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Case History

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Image not available. A 28-year-old actress attends a consultation for contraception. She has never had a smear, as since leaving home at the age of 18 years she has never been in one place long enough to have a residential address, and has always consulted doctors for immediate problems with no proactive health planning. She is a non-smoker and uses condoms and an intrauterine contraceptive device, since in the past she has had two terminations of pregnancy.

What are the cervical screening programmes and risk factors for cervical cancer?

What are recommended screening frequencies?

What is patient care when taking a smear?

How can cervical cancer be prevented with human papillomavirus (HPV) vaccines?

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Background

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What are the cervical screening programmes and risk factors for cervical cancer?

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Image not available. Worldwide, about 500 000 cases of cervical cancer are estimated to occur each year,1 over 80% of which occur in developing countries where neither population-based routine screening (e.g. Papanicolaou smear test) nor optimal treatment are available. Risk factors for cervical cancer are detailed in Table 41.1.

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Table Graphic Jump Location
Table 41.1Risk factors for cervical cancer
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Screening is, by definition, the examination of asymptomatic individuals in an attempt to identify pre-invasive disease, early disease or the risk factors for a disease. Cervical screening programmes vary worldwide and in some countries there are none. In England, where there is a cervical screening programme, cervical cancer incidence fell by 42% between 1988 and 1997 in England and Wales.2 An analysis of trends in mortality from cervical cancer before and after cervical screening was introduced in England suggests that up to 4500 lives are saved each year as a result of screening.3 Nevertheless, 927 deaths from invasive cervical cancer were registered in 2002.

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What are recommended screening frequencies?

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Controversy remains over the most appropriate screening interval. Annual screening is common in the United States and five-yearly screening is offered in some European countries. In England, the current recommendations comprise a first invitation at 25 years of age, interval screening three-yearly from age 25–49, and five-yearly from age 50–64 years. In Scotland, the recommendations differ in that all women over the age of 20 years are invited every three years until the age of 60 years. By screening every five years, the incidence of the disease falls by 84%. Reducing the screening interval to three-yearly leads to a further reduction in incidence of cervical cancer of 91%. Women who have never been sexually active have an ...

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