NHS CERVICAL SCREENING PROGRAMME AND REFERRAL PATTERNS FOR COLPOSCOPY by mikeholy

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									NHS CERVICAL SCREENING
    PROGRAMME AND
REFERRAL PATTERNS FOR
      COLPOSCOPY

       Dr Sue Calvert
      History of the screening
            programme
• Introduced in 1964 but not in a structured
  way
• Call-recall instituted 1988
  – Recommended screening women aged 20-64
    every 3-5 years
• Financial incentives to GP’s introduced
  1990
                      Results
• Gradual increase in number of women screened
  – 40% 1989
  – ~85% now (83% of women 25-64 years screened once
    in last 5 years)
• 2000-01 (England)
  – 4.1 million smears,
  – 3.6 million as a result of the screening programme
                     Results
• 2000-01 (England)
  – 9.6% inadequate
• Of adequate smears
  –   92.9% negative
  –   5.7% borderline / mild
  –   0.7% moderate
  –   0.7% severe or worse
                       Results
• Referrals to colposcopy (2000-01)
   –   inadequate 10%
   –   borderline 18%
   –   mild 21%
   –   moderate 18%
   –   severe 13%
   –   severe ?invasive <1%
   –   ?glandular 2%
   –   other 17%
                     Results
• Referrals to colposcopy April to June 1998
• Following persistent borderline / mild
  – 0.2% cancer
  – 22% CIN II/III
• Following moderate / severe or worse
  – 2.7% cancer
  – 72% CIN II/III
  Effect of screening on cervical
               cancer
• Incidence of cervical cancer was 35% lower
  in 1995 than 1990
• Since 1988 accelerated decrease in
  mortality from ~1% to ~7% / year
• Screening has saved ~8000 lives in England
  and Wales between 1988 and 1997
  – Susieni P., Adams J. BMJ 1999;318:1244-45
  National recommendations for
           colposcopy
• x3 borderline smears
• x2 mild smears
• Any smear showing
  –   Moderate
  –   Severe
  –   ?Invasive
  –   Glandular abnormality
             Local variants
• Leeds/Bradford and others
• x2 borderline
• Any smear mild or worse

• Surveys in Bradford (unpublished)
  – 11/43 (25%) women referred with 2 borderline
    smears had high grade CIN

								
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