screening is still important, even if you have been vaccinated. I am trying to get pregnant, will HPV have an impact on fertility? The presence of HPV by itself should not affect your ability to get pregnant. hrHPV has no symptoms and the immune system often clears with without treatment, so most people may never know they had it. The Cervical Screening Programme

COMMON QUESTIONS I'm pregnant – can I still go for cervical screening? It is usually recommended that you do not have cervical screening while you are or could be pregnant. If you are invited for cervical screening while pregnant, wait until 3 months after your baby is born to have the test. Tell your doctor or nurse you are pregnant if you are invited. If you have previously had an abnormal cervical screening result, you may need to have the test while pregnant. Your doctor or midwife may ask you to have it at your first antenatal appointment. This test will not affect your pregnancy. The Cervical Screening Programme

COMMON QUESTIONS Do I need a cervical screening test if I have never been sexual active? Your risk of developing cervical cancer is very low if you've never had any kind of sexual contact with a man or woman. If you've never been sexually active, you may decide not to go for cervical screening when you are invited. But you can still have a test if you want one. Presentation title

Further Information and Guidance- Reference NHS Choices- https://www.nhs.uk/conditions/cervicalscreening/?gclid=CNyhgY7QxeECFRESGwodaNID5g Jo’s Trust Website- https://www.jostrust.org.uk/ Further Information and Guidance- Contact your GP practice NHS Choices Jo’s Trust offer a ‘Ask The Expert’ service- https://www.jostrust.org.uk/support/ask-expert Jo’s Trust Cervical Cancer Trust Helpline- 0808 802 8000 The Cervical Screening Programme