Summary
Early detection and treatment of pre-cancerous changes is 98% effective
The screening programme has been effective in decreasing both the rate of
cervical cancer and the death rate from cervical cancer.
All women aged 20-69 years who have ever been sexually active should have a
smear every 3 years
If you have abnormal cervical cells you will have more frequent smears and may
be referred to a specialist
The Long Version !
Why screen?
Unlike most cancers the most common type of cervical cancer - squamous cell carcinoma - is largely preventable. Cells in the cervix go through changes, which if not detected and treated may develop into cervical cancer in some women. Cervical cancer takes on average 10 - 15 years to develop. A cervical smear test can detect changes in the cells of the cervix. The success rate for adequate treatment of abnormal cervical cells, also called pre-cancerous changes, is around 98 per cent effective. As with all screening tests there is a small chance that some abnormalities may not be detected at a single screen. This is why it is important to have regular three-yearly cervical smear tests.
Who needs cervical screening?
All women aged 20-69 years who have ever been sexually active. The usual screening interval is every three years for women with normal smear results. The women most likely to develop cervical cancer are those not regularly screened. What is the National Cervical Screening Programme (NCSP)? The National Cervical Screening Programme was the first organised cancer screening programme in New Zealand. It was established in 1990, by the then Department of Health, to reduce the incidence of and mortality from cervical cancer through a nation-wide ongoing organised screening programme that would detect the majority of cases in the early precancerous curable stage. The NCSP encompasses health promotion, smeartaking, laboratory analysis of cervical smears and cervical biopsies and management of women with abnormal smear results. The NCSP is delivered to New Zealand women by a range of providers including health promoters, general practitioners, gynaecologists, nurse and lay smear-takers, family planning centres, midwives and laboratories. Regional co-ordination of the NCSP, which includes the operation of the National Cervical Screening Register (NCSR), is managed through 14 sites linked to a central database. A total of 421,427 smears were taken from 395,185 women in 1999. The recruitment focus of the NCSP is on women aged 20-69 years who have never had a smear or whose previous smear was more than five years ago. Women aged over 50 years and Maori and Pacific women of all ages are priority groups in the programme. What is the aim of the programme? The aim of the programme is to reduce the incidence of and mortality from squamous cell cancer of the cervix. The number of women developing and dying from invasive cervical cancer has declined since the 1990s, and much of this decline can be attributed to the NCSP. Age-standardised mortality rates for cervical cancer have declined from 4.9 per 100,000 in 1988 to 2.9 per 100,000 in 1997. One of the targets set by the Ministry of Health was to enrol 85 per cent of eligible women on the NCSR by the end of 2000, and this was achieved in 1998.
How does the NCSP work?
Cervical smears are sent by smeartakers to laboratories for analysis. The laboratory reports the result to the smear-taker and sends it to the National Cervical Screening Register (NCSR). A ‘welcome’ and results letter is sent to a woman after the NCSR receives her first smear, thereafter she will be sent a result letter only if her smear result is not normal. If a woman is overdue for her smear the NCSR will send her a reminder letter. The NCSR sends a number of reports to smear takers to aid them, including a recall report, which reminds them of women due for cervical smears. Women can contact their local NCSR site to inquire if they are enrolled or for any other information about their cervical smears. What is the National Cervical Screening Register (NCSR)? The NCSR is a key management tool of the NCSP. It is a stand-alone system that records and provides information to assist individual women and their smear-takers with appropriate follow up, as well as providing data for monitoring and evaluation. Provided they do not "opt off" it should contain a complete smear history for women enrolled in the NCSP. This information is made available to cytology laboratories, smear-takers and the women themselves.
How many women are enrolled on the NCSR?
At the beginning of December 2000, there were 978,586 New Zealand women aged 20 - 69 years enrolled on the NCSP, or some 90.17% of eligible women.
How have cervical cancer rates changed since the NCSP began?
Since the programme began there have been significant reductions in both the rates of disease and deaths from cervical cancer. In the 10 years from 1987 - 1996 cervical cancer incidence rates decreased by 22 per cent. From 1987 - 1996 the death rate for cervical cancer dropped by 43 percent. Age-standardised incidence rates for cervical cancer have declined from 13 per 100,000 in 1988 to 9.2 per 100,000 in 1998. Age-standardised mortality rates for cervical cancer have declined from 4.9 per 100,000 in 1988 to 2.9 per 100,000 in 1997.
What actions have been taken to strengthen the NCSP?
The HFA’s National Screening Team took over the management of the NCSP in May 1998. Following a review of the programme an additional $1.4 million was injected into the NCSP during the 1999/2000 year to strengthen elements of the programme. These areas included improved quality standards, new independent monitoring processes, improved co-ordination between providers and better information for women and training for health educators. The National Screening Team transferred to the Ministry of Health as a separate unit - the National Screening Unit (NSU) - within the Public Health Directorate in January 2001. It is currently being enhanced to have a full staff of 33 to manage the two national screening programmes. What quality assurance mechanisms does the NCSP require from laboratories? In October 2000 the National Screening Unit introduced the NCSP Interim Operational Policy and Quality Standards. The standards were the product of eighteen months work and substantial consultation with women and service providers. Some 6000 copies were distributed to all health providers in the programme including health promoters, smear takers and providers of laboratory and colposcopy services. The document includes 21 laboratory standards which cover a wide range of areas including minimum staffing numbers, training of staff, minimum volumes for laboratories, pathologists and cytotechnologists and other quality control and quality assurance measures. Laboratories will be required to process a minimum of 15,000 cytology smears a year from 1 July 2001. This is viewed as an important factor in ensuring quality of care for women enrolled in the programme. A review of the interim standards will be commenced within a year to take into consideration any issues that may arise for providers during this time and the Gisborne Report.
What external expert advice does the NCSP draw upon?
A multi-disciplinary Expert Advisory Group to the national cancer screening programmes was established in December 1998. Its purpose is to provide expert advice on strategic policy issues and programme monitoring and evaluation as well as other technical advice when required. Importantly this group provides a consumer perspective to ensure the needs of women using the programme are met.
What monitoring is in place for the NCSP? An Independent Monitoring Group was contracted in September 2000. It has commenced routine monitoring of the NCSP and will provide its first quarterly monitoring report in May 2001. Routine monitoring of the NCSP will ensure providers are meeting standards and will enable identification and resolution of problems at an early stage.
For further information: http://www.healthywomen.org.nz
