Cervical screening in England: The past, present, and future

Abstract

*Cervical screening in England commenced in a disorganized fashion in 1964. The flaws of this approach became apparent in the mid-1980s and led to the inception of the National Health Service Cervical Screening Programme (NHSCSP). The main features of this program are its population-based registry, accessibility to all women within the screening age range, its systematic process of call and recall, national coordination, and quality assurance. Its success is in part based on its ability to evolve as evidence necessitates, and throughout the period of 2000-2010, it embarked upon a series of developments involving liquid-based cytology, which also provided the means to conduct reflex high-risk human papillomavirus (HR-HPV) testing and the potential to automate the screening process. As a result of evidence acquired since 2000, the NHSCSP is currently based on a system of primary cytology with HPV triage for low-grade abnormalities combined with cytology plus a HR-HPV ''test of cure'' for women who have received treatment for cervical intraepithelial neoplasia. Future challenges for the program will involve finding solutions to increasing screening uptake among women <30 years of age-a problem that may be exacerbated when vaccinated women reach the screening age, while making plans to accommodate HPV primary screening. Cancer (Cancer Cytopathol) 2012;120:87-96. V C 2012 American Cancer Society.KEY WORDS: cervical intraepithelial neoplasia, mass screening, vaginal smears, papillomavirus infections. 1964-1999Cervical screening was introduced in 1964 in England in a haphazard way. Cervical smears were taken from many women, with most taken opportunistically; however, the women at greatest risk and women with positive results were frequently inadequately followed up.1 There was inadequate policy regarding which women ought to be screened, poor evidence for how often women should be screened, and a tendency to treat cervical intraepithelial neoplasia (CIN) with either a cone biopsy or hysterectomy. 2 These treatment modalities, coupled with the lack of a classification system for cellular changes, increased the

Knowledge of cervical cancer risk factors among students at the Jan Kochanowski University in Kielce

“…Cervical screening programmes in the UK are based on LBC and high grade HPV molecular testing. The authors of the programme observed dynamic changes in the number of the women vaccinated against HPV, as well as cultural and social changes imposing alternation of the existing patterns [9,10]. Similar conclusions regarding the changes in screening patterns were made by Norwegian scientific researchers.…”

“…Since the efficiency of the programmes differs in many countries, although similar methods are used, the assumption can be made that the reason for poor cervical cancer diagnosis in most countries is women's poor knowledge of carcinogenic and cancer risk factors [5][6][7][8][9]. The statistics in Poland during the period 2000-2009 show a decrease in the total number of cancer diagnoses in 3100 cases out of 3800 annually.…”

Human Papillomavirus (HPV) Testing for Secondary Prevention of Cervical Cancer

“…Persistent HPV infection after treatment predicts the risk of disease recurrence or invasive cancer; therefore, HPV test can be used for follow-up of treated women. Evidences from several follow-up studies suggest that women negative for both cytology and HPV test at 6-12 months follow-up may be considered Bcured^and can be sent back to routine screening and rescreened after 3 years [51,52]. A systematic review of the studies about the performance of HPV test in posttreatment follow-up shows that the test is significantly more sensitive (95 %) as compared to follow-up cytology (70 %) in detecting persistent/recurrent high-grade lesions [53].…”

‘Organised’ cervical screening 45 years on: How consistent are organised screening practices?

“…Many countries have commenced with ad hoc screening offered and taken up by a few, followed by a wider policy of promoting opportunistic screening, and eventually by the development and implementation of a national or regional 'organised' screening programme [1][2][3][4][5]. It is widely held that organised programmes are more effective than non-organised, or opportunistic, screening programmes in preventing cervical cancer, and it is well recognised that organised cervical screening reduces cervical cancer incidence and mortality [6][7][8][9][10][11][12][13][14][15].…”