1.0 patient’s vagina which widens it to allow

1.0 Introduction: The need for cervical screening

Cervical screening is a type of medical examination that involves taking and analyzing cell samples from the cervix. The main objective of the screening is to detect early changes on the cells, before they become cancerous cells.

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1.1 Methods of cervical screening

There are two methods of a cervical screening test. One is a basic physical examination of the pelvis to check for symptoms like abnormal vaginal bleeding whereas the other involves testing for human papillomavirus (HPV), pap smear test and liquid based-cytology.

A more traditional analysis is the pap smear test, whereby a speculum is inserted into a patient’s vagina which widens it to allow access to the cervix. Then, a sample of cells is collected by scraping the outer opening of the cervix with a spatula. The sample is placed onto a microscope slide and sent to the lab for further examinations.

Liquid-based cytology (LBC) is the more primary screening test which works quite similar to the pap smear test with the differences being instead of a spatula, the cells are collected with a small brush. The head of the brush is then broken off and inserted in a small pot of liquid before it is sent to the lab. The tests takes about 5 minutes and patients would have to wait for about 3 weeks before the results can be obtained.2

1.2 Abnormal results

An abnormal result does not indicate the presence of cancer itself but rather reveals that cell changes were found on the cervix which are often due to HPV. They can either be low-grade (minor) cell changes due to cervical erosion or ectropion which is common among contraceptive pill users and pregnant women owing to some slight bleeding after sexual intercourse that usually resolves by itself without needing further treatment.2

A “high-grade” cell change is more serious as they risk becoming cancerous if they are not remove and thus are known as “precancer”. Results may reveal the presence of cervical intraepithelial neoplasia (CIN) which translates as abnormal skin cell layer covering the cervix. CIN1 is the mildest with only a third of the skin covering the cervix has abnormal cells while CIN 3 is diagnosed for when all the skin covering the cervix has abnormal cells.2

1.3 Importance of cervical screening

If an abnormal cell is detected, it needs to be removed by colposcopy. In 85% of cases, these cells would not come back, thus greatly reducing risks of cervical cancer. HPV testing is crucial in determining the need for a colposcopy among women with “low-grade” cell changes. Apart from that, HPV testing is important to confirm that the human papillomavirus have been completely cleared for women who have had colposcopy, returning them to the normal screening process which avoids them from unnecessary testing.1

3.0 Policy of cervical screening

Screening policies in most European Union member states recommends women aged between 20-30 years old to start their cervical screening, stopping at 60-70 years old. Based on the European Journal of Cancer, cervical screening in Ireland is only eligible for women who have reached 24 years old and the procedure stops at 60 years old. Here, cytology screening is recommended to be done in every 3 years for women aged 25-44 and every 5 years for women beyond that age with the option of adding the HPV test (co-test) along with the cytology screening. Based on the recommended screening schedule, the lifetime number of tests is estimated to be at most 10 times.

3.1  Status, policy and progress in Ireland

Table 1. Annual volume and capacity of cervical cancer screening in Ireland.3

Age eligible national or regional population

Screening programme

Non-programme / all tests

Personally invited per year

Screened per year

Eligible age (years)

Women (x1000)

Screening interval (years)

Women (x1000)

% of target population assuming the scheduled interval

Women (x1000)

% of invited 

Non-programme tests (x1000)

All tests (x1000)

Capacity (%) assuming the scheduled interval

25-60

90

3 & 5

6

27

20

20

89

Based on Table 1, the screening capacity in Ireland is assessed by comparing the number of tests performed with the number of women in the respective targeted populations. The data reveals that even since 2006, Ireland had had an outstanding 89% screening capacity indicating an outstanding competency to accommodate the woman population in Ireland that which seems reasonable considering that their number is relatively low.

Started as an opportunistic testing, Ireland then applied a regional population-based screening programme. It was not until 2008 that Ireland began to implement a nationwide population-based programme in compliance with the recommendation of the Council,5 with a team responsible for the execution of it under a programme called CervicalCheck.1 Though some EU countries had cervical screening policies that were mandated by law, Ireland stood among the many countries that documented such screening policy as an official recommendation. Unfortunately, it is not one of the countries that regularly publishes their programme performance reports. But on a brighter note, in terms of finance, there seems to be no reliance on health insurance as the programme here in Ireland is publicly funded and screening tests as well as diagnostic tests are administered free of charge.

4.0 Challenges and public concern
 
One of the problems arises within the screening process itself. For instance, when inadequate amount of cells are taken, the patient is required to repeat thhe screening procedures which could be bothersome. On occasion, the  cells are unable to be seen clearly due to the infection or inflammation of the cervix or there is presence of menstruation blood.2

4.1 Steps to encourage cervical screening

Hence, the Medical Council emphasizes appropriate and sufficient screening tests at recommended intervals which ensures that women would not have to undergo any unncessary tests, encouraging them to complete their screening tests throughout their lives.

5.0 Conclusion

Cervical cancer does not show any symptoms unless until a women usually reaches her 40s when it is then diagnosed as one. Through screening, any potentially cancerous cells can be identified while it is still small and before it has spread. Therefore, they can be removed and hence, successfully preventing cervical cancer.