Clinical update

RCN urges nurses to encourage cervical screening tests

New RCN guidelines advise nurses to encourage eligible women to access cervical screening tests

New RCN guidelines advise nurses to encourage eligible women to access cervical screening tests


Picture: Science Photo Library

Essential facts

Cervical cancer affects 3,200 women in the UK each year, leading to around 900 deaths. It is generally preventable. The primary cause is persistent or chronic infection with human papillomavirus (HPV). HPV infection is a normal consequence of sex and in most women will not cause harm. For a minority of women, it leads to abnormal or pre-cancerous changes to the cervix, which, if not treated, may progress to cancer ten to 20 years later. The HPV vaccine programme was introduced in September 2008 for girls age 12–13 years, but does not completely eradicate risk.

What’s new

Nurses are urged to encourage women to access cervical screening tests in new RCN guidance on HPV and cervical cancer. The clinical professional resource supports informed and sensitive care with an overview on HPV, vaccination recommendations, cervical screening programmes, cervical cancer and colposcopy. Across the UK, one in four eligible women age 25-64 do not take up their smear test invitation, according to Jo’s Cervical Cancer Trust charity.

Signs and symptoms

There are no visible physical signs of high-risk HPV, it can only be diagnosed by undergoing specific tests. Cervical cancer often has no early stage symptoms. The most common is unusual vaginal bleeding, which can occur after sex, in between periods or after the menopause.

Causes and risk factors

High-risk HPV is the cause of 99.7% of all cervical cancers. Condoms and other barrier methods reduce risk, but do not eradicate it. Taking the contraceptive pill increases risk, as does having HIV, not attending smear tests, having a compromised immune system and smoking. Younger women and women who have had children are at higher risk. Exposure to diethylstilbestrol, a man-made form of oestrogen given to pregnant women between 1945 and 1970 to reduce miscarriage risk, also increases risk.

How you can help your patient

Regular cervical screening will pick up the changes which could progress to cancer. All nurses who come in contact with women aged between 25 and 64 should be encouraging them to get screened. In England in 2015-2016, only 72% of eligible women were screened. Many women feel uncomfortable about a smear test so the environment should feel private, warm, secure and comfortable and should contain changing facilities. The examination should take place in a closed room that cannot be entered while screening is in progress. Women should be offered a chaperone.

Expert comment

Debby Holloway, nurse consultant in gynaecology at Guy’s and St Thomas’ NHS Foundation Trust and chair of the RCN women’s health forum committee

‘Human papillomavirus (HPV) and cervical cancer are complicated subjects, and the screening programme has recently changed, and will change again either later this year or next year.

'It is easy to see why, among patients and nurses, there can be confusion on these subjects, so this guidance is intended to set out clearly the facts around HPV, cervical cancer, vaccination, screening and colonoscopy.

'Any nurses involved with screening should be fully up to date on the latest screening guidance, but any nurses involved with women’s health are likely to be asked questions around HPV and cervical cancer, and need to know the basics.

'There are a lot of myths, particularly in the media, around HPV vaccination that nurses can help correct. Nurses should take opportunities to promote screening, and positive health messages such as stopping smoking, as those who smoke cannot clear the HPV infection as well as those who don’t.’

 

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