Cervical Cancer Screening

Cervical Cancer Screening

Cervical smears are usually taken in primary care as part of the cervical screening program. This is available to women aged 25 to 64 in England. Women aged 25 to 49 receive invitations every 3 years and women aged 50 to 64 receive invitations every 5 years.

Patients who need follow up following an abnormal smear are referred directly to colposcopy clinics by the laboratory (outside of e-referral).

Cervical Screening Information leaflets are available in English, Arabic, Bengali, Simplified Chinese, Traditional Chinese, French, Gujarati, Polish, Portuguese, Punjabi and Urdu.

This leaflet is also available in an Easy Read format.

Cease or Defer Cervical Screening

Overview

CSAS provides Prior Notification Lists (PNLs) to GP practices either hardcopy via post or electronically via Open Exeter approximately 10 weeks before patients’ cervical screening tests are due. Practices need to review the PNLs and identify any patients who shouldn’t be screened.

Please use the PNL guide to help GP practices access and update ePNLs and Non Responders on Open Exeter.

GP Practices can delay screening due to the patient:

• Being pregnant
• Having had a recent test
• Currently under cytological follow-up

Women can be removed from the screening programme:

• By informed choice – a signed Disclaimer form is required
• If they are aged over 65
• If they have no cervix
• Under the Mental Capacity Act
• If they are undergoing radiotherapy

Pregnancy

If called for a routine screening test in pregnancy this should be deferred until at least 3 months post-partum.

Pregnant patients referred with an abnormal screening test should ideally attend colposcopy in the late first trimester or early 2^nd trimester unless clinical contraindication.

Patients with previous abnormal colposcopy who become pregnant should NOT delay follow-up in colposcopy.

If a pregnant patient requires colposcopy or screening after treatment (or follow-up of untreated CIN 1) this may be delayed until after delivery.

It is very important that patients referred to colposcopy who are pregnant inform the colposcopy clinic.

The following groups should attend for smears in pregnancy;

1. Post-LLETZ treatment patients –some of these patients can be deferred colposcopy clinic will advise
2. HIV positive patients
3. Patients who are overdue screening

Notify CSAS of Cease or Defer

GP Practices should submit Cease and Deferral requests via Open Exeter to CSAS before the cut off shown on the Open Exeter Prior Notification List (PNL) to avoid inappropriate invitations.

Women can be ceased via Open Exeter for reasons of: Age or No Cervix.

They can be deferred for reasons of: Recent test, current pregnancy, patient wish to defer or under treatment relevant to screening.

Please ensure the deferral period does not exceed 18 months.

For any other reason to cease or defer, which you are unable to submit via Open Exeter, a cease or deferral form should be completed.

These forms can be found on EMIS and should be submitted via the CSAS Contact Us page by clicking on the Delay/Defer button and following the instructions.  A confirmation request will then be received.

• Ceasing from the Cervical Screening Programme
• Ceasing from the Cervical Screening Programme - Mental Capacity Act (MCA)
• Informed Consent for withdrawal from the Cervical Screening Programme
• Reinstate into Cervical Screening Programme
• Cervical Screening Programme Deferral

Referring to Secondary Care for Cervical Screening

Most women/people with a cervix can have their cervical screening sample taken in primary care but there is a group of individuals for whom this is difficult. There is no set guidance for the number of attempts at screening that need to be made in primary care before referral, if an experienced sample taker has been unable to view the cervix and so take the sample then the patient “could” be referred after one failed attempt. If the sample taker is not experienced or there are patient factors on the day that have made it difficult to take the sample then it is reasonable for the women to be rebooked in primary care for a second attempt before onward referral to colposcopy.

Patients may find having a cervical screening sample taken difficult for a number of reasons, there are useful cervical screening resources that can be shared with patients as well as reasonable adjustments that can be made such as a longer appointment or bringing a companion. For peri/post menopausal women use of vaginal oestrogens for a minimum of 6 weeks before attempting to retake a cervical smear can significantly help (as long as not contraindicated). For patients who have a history of trauma where intimate examination is difficult, consider referral to psychosexual counselling team.

Easy Read and Other Formats

Reasonable adjustments are a legal requirement under the Equality Act (2010). Examples of reasonable adjustments in cervical screening include:

• Offering double appointments.
• Offering pre-visits for familiarisation.
• Sending easy read invitation letter or an easy read leaflet or easy read result letters.
• Being accompanied by a family member or support worker.
• Consideration of mobility issues e.g., hoist, bariatric equipment, standing aids.
• Consideration of trauma informed approaches to cervical screening after sexual violence.

If you need support or advice and guidance about supporting a patient with a learning disability, contact the Adult Learning Disability Health Service on 0300 124 5888 or sirona.bcldtadviceline@nhs.net

You can also view the population screening timeline poster with contact details for Bristol, North Somerset and South Gloucestershire.

An Easy Guide to Cervical Screening

What is Cervical Screening

Having a Smear Test

Jo's Cervical Cancer Trust - The Smear Test Film

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.