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Monday, 14 December 2009

Cervical Screening Clinical Update

The purpose of this update is to highlight some aspects of good practice for smear takers, provide an update on recent changes to cervical screening in New Zealand, and inform health practitioners of new information resources now available for women.

Good Practice for Smear Takers

False negative smears

Cervical screening, like all screening, is not 100% effective and some women will still develop cervical cancer despite regular screening. While the risk of cervical cancer can be reduced, it cannot be eliminated by screening.

All smear takers are required by law to explain the cervical smear procedure and provide information to women about the limitations as well as the benefits of cervical screening. The National Cervical Screening Programme (NCSP) provides educational resources to help health professionals with this.

It is estimated that, in New Zealand, an average woman’s risk of cervical cancer is 1 in 90 without regular screening but reduces to 1 in 570 with regular screening. The fact that risk is not eliminated implies that some false negative smears are inevitable. Laboratories who perform cervical cytology report a false negative result of up to 20%.

The educational resources available from the NCSP (as well as information provided by the laboratories themselves) may assist health professionals to provide this information to women participating in cervical screening.

The introduction of human papillomavirus (HPV) testing, together with liquid based cytology (LBC), should help to reduce the rate of false negative smears.

In the longer term, HPV vaccine will help to further reduce the risk of cervical cancer.

Clinical symptoms

Revised Guidelines for Cervical Screening in New Zealand were published in September 2008. These guidelines set out best practice. Clinicians however must continue to exercise judgment and make decisions in consultation with their patients, that reflect individual clinical circumstances.  In this regard, if a woman is symptomatic or if there is a concern about the clinical appearance of her cervix, she should be referred for a colposcopic assessment irrespective of her cytology results.

Referrals to colposcopy

The NCSP monitors waiting times for women with high grade and low grade lesions who have been referred to DHB colposcopy services. Women with high grade lesions should be seen within 4 weeks. Health practitioners should advise the Programme if they have any concerns about delays in women being seen.

Recent Changes to Cervical Screening in New Zealand

From 1 October this year, HPV testing became part of the cervical screening pathway. 

HPV testing is used to supplement (not replace) cytological testing and is funded for use in three clinical situations:

  • for women over 30 years of age who have a low grade cytological result (ASC-US/LSIL). NCSP contracted laboratories will undertake this test automatically
  • to guide further patient management following treatment at colposcopy. Smear takers will need to request this test from NCSP laboratories
  • to assist colposcopists (who will request this test) where cytology and colposcopy results are not clear or are inconsistent with each other.

New Patient Education Resources

The following new resources are available to support health professionals in providing information to women.

Additional information for women and smear takers can be found at www.cervicalscreening.govt.nz

All smear takers should have their own copy of the Guidelines for Cervical Screening in New Zealand (published in September 2008). These can be ordered through Wickliffe ph 04 496 32277 or email moh@wickliffe.co.nz