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PubMed1987

Cervical screening in general practice: call and recall.

Regular universal screening for cervical cancer is associated with a considerable reduction in the disease. However, opportunistic screening has tended to reach groups at low risk and miss those at high risk from the disease. This study assessed the cost-effectiveness of a call and recall system for cervical screening which was set up in one general practice.The practice age-sex register and records were used to monitor the screening status of women patients. Of the eligible population aged 36-60 years 70% were found to have been screened in the previous five years. The remainder were offered an appointment for a cervical smear and 57% attended following this invitation. Three smears out of 110 undertaken were reported as showing marked dyskaryosis or cervical intraepithelial neoplasia grade III. The estimated cost per case identified was pound366.A call system in general practice can increase the uptake of cervical screening among women at risk. It is a relatively cost-effective method of preventing cervical cancer.

Adult↗

PubMed1998

Exploring the barriers to cervical screening in an urban Canadian setting.

Cervical cancer is potentially one of the most preventable cancers. The benefits of cervical screening come to those who are actually screened. Despite the known value of cervical screening, a significant number of women do not avail themselves of the procedure. This study examined the barriers to cervical screening in an urban Canadian setting. Focus group methodology was used to explore the perspectives of socioeconomically disadvantaged women regarding their access to health care. The sessions were tape-recorded, and subsequent content analysis revealed four broad themes: being able to talk with doctors is important; being treated as a person is important; finding answers to many questions about cancer is important; and having a Pap test is uncomfortable. Implications for practice and program design were highlighted.

Adult↗

PubMed2006

Cervical screening in 20-24-year olds.

BACKGROUND: In 2003 the NHS Cervical Screening Programme in England changed the age at which women are first invited for cervical screening from 20 to 25 years. The aim of this review was to assess the evidence for benefit and harm of undertaking cervical screening in Wales for women aged 20-24 years. METHOD: A literature review looking for evidence of the effectiveness and potential harmful effects of cervical screening was undertaken. Welsh data for the number of cases of high-grade cervical intraepithelial neoplasia (CIN3) were examined and rates of invasive cervical cancer (1981-2003) for young women calculated. The medical notes of women less than 25 years old diagnosed with cervical cancer were reviewed and a cost analysis was performed. RESULTS: The literature review failed to identify any randomized controlled studies of the effectiveness of cervical screening in young women, but demonstrated that organized screening programmes result in a decrease in the incidence of cervical carcinoma. Following the introduction of the Welsh organized call/recall cervical screening programme in 1988, cervical cancer has been reduced by 58% in women aged 20-24 years and 45% in women aged 25-29 years (mean age-specific rate per 100,000 women aged 20-24 years: 4.2 in 1981-88 compared with 2.2 in 1989-2003). If these changes can be attributed to the screening of women aged 20-24, then the costs of at least pound sterling 82,500 are estimated to prevent one cervical cancer in this age group. CONCLUSIONS: The incidence of cervical cancer in young women has halved since the introduction of the Welsh-organized call-recall cervical screening programme. In Wales we recommend that women continue to be invited for cervical screening from 20 years of age. This will provide the information required to compare the incidence and stage at diagnosis of cervical cancer in young women invited for first time cervical screening at different ages across the UK.

Adult↗

PubMed2001

Early discharge of low-risk women from cervical screening.

BACKGROUND: The Scottish Cervical Screening Programme currently offers three-yearly screening to all women between the ages of 20 and 60. However, previous studies have indicated that well-screened women over the age of 50 are likely to be at low risk of cervical neoplasia. This study aimed to explore the implications of discharging these women from screening in a typical area of Scotland. METHODS: A case-control study of the screening histories of women with and without screen-detected cervical neoplasia between ages 50 and 59 in Lanarkshire was carried out, as well as a cross-sectional study of the prevalence of adequate screening histories among women currently aged 50 in Lanarkshire. Routine screening programme statistics were used to estimate the effects of introducing an early discharge policy. RESULTS: Women reaching the age of 50 with two recent, consecutive, negative smears had reduced odds of screen-detected neoplasia in the subsequent decade. The estimated odds ratio for all screen-detected neoplasia (CIN 1-3, adenocarcinoma in situ and invasive carcinoma) was 4.4 [95 per cent confidence interval (CI) 1.6-13.2, p = 0.002]. The estimated odds ratio for screen-detected high-grade CIN and invasive squamous carcinoma was 17.0 (95 per cent CI 2.4-243.0, p = 0.0004). A total of 54.0 per cent (95 per cent CI 47.9-59.9 per cent) of screening participants currently aged 50 fulfilled the definition of adequate screening. Discharging these women might be expected to reduce screening workload by approximately 10 per cent, but those discharged would be at increased risk of neoplasia. CONCLUSION: Now that full screening histories are available in all health board areas since 1990, the identification of a low-risk group within the screened population could be the first step towards a screening programme targeted more closely on those with the greatest capacity to benefit.

Case-Control Studies↗

PubMed2005

Risk-adapted multimodal laboratory cervical screening -- application of new technologies to cervical cancer prevention.

The objective of screening for cervical cancer is to reduce the mortality and incidence of the disease. To date, there is extensive and strong evidence that this can be achieved by cytology-based screening programs, which continue to be the mainstay of cervical prevention worldwide despite their inherent methodological limitations. This article presents a review on the utility of conventional, ancillary, and experimental methods for cervical screening both as single tests and test-combinations, and describes possible future directions for enhanced screening accuracy using risk-adapted protocols.

Biomarkers, Tumor↗

PubMed1995

Women's experiences at cervical screening.

Concerns about attendance for cervical screening has focussed on determining the reasons why some women never attend. Less attention has been paid to whether women continue to attend for further smears, although this is essential for further screening. This study investigated women's experiences of cervical screening and their views on subsequent attendance. Three hundred and thirty nine women aged 20-64 were identified from a computerised register of cervical smears as having had a smear test within the previous three years. They were interviewed at home about their most recent experience of screening. Just over half of the women (53%) recalled being anxious before the test, and about one fifth reported embarrassment (19%) or pain (20%) during it. The frequencies of discomfort were higher amongst those who were anxious about the test, although 24% of those who were embarrassed and 28% who had pain reported being unconcerned beforehand. The frequencies of pain and embarrassment were only slightly higher when the smear taker was male. Many women (22%) reported being concerned about the test result although only 10% of those who were concerned were recalled for further assessment. Although a number of women had unpleasant experiences, almost all (95%) who were under 60 years of age said they were likely to attend for a subsequent smear. Taking cervical smears is often an unpleasant experience for women, although some of the distressing events could easily have been avoided. Attention to technique and to the concerns of individual patients, especially ensuring privacy, could reduce the extent of the problem. The uptake of subsequent smears should be monitored to ensure that women are not being discouraged from attendance.

Adult↗

PubMed2006

Cervical screening in HIV-positive women: characteristics of those who default and attitudes towards screening.

OBJECTIVES: To determine the characteristics of HIV-positive women who undergo cervical screening and to identify negative attitudes and experiences of these women to screening and the factors associated with these. METHODS: We compared the Royal Free Cohort data from 59 newly diagnosed HIV-infected women, 31 of whom did and 28 of whom did not attend for cervical screening in 2001, and from 227 women under active cervical screening follow-up (at least one cervical screen since June 2001) and 88 HIV-infected women lost to follow-up (not screened since January 2001). Attitudes to screening were investigated with the aid of a questionnaire given to all women attending clinic who had had a previous colposcopy. RESULTS: Of the 59 newly HIV diagnosed women, 31 (53%) underwent cervical screening. These 31 women were more likely to be heterosexual (100 vs 89%, P=0.05), to have lower median viral loads (< 50 vs 3210 HIV-1 RNA copies/mL) and to be receiving antiretrovirals (ARVs) (74 vs 54%, P=0.1) than those not screened. Of the 315 women who had at least one screen, 72% returned for further follow-up. There were no differences in age or ethnicity between these groups. Those under active follow-up had a higher CD4 count (P=0.04) and lower viral load (P=0.0001) at their last visit. They were also more likely to be on highly active antiretroviral therapy (HAART) (68 vs 52%, P=0.006). A total of 78 of 104 questionnaires (75%) were returned. Women participating in the questionnaire study were mainly of back ethnicity (68%), did not speak English as their first language (59%) and were taking ARVs (76%). Most agreed that regular smears and colposcopy were valuable. Women of white ethnicity, and those speaking English as a first language, were more likely to dislike colposcopy compared with those of nonwhite ethnicity (87 vs 25%, respectively, P=0.0007) and not speaking English as a first language (74 vs 26%, respectively, P=0.002). Those of white ethnicity were more likely to find smears and colposcopy painful (60 and 73%) compared with those of black ethnicity (46 and 51%, P=0.47 and 0.28, respectively). CONCLUSIONS: Our results suggest that women on HAART with better disease control, older women, and those of black African ethnicity are more likely to take up cervical screening. Cervical screening experience varies by ethnicity and language.

Adult↗

PubMed2005

Cervical screening and human papillomavirus.

BACKGROUND: Cervical screening in Australia has been successful in reducing the incidence and mortality of cervical cancer. Human papilloma virus (HPV) is a common sexually transmitted infection and an integral agent in the development of cervical cancer. OBJECTIVE: This article discusses cervical screening, HPV infection and counselling women with low grade abnormalities on cervical cytology. DISCUSSION: For most women, detectable HPV infection is transient and subclinical. While HPV is a precursor to cervical cancer, this is a rare outcome of HPV infection. Minor abnormalities on cervical cytology reflecting acute HPV infection are common. Women with low grade Pap test abnormalities require reassurance and education about the prevalence and natural history of HPV.

Cervix Uteri↗

PubMed1992

Does the offer of cervical screening with breast screening encourage older women to have a cervical smear test?

OBJECTIVE: The aim was to determine what effect the offer of a cervical smear test when attending for breast screening has on the uptake of cervical and breast screening. DESIGN: The study involved randomisation to compare uptake in those women invited for cervical screening in advance with their breast screening invitation (group 1) with those invited for breast screening only and then offered a smear test upon arrival for breast screening (group 2). The main outcome measure was improvement in the uptake of cervical screening among older women without detriment to the breast screening service. SETTING: The study took place at the Northern Hospital in North Manchester. PARTICIPANTS: Participants were 2131 women aged 50-64 years invited for breast screening at the Northern Hospital in the summer of 1990. MAIN RESULTS: Overall, 54% of the women who were eligible attended for breast screening, 52% attended from group 1 and 55% from group 2. Of those attending for breast screening, 957 were eligible for cervical screening and 193 (20%) had a smear test. There was a difference in the proportion tested from each group (p < 0.001), 28% had a smear test from group 1 and 13% from group 2. Forty five percent of the 193 had not had a cervical smear for at least five years. CONCLUSIONS: The cervical screening facility did attract some women who were overdue for a smear test and who might not normally have attended for cervical screening, and there was no evidence to suggest that it had a detrimental effect on the breast screening uptake. An advanced cervical screening invitation seemed preferable to an invitation upon arrival at the breast screening unit.

Breast Neoplasms↗

PubMed2005

Performance of nurses in the Department of Health as service providers for a cervical screening programme.

A territory-wide cervical screening programme was launched in Hong Kong in March 2004. Since 2002, 160 nurses from the Department of Health's Maternal and Child Health Centres have completed the training necessary to carry out the screening procedures. A clinical audit of their performance was carried out between 2002 and 2004. A customer satisfaction survey revealed that 94% of respondents agreed or strongly agreed that they were satisfied with the cervical smear procedure performed by nurses. Since January 2003, all routine cervical screening tests at Maternal and Child Health Centres have been performed by nurses. The mean time required to complete a test is 7 minutes. The mean unsatisfactory smear rate for the year 2003 was 1.3%, well below the benchmark of 5% set by the Working Party on Quality Assurance of the Cervical Screening Task Force. The results of this survey confirm that nurses at Maternal and Child Health Centres are highly effective and efficient at taking smears and that this is well accepted by clients.

Female↗

PubMed2000

An analysis of resources for indigenous women in NSW about cervical screening.

OBJECTIVE: To examine resources about cervical screening made available to Indigenous women in NSW. METHOD: An Aboriginal woman, on behalf of another Aboriginal woman, telephoned 47 NSW based organisations in May 1998 for information about cervical screening. Received materials were analysed for format, content and readability and then submitted to a panel of Indigenous women for their feedback. RESULTS: Of those 34 organisations agreeing to send resources, only 20 (59%) did so. After removing duplicates, 12 cervical screening resources were available for review of which six were designed and printed in NSW and the other six originated outside NSW. Of the six resources developed in NSW, two (33%) were for Aboriginal women. Of the six resources originating from outside of NSW, another two (33%) also were for Aboriginal women. The Flesch readability scores for resources ranged from 58.6 to 87.27. Those developed in NSW had a significantly lower readability score than those from outside of NSW (p = 0.025). Despite lower education levels among the target group, there was no difference in the readability scores of resources designed for Indigenous women (p = 1). CONCLUSIONS: Most resources obtained by us were not tailored for Indigenous women. IMPLICATIONS: This study has set a base line for resources available for Indigenous women. Our method could be replicated in the future to evaluate and monitor improvement.

Adolescent↗

PubMed2000

"It's just part of being a woman": cervical screening, the body and femininity.

This paper explores the importance of cervical screening discourses in framing women's perceptions of femininity. In-depth interviews with 35 women -- which focused on experiences of, and feelings about, cervical screening -- highlighted how medical discourses embedded within the cervical screening programme shape the feelings of normalcy and sense of obligation associated with having smear tests. With the introduction of the invitation based call and re-call programme in the UK, cervical screening has moved from an ad hoc system to a programme of mass surveillance and regulation of women's bodies. The paper highlights the ways in which cervical screening discourses were negotiated, accepted and resisted by the women interviewed. Possible theoretical explanations as to why cervical screening discourses have become important in framing femininity are discussed. The paper concludes by suggesting that the meaning and objective of mass screening programmes must be brought into question and reconsidered by feminists and those involved with the planning, implementation, research and use of screening services.

Adult↗

PubMed2006

Cervical screening and management of cervical intraepithelial neoplasia in HIV-positive women.

The high prevalence of abnormal cervical cytology in the context of immunosuppression has been recognized for many years. In response to repeated observations of cervical cancers in HIV-infected women, moderate and severe cervical dysplasia were designated as early symptomatic HIV infection (Category B) by the Centers for Disease Control and Prevention (CDC) in 1993, and invasive cervical cancer as an AIDS-defining condition (Category C). HIV-infected women, therefore, differ from the general population not only with a greater risk for more, but also potentially more severe cervical disease. In the era of highly active antiretroviral therapy, with HIV-infected women living for longer, there is a clear need to address this increased risk with appropriate management guidelines which this review attempts to provide.

Antiretroviral Therapy, Highly Active↗

PubMed2005

Liquid based cytology: a new cervical screening system for the UK.

Liquid based cytology is replacing the traditional Pap smear as the method of screening for cervical cancer in the UK. This article discusses liquid based cytology, the implementation programme and other developments in screening for cervical cancer.

Cytological Techniques↗

PubMed1989

Pattern of cervical screening utilization in Italy.

The pattern of cervical screening utilization in Italy was analyzed using data from the 1986-1987 National Health Survey on the basis of a sample of 27,455 women aged 20 to 79 randomly selected within strata of municipality of residence and age in order to be representative of the whole Italian population. Overall, about 17% of women aged 20 to 79 were screened per year, for a total of 3.5 to 4 million cervical smears per year. The highest frequency was reported in younger middle age, about one in four women being screened per year in the age groups 30 to 49, and there was a substantial decline above age 50. Cervical smear rates were higher in Northern areas (22%), where mortality from cervical cancer is lower, than in the Centre (16%) and South (11%) of the country. Further, there was a strong positive social class gradient in the utilization of cervical screening, in relation to both education and occupation. In spite of the absence of any organised mass screening program, cervical screening is a relatively common procedure among Italian women. However, this study provides further quantitative evidence of a markedly irrational utilization of non-organized cervical screening, which tends to end up selectively used by the groups in which cervical cancer is less common.

Adult↗

PubMed1998

Improving cervical screening in a remote aboriginal community.

Improved cervical screening has been identified as a priority in reducing the incidence of cervical cancer among Aboriginal women. This paper discusses the cervical screening recommendations of a women's health project developed by Nganampa Health Council (NHC), the Aboriginal-controlled medical service meeting the health needs of the people of the Anangu Pitjantjatjara (AP) Lands. A community participation public health model was used in program development. A process including community and staff consultation, literature review and prioritisation informed the program development, ensuring strategies thereby derived were culturally acceptable as well as practical and scientifically valid. The epidemiology of cervical cancer and screening in this community is discussed. Strategies aimed at maximising patient participation, improving patient satisfaction, running an effective call and recall system, improving quality of cervical smears, improving management of women with abnormal smears and evaluating the program are suggested. The involvement of the community in a scientifically sound, public health approach may increase the likelihood that the strategies suggested will be effective in this community. Both the model of program development and the cervical screening strategies derived are likely to be of relevance for other Aboriginal communities.

Community Participation↗

PubMed1990

How district health authorities organise cervical screening.

OBJECTIVES: To examine how district health authorities organised cervical screening with respect to Department of Health guidelines and to determine their assessment of the problems encountered. DESIGN: Postal questionnaire sent to all 190 district health authorities in England in 1989. PARTICIPANTS: 190 District health authorities in England. MAIN OUTCOME MEASURES: Population coverage of screening, quality of smear testing, and follow up of abdominal test results in comparison with national guidelines for district cervical screening services, and problems encountered by districts. RESULTS: Replies were received from 178 (94%) of districts, in 143 of which the person named as responsible for cervical screening contributed. All districts implemented a computer managed scheme, 150 by the target date of 31 March 1988, but not all of these conformed with the guidelines. At the time of the survey only just over half called women in the target age group of 20-64 and only 70% expected to meet the target date of 13 March 1993 for completing the call. Considerable variation was evident among the schemes with regard to how they dealt with issues related to population coverage, quality of testing, and follow up of abnormal results. The problems most commonly identified by the districts (n = 174) were laboratory workload (107, 61%), computer software (104, 60%), availability of resources (78, 45%), non-attendance (77, 44%), rate of opportunistic screening (62, 36%), and investigation and treatment (60, 34%). CONCLUSIONS: Current practice in running cervical screening schemes needs to be examined to determine the extent to which it contributes to the goal of reducing mortality from cervical cancer.

Adult↗

PubMed2006

Implementation of human papillomavirus testing in cervical screening without a concomitant decrease in participation rate.

Adding high-risk human papillomavirus (hrHPV) testing to screening increases the efficacy of cervical screening programmes. However, hrHPV testing may result in a lower participation rate because of the perceived association with sexually transmitted infections. We describe how testing for hrHPV was added to cervical screening in the POpulation-BAsed SCreening study AMsterdam (POBASCAM) trial. Participation rates of the screening programme before and after hrHPV implementation were evaluated in the region where the POBASCAM trial was carried out. The participation rate was 58.7% before and 61.4% after the addition of hrHPV testing to screening (p<0.001). An inventory of frequently asked questions is presented. Thus, hrHPV testing can be added to cervical screening by cytology without a decrease in participation rate.

Adult↗