Cervical Screening Test

Cervical Screening Test Indications Women aged 25 to 74 Under 25s not included because: Rare in them Does not change incidence or death Most girls aged 12 to 25 are vaccinated for it 1 in 8 women are affected by HPV In most will resolve on its’ own within 1 – 2 years Done every 5 years Screening test for oncogenic strains of HPV – 16, 18 and others – 9 100 subtypes only 40 cause cancer Does not screen for all types of HPV Can have a period of latency No treatment for HPV but finding it early and managing abnormal cells 70% of those who develop cervical cancer in Australia are under screened or have never been screened 80% of men and women who are sexually active will develop it. HPV causes 99% of cervical cancers Protection from vaccination is only 70% Gradisle vaccine – protects against 9 strands Offered to women who are sexually active Even if just once Condemns only provide a partial protection It is a very fine virus and can penetrate through the condom Squamous cell carcinoma more common Adenocarcinoma less common Women at higher risk of cervical cancer -> for these women may be useful to consider screening more often. Smokers Women exposed to DES in utero History of HPV or other cervical cell changes More sexual partners HIV positive women Tell the woman that we also look at the health of the vulva and the vagina HPV cancer takes 15 to 20 years to cause cancer Who should be screened every 3 years Women with highly immunosuppressive conditions Women with HIV Solid organ transplants Congenital immune deficiency Immunosuppressant therapy for autoimmune disease Changes Now on national rather than state register unless they opt out Women who are vaccinated still need it What if the woman is more than 74 If she had a recent abnormal results she should have it again Change of sexual partners It is her choice to continue Pap Smear vs Cervical Screening Test Aspect CST Pap Smear Intro 2017 1991 Target HPV DNA Abnormal cervical cells Age range 25 to 74 18 to 70 Every 5 years if HPV is negative Frequency Every 2 years As it takes 10 to 15 years to cause cell changes Lower Higher Sensitivity Detects risks before cell changes occur Detects cell changes after the occur – precancerous cells Does not detect the virus itself Sample collection Available for eligible patients Not available for any patients Vaccination impact Complements HPV vaccination Less effective post vaccine rolls out Risk stratification Reflex cytology + colposcopy based on HPV subtype Cytaology alone Reduces incidence and mortality by 20%. Does not detect all cervical cancers Does not screen for other STIs and all types of HPV Liquid based cytology Reduced mortality by 50% For self-collected: Laber intensive – less likely to do Other If lab detects oncogenic HPV Lab cannot do reflex cytology as LBC needs cervical cells, and the self-collection method only involves the vaginal canal not directly the cervix Will need an LBC -> must be clinician collected. Procedure Explain to patient and obtain consent Wash hands Over diagnostic -> over treatment and anxiety Open the speculum packaging while avoiding touching the speculum Open lubricant Position the patient Re-check consent In modified lithotomy position/ frog position Draw ankles up towards your buttocks, and keep your feet flat on the bed and let your legs fall open Vulval inspection Expose genitalia Inspect the vulva for: Ulcers Abnormal vaginal discharge Scarring Vulvovaginal atrophy White lesions -> leucoplakia Other lesions e.g. folliculitis Masses Varicosities FMG Insert the speculum Separate the labia using thumb and index finger of non-dominant hand While the blades of the speculum still closed insert with handle positioning sideways -> at 9 o’clock or 3’ o’clock Rotate once inside -> handle facing upwards Open speculum blades until optimal view of the cervix Tighten the locking nut -> fix the position of the blades Inspect of vaginal wall and cervix Cervix: Cervical os -> if open and woman is pregnancy -> inevitable or incomplete miscarriage Erosion around the os -> commonly associated with ectropion Cervical cancer can also have a similar appearance Cervical masses -> malignancy Scaring -> from a previous colposcopy procedure Cervix and vagina: Ulceration: most commonly genital herpes Atrophy: post-menopausal women Foreign body: e.g. retain tampon or condom Abnormal discharge: bacterial vaginosis, vaginal candidiasis, chlamydia and gonorrhoea Sample collection Insert the endocervical brush through the speculum into the endocervical canal, avoiding touching the sides of the speculum with the brush . Rotate the brush 360 degrees, in a clockwise direction, 5 times Remove the endocervical brush, avoiding touching the speculum Immediately transfer the sample to the liquid-based cytology container Label sample Removing speculum With non dominant hand -> , hold the blades of the speculum whilst you loosen the locking nut with your dominant hand. Gently remove the speculum whilst slowly closing the blades and inspecting the walls of the vagina Ask patient if they have any questions or concerns Other Tell patient sometimes it may not be satisfactory In this case redo Does not mean something is wring