Hundreds of lives will be spared every year in England thanks to a more sensitive cervical screening test rolled out as part of the NHS Long Term Plan | via NHS England
NHS experts said that there is “potential” to eliminate cervical cancer completely thanks to the change in primary test within the NHS Cervical Cancer Screening Programme, combined with the effectiveness of the HPV vaccine.
The new and more sensitive test now looks for traces of high risk Human Papillomavirus (HPV), which causes nearly all cases of cervical cancer. Any tests that are HPV positive are then checked for abnormal changes of the cervix.
HPV is a group of viruses with more than 100 types, but 14 types can cause cervical cancer as well as some head and neck cancers. It means that any sign of infection will be spotted at an earlier stage before it could potentially develop into cancer.
Since the beginning of December, every part of the country has had the new way of screening in place. There are 2,500 new cases of cervical cancer in England every year but research says that a quarter of those could be prevented with this new way of testing.
The introduction is part of the NHS Long Term Plan’s ambitions to catch tens of thousands more cancers earlier, when it is easier to treat and the chance of survival is higher.
A new study published in the BMJ indicates that of the screening services offered to women in their 60s, which include cervical, breast and bowel screening only a third attend these screening sessions.
The study included over 3000 women aged between 60-65 who had responded to their last invitations from each of these three screening programmes.
Results showed that:
35% took part in all three screening programmes;
37% participated in two programmes;
17% accessed one type of screening; and
10% were not screened at all.
They found that in the last screening round, 2525 (83%) had taken up mammography, 1908 (62%) cervical screening, and 1635 (53%) bowel cancer screening, which is consistent with the proportions reported in the official statistics for England (78%, 58-59%, and 57-59%, respectively).
The researchers also explored area level correlations between participation in the three screening programmes and various population characteristics for all English general practices with complete data in the Fingertips database curated by Public Health England. This database reports health related data for England aggregated by administrative area.
General practices with higher proportions of unemployed patients and smokers had a lower rate of take-up of all three screening programmes. Conversely, general practices from areas with less deprivation, with more patients who are carers or have chronic illnesses themselves, and with more patients satisfied with the provided service were significantly more likely to attain high coverage rates in all programmes (Source: Torjesen, 2019).
To determine how many women participate in all three recommended cancer screening programmes (breast, cervical, and bowel). During their early 60s, English women receive an invitation from all the three programmes.
For 3060 women aged 60–65 included in an England-wide breast screening case–control study, we investigated the number of screening programmes they participated in during the last invitation round. Additionally, using the Fingertips database curated by Public Health England, we explored area-level correlations between participation in the three cancer screening programmes and various population characteristics for all 7014 English general practices with complete data. Results
Of the 3060 women, 1086 (35%) participated in all three programmes, 1142 (37%) in two, 526 (17%) in one, and 306 (10%) in none. Participation in all three did not appear to be a random event (p less than 0.001). General practices from areas with less deprivation, with more patients who are carers or have chronic illnesses themselves, and with more patients satisfied with the provided service were significantly more likely to attain high coverage rates in all programmes.
Only a minority of English women is concurrently protected through all recommended cancer screening programmes. Future studies should consider why most women participate in some but not all recommended screening.
Statistics from Cancer Research UK show that in 2015 there were around 2,500 new cases, and nearly 700 deaths attributable to cervical cancer, in England. The overall age standardised incidence rate has been declining since the 1990s, however incidence is increasing in younger women.
Cervical cancer is 99.8% preventable through the cervical screening and the human papilloma virus (HPV) vaccination programmes. A cervical screen collects cells from the cervix to be tested for abnormalities. In 2019, primary HPV testing will also be introduced as part of the screening process.
Most cases of cervical cancer are linked to HPV and the vaccine, currently offered by the NHS for free to girls aged 12 and 13 in UK schools, protects against the most of the virus strains responsible. The national HPV vaccination programme has successfully reduced infections of HPV type 16/18 in 16-21 year old women by 80%.
This report presents information about the NHS Cervical Screening Programme in England in 2016-17. It includes data on the call and recall system, on screening samples examined by pathology laboratories and on referrals to colposcopy clinics | NHS Digital
• At 31 March 2017, the percentage of eligible women (aged 25 to 64) who were recorded as screened adequately within the specified period was 72.0 per cent. This compares with 72.7 per cent at 31 March 2016 and 75.4 per cent at 31 March 2012.
• A total of 4.45 million women aged 25 to 64 were invited for screening in 2016-17, representing an increase of 5.6 per cent from 2015-16 when 4.21 million women were invited.
• In total, 3.18 million women aged 25 to 64 years were tested in 2016-17, an increase of 2.9 per cent from 2015-16 when 3.09 million women were tested.
• Of samples submitted by GPs and NHS Community Clinics, 94.8 per cent of test results were returned Negative.
• 8.8 per cent of patients did not attend colposcopy appointments and gave no prior warning.
Attendance for cervical screening has been falling year on year. This professional resource from Public Health England aims to address this decline in attendance by presenting recommendations that can help increase access to screening and awareness of cervical cancer.
Download the infographics, references and a shorter version of this publication here
Concurrent chemoradiotherapy (CCRT) is the standard treatment for local advanced cervical cancer. However, for elderly patients, studies are limited and the outcomes are controversial | BMC Cancer
Methods: We retrospectively analyzed the elderly cervical cancer patients treated with radical RT or CCRT between January 2006 and December 2014. For external beam radiotherapy, 50Gy in 25 fractions or 50.4Gy in 28 fractions were delivered via 3-dimensional conformal radiation therapy or intensity modulated radiation therapy. High-dose-rate intracavitary brachytherapy was performed with a dose of 30-36Gy in 5–7 fractions to point A. Concurrent chemotherapy regimens included weekly cisplatin and paclitaxel.
Conclusion: Elderly cervical cancer patients could tolerate radical RT and CCRT very well and get a favored survival. Compared with RT, CCRT could improve the survival of elder cervical cancer patients with similar nonhematological toxicity. CCRT should be considered in elderly cervical cancer patients.
Illustration showing an artists interpretation of a Cervical cancer cell
The NHS in England is introducing a “superior” test for cervical cancer, following a successful pilot programme. Experts say it is a switch that could pick up an extra 600 cancers a year.
Women invited for a routine smear test will now automatically be checked for an infection called HPV (Human Papilloma Virus), which has been strongly linked to cervical cancer. Until now, an HPV test has only been done if doctors noticed abnormal cells in the smear sample.
Public Health Minister for England Jane Ellison said: “These changes are a breakthrough in the way we test women for cervical disease. The new test is more accurate, more personal and will reduce anxiety among women.
Justin A. Bishop and Patrick K. Ha. Cancer. Published online: 17 March 2016
Image shows a high power view of squamous mucosa of the cervix, with mild abnormalities related to human papillomavirus (HPV) infection.
It is increasingly important to identify the presence of human papillomavirus (HPV) in patients with oropharyngeal squamous cell carcinoma, because HPV status is now useful for clinical trial stratification, prognostic determination, diagnosis in patients with neck masses, and identification of the primary tumor site. Therefore, it is important that the technique used for identification be feasible, accurate, reproducible, and cost effective. The authors summarize these aspects of HPV detection and the use of newer digital polymerase chain reaction technology for this purpose.
European Journal of Cancer: November 2015 Volume 51, Issue 16, Pages 2375–2385
Population coverage for cervical cancer screening is an important determinant explaining differences in the incidence of cervical cancer between countries. Offering devices for self-sampling has the potential to increase participation of hard-to-reach women.
A systematic review and meta-analysis were performed to evaluate the participation after an invitation including a self-sampling device (self-sampling arm) versus an invitation to have a sample taken by a health professional (control arm), sent to under-screened women.
Sixteen randomised studies were found eligible. In an intention-to-treat analysis, the pooled participation in the self-sampling arm was 23.6% (95% confidence interval (CI) = 20.2–27.3%), when self-sampling kits were sent by mail to all women, versus 10.3% (95% CI = 6.2–15.2%) in the control arm (participation difference: 12.6% [95% CI = 9.3–15.9]). When women had to opt-in to receive the self-sampling device, as used in three studies, the pooled participation was not higher in the self-sampling compared to the control arm (participation difference: 0.2% [95% CI = −4.5–4.9%]).
An increased participation was observed in the self-sampling arm compared to the control arm, if self-sampling kits were sent directly to women at their home address. However, the size of the effect varied substantially among studies. Since participation was similar in both arms when women had to opt-in, future studies are warranted to discern opt-in scenarios that are most acceptable to women.