1. SPAN Inaugural meeting Cervical Cytology -What Next? Jocelyn Imrie SPAN Inaugural Meeting 2 May 2006

2. SPAN Inaugural meeting Cervical Cytology in Scottish Labs SCCRS Automation HPV testing HPV vaccination NHS Scotland structure

3. SPAN Inaugural meeting Cervical Cytology in Scottish Labs What do we do? How do we do it? Who does it? Where do we do it? How much do we do? How long will we do it?

4. SPAN Inaugural meeting Cervical Cytology in Scottish Labs How do we do it?

5. SPAN Inaugural meeting Thin Prep Imager

6. SPAN Inaugural meeting Cervical Cytology in Scottish Labs Who does it ? Medical staff Technical staff Clerical staff

7. SPAN Inaugural meeting Cervical Cytology in Scottish Labs Now Screeners cytoscreeners, BMS Checkers BMS,APs medics Reporters APs medics Next Screeners Imager Checkers c ytoscreener, BMS Reporters APs Responsibility ??? Who does it ?

8. SPAN Inaugural meeting Cervical Cytology in Scottish Labs Medical staff recruitment/retention Technical staff Recruitment/retention Training Age profile Planning (2 year lead-in for new staff) Clerical staff Re-deployment????

9. SPAN Inaugural meeting Cervical Cytology in Scottish Labs Where do we do it?

10. SPAN Inaugural meeting Cervical Cytology in Scottish Labs Where do we do it?Facilities Labs 11 T-3000s 11+ 1T2 Transport Connectivity

11. SPAN Inaugural meeting Smear taker enters request details on central database CENTRAL CALL- RECALL DATABASE Processing Lab slides made Vials sent to processing lab Slides sent to reporting lab Reporting lab Results put on central database Results received from central database Patient details received from central database slides stained and screened 1 2 3 4 5 6 SCSP 200?

12. SPAN Inaugural meeting Cervical Cytology in Scottish Labs How much do we do? ISD data 307 cases of cervical carcinoma 406,305 smears of which 2.2% unsatisfactory 92.6% negative 6% low grade abnormality 1.3% high grade abnormality

13. SPAN Inaugural meeting Cervical Cytology in Scottish Labs How much do we do? “Persistent infection with one or more of the oncogenic subtypes of human papillomaviruses (HPV)is a necessary cause for cervical neoplasia.” Extract from IARC report on Cervical Cancer

14. SPAN Inaugural meeting Cervical Cytology in Scottish Labs How much do we do?HPV testing First line screening - before cytology To identify subsets of at risk women -after cytology Instead of cytology? – post treatment follow-up

15. SPAN Inaugural meeting Wednesday, 20 November, 2002, 18:12 GMT Cervical cancer vaccine success The vaccine could mean an end for smear tests A vaccine to protect women from one of the biggest cancer killers could be available within five years. BBC News How much do we do?

16. SPAN Inaugural meeting thelancet.com today - 11 April 2006 Trial shows vaccine against cervical cancer provides long-term protection A vaccine against the virus that causes cervical cancer (human papillomavirus) could protect women for up to four and half years, according to a study. The researchers found that women given the vaccine had sustained high levels of antibodies against HPV-16 and HPV-18 for up to 4·5 years after receiving the last dose How much do we do?

17. SPAN Inaugural meeting Cervical Cytology in Scottish Labs How long will we do it? ???