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Gill Burgess: Decline in cervical cancer screening uptake is risking lives

Latest figures showing a further drop in screening coverage in England make increased diagnoses and mortality a real threat, says helpline coordinator of a cervical cancer charity Gill Burgess. 
further decline in cervical cancer screening

Latest figures showing a further drop in screening coverage in England make increased diagnoses and mortality a real threat, says helpline coordinator of a cervical cancer charity Gill Burgess

Latest figures, released this month, show cervical screening coverage in England has dropped once again and is now at 72.7%. This means 1.12 million of the 4.2 million women invited for screening during 2015-16 did not attend, significantly increasing their risk of cervical cancer.

Attendance has fallen across every age group and almost every local authority, and mirrors a worrying pattern of declining attendance in Scotland and Wales.

Cervical screening can prevent 75% of cervical cancers, so if the number of women not attending continues to rise, then increased diagnoses and even mortality are a real

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Latest figures showing a further drop in screening coverage in England make increased diagnoses and mortality a real threat, says helpline coordinator of a cervical cancer charity Gill Burgess


The ability to make patients feel at ease and better informed about the
procedure is paramount. Picture: iStock

Latest figures, released this month, show cervical screening coverage in England has dropped once again and is now at 72.7%. This means 1.12 million of the 4.2 million women invited for screening during 2015-16 did not attend, significantly increasing their risk of cervical cancer. 

Attendance has fallen across every age group and almost every local authority, and mirrors a worrying pattern of declining attendance in Scotland and Wales.

Cervical screening can prevent 75% of cervical cancers, so if the number of women not attending continues to rise, then increased diagnoses and even mortality are a real threat.

Practice nurses undertake the vast majority of screenings, and so the ability to make patients feel at ease and better informed about the procedure is paramount. It is just as important that nurses are well informed, have regular training and are up to date with the reasons that women do not attend.

Time for conversation 

Before a woman enters the consulting room, the nurse should ensure all preparations have been made in advance to put the patient at ease. Many women worry someone will come in during their appointment, so ensure you lock the door and explain why.

75%

The proportion of cervical cancers that can be prevented by cervical screening

Take time to have a conversation to ensure your patient is fully informed and understands why screening is important. Discuss the role of the human papillomavirus (HPV), stressing it is common and in most cases will clear on its own. Explain what is meant if HPV or abnormal cells are found and what the next steps could be and use images if needed to demonstrate.

Ask your patient about previous experience of screening and use the HMR101 form as a prompt. Discuss any symptoms she may be experiencing and her sexual health history.

Be mindful of for signs of fear or uncertainty. This is crucial, especially if the patient had a previous bad experience. Many patients feel embarrassed about screening, so make sure they have privacy to undress and prepare.

If your patient is peri or post-menopausal, she may suffer from vaginal dryness, which may cause pain. Consider suggesting a course of vaginal oestrogen and refer to the NICE Guideline NG23 Menopause: diagnosis and management.

Comfortable setting 

Be mindful of changes in body language or facial expressions while you are taking the sample, and talk through what you are doing. Afterwards, allow the patient privacy to dress and take time to explain when she will get her results and where she can go for further information.

The reduction in screening at sexual health clinics and reduced public health budgets have almost certainly contributed to falling coverage. Holding a monthly screening clinic out of hours could enable you to reach non-attenders and give practice nurses further experience in this area.

Jo’s Cervical Cancer Trust  offers information and support for all women, from those who are worried about cervical screening to those facing a terminal diagnosis. This includes a helpline, online information and printed resources that are free to order.

It is essential that more women start taking up their screening invitation and as a nurse you can help by making the experience as comfortable as possible. If a woman has a bad experience, they may leave the screening programme, and that is something we cannot afford.

The reasons why women do not attend cervical cancer screening include:
  • Feeling uncomfortable in a surgery environment.
  • Fear of something being wrong.
  • Embarrassment.
  • Cultural or language barriers.
  • Lack of understanding about screening. 
  • Not thinking it is relevant, for example some lesbian or bisexual women.
  • Thinking screening is not necessary following HPV vaccination.
  • Experience of sexual abuse.
  • Previous bad experience of screening.
  • Experience of genital mutilation.
  • Women with learning difficulties.
  • Experiencing pain post menopause.

 


Gill Burgess is a nurse and helpline coordinator at Jo’s Cervical Cancer Trust 

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