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CERVICAL SCREENING

CERVICAL SCREENING. Changes to Age Range and Frequency CPD Resource [Updated: March 2016]. Aims & objectives of this session. Aim: To encourage discussion and clarification of the changes to age and frequency of Scottish C a ll and Recall Services as of 6 th June 2016*.

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CERVICAL SCREENING

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  1. CERVICAL SCREENING Changes to Age Range and Frequency CPD Resource [Updated: March 2016]

  2. Aims & objectives of this session Aim: To encourage discussion and clarification of the changes to age and frequency of Scottish Call and Recall Services as of 6th June 2016*. Objective: Discuss the reason for and implications of changes to the national cervical cytology screening programme. Further details are available in the Questions and Answers (Q&A) document: http://www.nsd.scot.nhs.uk/services/screening/cervicalscreening/index.html *Please note this is a change in implementation start date. The original planned start date was April 1st 2016.

  3. Detailed Learning Objectives • Discuss the reasons for the changes tothe national cervical cytology screening programme • Understand how these changes will affect women aged 20-24 years • Understand how these changes will affect women aged 50+ • Allow further discussion of the practical implication of the changes to the screening programme • These slides do not negate the need for new smear takers to carry out a training programme or for experienced smear takers to attend an update day

  4. What do you already know about changes to the cervical screening programme in Scotland?

  5. Background • National cervical screening programme introduced in Scotland in 1988 • Programme aims to reduce the incidence of invasive cancer of the cervix • Currently screening is offered to eligible women aged 20-59 every three years • In 2013/14, uptake rate in Scotland was approximately 70%

  6. Overview of changes to age range and frequency of screening • From 6th June 2016, the age range for routine cervical screening will change to ages 25–64 years plus 364 days • The frequency of routine cervical screening will continue to be every three years from age 25 to age 50, but will change to be every five years for women from age 50 to 64 plus 364 days of age • Women on non-routine screening will be invited up to age 70 years plus 364 days.

  7. Changes affecting women aged 20-24 years old • What is changing? - From 6th June 2016, women will be invited for screening for the first time aged 25 • Who will be affected? - Only women being invited to the screening programme for the first time - If a young woman aged under 25 has already been invited for a test as part of the screening programme she will continue to be invited for screening

  8. Reasons for changes to delay in commencing screening • A panel of experts reviewed evidence on behalf of the National Screening Committee • Found no detrimental effects from delaying the age of first screening to 25 • These changes bring the cervical screening programme in Scotland in line with those in the rest of the UK.

  9. What is being done for young women • HPV vaccination programme was introduced in Scotland in Sept 2008 • Girls aged 11-13 are vaccinated against two high risk types of HPV that have been shown to contribute to at least 70% of cases of cervical cancer • If a young woman has symptoms suggestive of cervical cancer she should be referred to have diagnostic tests carried out, a smear test should not be taken

  10. Case study 1 (after 6.6.2016) A 21 year old girl, who received HPV vaccination at school, attends the surgery requesting a ‘smear test’. She says she has noticed some unusual vaginal discharge recently. She tells you that her sister, who is 24, got her first ‘smear test’ when she was 21 and has just had her second test.

  11. Case study 1 Cont’d. (after 6.6.2016) If a woman has symptoms which could be suspicious of cancer, she should not have a cervical screening test carried out. A woman with symptoms requires diagnostic tests. It is possible that a cervical screening test result could be a false negative and provide false reassurance to both the professional and patient. The Scottish Referral Guidelines for Suspected Cancer can be found at: www.healthcareimprovementscotland.org/our_work/cancer_care_improvement/programme_resources/scottish_referral_guidelines.aspx

  12. Case study 1 Cont’d. (after 6.6.16) If a woman under the age of 25 (d.o.b between 6.06.91 & 6.06.96) has already been invited for a test as part of the screening programme (i.e. her details are already on the Scottish Cervical Call and Recall System (SCCRS) on 6.06.16) she will continue to be invited for screening regardless of whether:- • her screening history was routine or non-routine • her recall date is before or after she reaches 25 years • she defaulted previously but the exclusion status is now closed • she previously had a temporary exclusion (now closed) • she has received the HPV immunisation • she left Scotland for a period of time and has now returned (woman must have had an active SCCRS record prior to leaving Scotland)

  13. Any questions… ?

  14. Changes affecting women aged 50+ years old • What is changing? - Women who have a routine screening history will be invited to attend cervical screening until they are 64 years old +364 days - The frequency of screening for women aged over 50 on routine recall will be increased to 5-yearly - Women with a non-routine history will be invited up until the age of 70 + 364 days

  15. Changes affecting women aged 50+ years old • The frequency of screening for women at age 50 should be determined by the last screening test reported i.e. women already in the programme with a negative result and recommended management of 3 years would be recalled in 3 years, any subsequent negative tests would be reported with a recall of 5 years. • The upper age parameter for routine screening is 64 years + 364 days. • The upper age parameter for non-routine screening is 70 years + 364 days.

  16. Changes affecting women aged 50+ years old  Women who commence a call cycle before the ‘go live’ date and default should be recalled after 3 years, women who commence a call cycle on or after the ‘go live’ date and default should be recalled after 5 years. This applies to all women irrespective of screening recall (routine and non-routine recall). Women who have a temporary exclusion added to their record before the change in frequency should be re-included automatically when the exclusion expiry date has been reached i.e. change to frequency of screening should not be considered.

  17. Reasons for changes to lengthen cervical screening programme • A panel of experts reviewed evidence on behalf of the National Screening Committee • Evidence concluded that 5-yearly screening offered similar protection to 3-yearly screening in women aged 50+ • These changes bring the cervical screening programme in Scotland in line with those in the rest of the UK

  18. How these changes will be implemented • Work has been carried out to the IT system and to the administrative processes to ensure that effective administration of the cervical screening programme will continue. • Women will continue to be invited for screening by receiving a letter automatically sent from SCCRS

  19. Case study 2 (after 6.6.16) A 62 year old woman phones the surgery. She is concerned that she has received an invitation for cervical screening. She has always had ‘normal’ smear test results in the past and was not expecting to have to attend screening anymore.

  20. Case study 2 Cont’d. (after 6.6.16) • From 6th June 2016, the frequency of screening for women aged 50 and over on routine recall will be increased to five-yearly. Women must, however, be offered routine screening at least twice between the ages of 50 years and the upper age limit of screening which will be 64 years and 364 days. • A woman who is 50+ on 6.06.16 (date of birth before 6.6.66) who has been advised that she will be invited in 3 years’ time will still be invited according to that advice. All subsequent screening invitations for this woman with routine results will be sent five-yearly until she reaches the upper age range (i.e. 64 years 364 days).

  21. Any questions… ?

  22. Summary • From 6th June 2016 the age range and frequency of cervical screening is changing • These changes are being made after extensive review of evidence and are in the best interests of women in Scotland • Women will continue to be invited for cervical screening as appropriate via SCCRS

  23. Questions and further discussion… ?

  24. Acknowledgments • NHS Lothian Department of Public Health and Health Policy: Dr H Austin StR Public Health • NHS Health Scotland: CARAF Communications Group • NHS Education Scotland: Susan Kennedy • Screening coordinators at each Health Board Further reading ‘Questions and Answers Paper’; Cervical Screening CARAF Communications Group. http://www.nsd.scot.nhs.uk/services/Screening/cervicalscreening/index.html

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