Cervical screening
3.14 Cervical screening identifies cervical abnormalities which, if left untreated, may develop into cervical cancer. It is not a test for cancer.
Screening was first introduced in the late 1960s but it was not until 1988 that comprehensive call and recall was introduced. All women aged 20 to 64 are invited for a smear test at least once every five years.
3.15 The cervical screening programme in this country is a success story. Since introducing computerised call and recall, the coverage rate of the screening programme has gone up to a national average of 85%. Four million women benefit from cervical screening each year and the cervical cancer death rate has been falling by 7% a year.
3.16 However in laboratories, the screening process is a repetitive, difficult task and mistakes have been made which have not been identified until too late. It is difficult to recruit screening staff and morale is low. Laboratories are stretched and in some places there are long delays in getting smear test results.
Developments in cervical screening
3.17 New developments in technology may help address these problems and improve the quality of screening. On the recommendation of NICE, pilot studies will begin in 2001 to assess the potential of liquid based cytology (LBC) techniques, where the cells from the cervix are preserved in a chemical solution instead of smeared on a glass slide. NICE will review the outcome of the pilots and will advise on the national introduction of these techniques in 2002.
3.18 The LBC pilots will also be assessing the feasibility of using a test for the Human Papilloma Virus (HPV), which is known to be implicated in over 99% of cases of cervical cancer, as a means to identify those women with mild or borderline abnormalities that should undergo further assessment.
3.19 New investment in pathology services will benefit the cervical screening programme. Over the last two years, the Pathology Modernisation Fund has allocated over £250,000 to cervical cytology projects. More modern screening techniques are likely to require laboratories to screen a higher volume of tests and NHS Trusts will need to keep the service provision for cervical screening under review to ensure optimal service delivery.
3.20 The results of the liquid based cytology pilot will be known in 2001 and the HPV pilot in 2002. If evaluation proves that the pilots are successful, and if recommended by NICE, the government will fund their introduction across the NHS.
Cervical screening workforce
3.21 The NHS Plan set out action to support and develop NHS staff. Cervical screening staff are an important group and we will be investing to support their continuing development. A four-tier skill mix model is under development which will encompass all grades. It will explore the potential for an advanced practitioner grade which will lead to a more flexible workforce. The cytology screening qualification is being examined to see if there is potential for screening staff, with additional study and training, to become state-registered biomedical scientists of whom laboratories are also in need. Chapter 8 sets out action to review pay scales for scientific staff and others.
