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Medical - Cervical Cancer
Wednesday 26 January 2011
Cervical cancer is one of the leading causes of death among Irish women under 44. There are some hopeful initiatives in place -a free screening programme and school-based HPV vaccination.
Today, we hear about this and the facts of Cervical Cancer.
Dr Caitriona Henchion, Irish Family Planning Association
. Over 90 lives lost in Ireland to the disease every year
. Second most common cancer in women under 44 worldwide
Initiatives in Place:
. CervicalCheck is the government-funded national cervical screening programme. The programme provides for women aged 25-44 to have free cervical screening tests from a registered GP, nurse or family planning clinic of their choice every 3 years and women aged 44-60 every five years.
. A free HPV vaccination programme for girls in their 1st and 2nd years of second level school was rolled out in 2010. Starting from 2011, only girls entering into their 1st year of second level school are eligible for the free vaccination programme.
Dr Caitriona Henchion, cervical cancer prevention, its one of the few good news health stories at the moment..
It is and we need good news! Women can avail of a free cervical screening from a GP or family planning clinic of their choice. It's funded by the National Cervical Cancer Screening Service and is available to over 1.1 million women between the ages of 25 to 60 with the goal of reducing the incidence and mortality rate of cervical cancer.
In the UK, Jade Goody's illness and the shocking news that it was fatal had a major impact on the NHS cervical cancer screening programme.did it have an impact here?
Yes people on the ground taking smears did notice a huge peak in smear activity, I don't have any numbers but we need to maintain that momentum.
The screening programme is designed to detect changes on the cells of the cervix before they become cancerous
Yes, almost 85 per cent of women tested return smear test results which are negative or normal. We know that perhaps 13 per cent show low grade abnormalities and the remainder high grade abnormalities.
And the school-based HPV vaccination programme is designed to protect.
The HSE now offers a safe, fully tested HPV vaccine called Gardasil to every girl in the country who's starting first and second year in secondary school. It will then be offered to all future first years. The vaccine is free, and international studies have shown that vaccinated women are less likely to become infected with HPV, and are therefore less likely to develop cervical cancer. The programme aims to achieve a high uptake of more than 80 per cent for the vaccine. Each girl will need three doses of the vaccine over a six-month period, which will substantially reduce their risk of developing cervical cancer as adults.
Teresa, you did what many of us do, you kept putting off a medical appointment for, in this case, a smear test..
I just kept putting it on the long finger -before I had children I went for a smear every two years, now I'm the mum of two girls Lisa (5) and Nina (7), after the birth of my second child I would have known that I should have gone back but I suppose I was too busy to do so. I was so busy putting my kids first that they almost lost their mother!
And it was the new campaign that really pushed you to go for the smear?
I signed up to be screened in January last year; I got a letter about it in March but ignored it and then got a second letter in June and made the appt with the GP in July to actually have the smear. It was the end of August when I got the result - the GP told me the result was highly abnormal and I was referred to the National Maternity Hospital for a colposcopy and extensive LLETZ treatment.
And to clarify Dr Henchion, what is LLETZ treatment?
Large loop excision of the transformation zone (LLETZ) is the most common treatment for removing abnormal cells from the cervix. It's sometimes called LEEP (loop electrosurgical excision procedure). It takes about 5-10 minutes and is usually done under local anaesthetic as an outpatient procedure. Sometimes, if a larger area of the cervix is treated, a general anaesthetic may be used.
Teresa was there any indication that you should have gone for a smear sooner than you did?
I showed no symptoms whatsoever, there was no indication that my health was compromised, I know you are supposed to do these things - I can say I would not have gone if it had not been the campaign. My doctor said she was quite certain that if I hadn't gone for my smear when I did and been caught when I was, she'd have been seeing me within a year in the oncology department.
Dr Henchion what are the symptoms of cervical cancer?
The symptoms are bleeding between periods or after sex but I can't stress enough of you have those symptoms you may have advanced cancer, my point is that its too late.
Women are afraid of going in case they have an abnormal result but you have to hear hundreds before you hear of one that is cancerous, an abnormal smear result is nothing to get freaked out about.
Cervical Cancer Symptoms:
. Bleeding between periods or after sex.
. Any sort of unusual or unpleasant smelling vaginal discharge.
. Discomfort/pain during intercourse.
. Pain in the pelvic area.
. Painful or difficult urination
Can we clarify some myths about cervical cancer.
MYTH: An abnormal cervical smear test means a woman has cancer.
FACT: An 'abnormal result' is not cancer. However in some cases cancer may be found when an abnormal test is investigated further.
MYTH: Regular cervical smears do not protect women from cervical cancer.
FACT: A cervical smear test (also known as a smear test) is part of a routine gynaecological exam and helps detect abnormal cells in the lining of the cervix.
MYTH: Cervical cancer only occurs in promiscuous women and therefore only they need cervical screening.
FACT: Any woman could be affected
MYTH: A smear test can bring on a period.
FACT: Generally, smear testing does not cause bleeding. Sometimes 'spotting' can occur for a short time.
Teresa, what is your advice to women who put off being screened?
You put so much energy into looking after your children that you neglect yourself but you don't think that by doing so you could ultimately deprive them of a mother. This is one thing where you are doing your children a favour - I strongly feel this, go for a smear test.
For more information go to www.cervicalcheck.ie
What is CervicalCheck - The National Cervical Screening Programme?
CervicalCheck - The National Cervical Screening Programme is a quality assured, organised and population-based screening programme that is managed by the National Cancer Screening Service (NCSS). The Programme provides free cervical screening to women aged 25 to 60 and is operated in line with best international practice. The Programme is funded by the Department of Health and Children.
Why has a cervical screening programme been introduced?
The overall aim of the Programme is to reduce the incidence and the death rate from cervical cancer in Ireland by providing free cervical screening.
Free smear tests are provided every three years for women aged 25 to 44 and every five years for women aged 45 to 60 years. The Programme aims to achieve a coverage rate of 80 per cent of the eligible population (women aged 25 to 60). A national screening programme in Ireland has the potential to cut incidence rates from cervical cancer by up to 80 per cent. There are approximately 170 new cases of cervical cancer and 76 deaths from cervical cancer annually in Ireland.
What is the purpose of a smear test?
A smear test (sometimes called a PAP test) can detect changes in the cells of the cervix (neck of the womb). The earlier abnormal cell changes are found, the easier they are to treat.
Is cervical screening effective?
Cervical screening is internationally accepted as a preventative health measure. While it is recognised that no screening technology is 100 per cent accurate, cervical screening is the most effective method of reducing a woman's risk of developing cervical cancer. A screening programme must be well organised and of equal benefit to the entire screening population.
What is the link between CervicalCheck and the ICSP?
The Irish Cervical Screening Programme (ICSP) Phase One commenced screening women in the mid-western area in October 2000. It was originally set up on a pilot basis to provide free cervical screening to women aged between 25 and 60 years in Counties Clare, Limerick and North Tipperary. The ICSP became CervicalCheck in 2008.
Women who participated in the ICSP Programme are automatically included in CervicalCheck - The National Cervical Screening Programme. Smeartakers who were previously registered with the ICSP may continue to be registered now in the CervicalCheck Programme.
Who is eligible for screening?
Woman aged 25 to 60 resident in Ireland will be eligible to avail of a free smear test over the next three years. CervicalCheck has developed a register (list) of eligible women nationwide aged 25 to 60 through up-to-date information received from the Department of Social and Family Affairs.
Over the next three years, CervicalCheck will send an invitation by post to women on this list who have never had a free CervicalCheck smear test.
Women who have already availed of a CervicalCheck smear test will automatically be re-called when their next smear test is due.
Women are entitled to avail of their free smear test providing:
* They attend a smeartaker (a doctor or practice nurse) who is registered with the National Cervical Screening Programme
* The woman has received a CervicalCheck invitation letter, re-call letter or letter following a smear test advising her to attend for a repeat smear test
* They sign the Programme Cervical Cytology Form
* Programme screening intervals are respected (see further detail below)
* If the result of a woman's previous smear test recommends further screening, she is eligible for a free smear test
* The Programme supports any woman who has received a recommendation for a post-colposcopy follow-up smear test
* Some additional specific considerations of eligibility apply and a doctor should consult the CervicalCheck Eligibility Framework
Is a woman's written consent necessary to avail of a free smear test as part of the Programme?
Yes, A women must sign the Cervical Cytology Form to take part in the Programme and avail of a free CervicalCheck smear test. This allows CervicalCheck to receive, hold and use a woman's personal details and information about her smear test sample. This may include post-smear samples and colposcopy results.
How does the CervicalCheck Programme currently work?
The Programme is operated through a call, re-call process for eligible women. Once a woman has availed of her first smear test following a call (letter of invitation), the Programme will invite her to attend for free smear tests every three to five years depending on her age. The Programme is responsible for notifying women when their smear test is due and provide clear referral and follow-up procedures where necessary. Women who have already availed of a CervicalCheck smear test will automatically be re-called when their next smear test is due.
What are the recommended screening intervals?
* Women aged 25 to 44 will be offered a free smear test every three years
* Women aged 45 to 60 will be offered a free smear test every five years
* A woman may also be advised by CervicalCheck to attend for additional smear tests if further investigation is needed, as recommended by the designated cytology laboratory through the Programme
* The introduction of screening intervals will avoid opportunistic smears (ad hoc or too frequent regular smears) in the longer term
The Programme will be based on:
1. Women attending their registered smeartaker following receipt of a CervicalCheck invitation or re-call letter
2. Women attending their registered smeartaker for a repeat smear test as advised by a letter from CervicalCheck
3. Women attending their registered smeartaker without a CervicalCheck invitation or re-call letter but who are eligible for screening in accordance with the Programme's Eligibility Framework
How are smear test results provided to women?
The CervicalCheck programme office writes to a woman with the recommended next step in the screening programme, while smear tests results are issued to her doctor. Results are delivered within four weeks of having a smear test, ensuring a quick service to women. Every test is screened twice by two separate cytologists at a contracted laboratory. The great majority of tests - approximately 90 per cent are negative or normal.
What does CervicalCheck do?
CervicalCheck - The National Cervical Screening Programme is responsible for:
* The delivery of a national cervical screening programme
* Establishment and management of the register of eligible women - the Cervical Screening Register
* Communication with registered women
* Co-ordination of registered smeartakers in primary care setting
* Co-ordination of laboratory services
* Co-ordination of colposcopy and clinic services
* Health education and screening promotion
* Ensuring Quality Assurance standards are adhered to across all aspects of the Programme
How are an eligible woman's details registered and stored?
The woman's details are registered and stored confidentially on the Programme Cervical Screening Register (CSR). This is a secure, centrally located, electronic database that contains a woman's full demographic details including name, address, date of birth and Personal Public Service Number. The CSR also records a woman's screening history and results of her smear tests, colposcopy procedures and any biopsies taken at a colposcopy clinic.
To maintain confidentiality, each woman has a unique identification number on the Register. Information on the CSR will be shared only with the smeartaker, the laboratory, colposcopy clinic and the National Cancer Registry.
Where is the data sourced?
CervicalCheck has developed a Cervical Screening Register (CSR) of eligible women aged 25 to 60 through information received from the Department of Social and Family Affairs, self registration by women, doctors, cytology laboratories and colposcopy clinics. Women are invited for screening based on age, across the age range 25 to 60 years. The CSR has the functionality to identify women in age cohorts based on their date of birth, allowing the Programme to target lower uptake age groups if needed.
What Quality Assurance measures are in place?
A quality assurance structure is a vital part of the National Cervical Screening Programme. Quality standards and policies are in place through-out the programme.
The NCSS has established a National Quality Assurance Group that reports to the Chief Executive Officer of the NCSS who has responsibility for quality assurance across the National Cancer Screening Service programmes. The National Quality Assurance Group is responsible for the development of quality standards for all aspects of the delivery of a national programme and is supported by a number of specialist subgroups.
Quality Assurance sub-groups include:
* Primary Care and Smeartaking includes members of the ICGP (Irish College of General Practitioners), practice nurses, NCSS and a nurse tutor
* Laboratory, cytology and histology; and
* Colposcopy, Gynae-Oncology and primary treatment.
The Programme adopted the UK NHSCSP BSCCP / RCOG standards in September 2007. In January 2010 the National Cancer Screening Service published its guidelines for Quality Assurance in Cervical Screening.
Is there a feedback or complaints procedure?
The Programme has a feedback and complaints handling system in place that will ensure fair and transparent consideration and investigation. The system is designed so that steps are simple and transparent.
Providing feedback or making a complaint can be done verbally via the Freephone information number (1800 45 45 55) or in writing to the Programme office. All communications will be followed up in a timely fashion. The Programme accepts that a good feedback and complaints system contributes to a higher quality service by highlighting shortcomings and capturing positive feedback so that identified areas of the Programme can be improved.
CervicalCheck - The National Cervical Screening Programme
PO BOX 161
Does CervicalCheck have an Access Officer?
Yes, CervicalCheck has appointed Dr Marian O' Reilly as Access Officer. She can arrange extra help for people with disabilities who use CervicalCheck's information and services. The Disability Act 2005 requires every public body to have at least one Access Officer. If you need help to use CervicalCheck's information and services you can contact Dr Marian O' Reilly by phone at (061) 4613900 or by sending an email to firstname.lastname@example.org.