Cervical Issues Annual update 2010 Tamsin Groom • • • • Overview of screening and management Do’s and Don’ts The “suspicious cervix” Quiz Screening • Why? Screening • To identify precancerous lesions • Allow early detection and prevention of progression to cancer • SCSP started 1988 • Incidence of cervical cancer has fallen by 47.7% (1986 to 2005) • 20-60 only (3 yrly) Current Screening management Negative, after borderline Further repeat at 6 months Return to routine recall after 2nd negative. Negative, after mild Further repeat at 6, & 18 months Return to routine recall after 3rd negative Unsatisfactory 3 month recall. Refer after third in succession Borderline Squamous Changes +/- 6 month recall. Refer after third. HPV Borderline ?High grade – Flag as such and Refer to Colposcopy on 1st. Borderline Glandular Changes 6 month recall. Refer after second. Current Screening management Mild dyskaryosis Repeat in 6 months. Refer after second. OR Refer to Colposcopy on 1st 3 abnormal results within the last 10 years, refer to colposcopy 2008-09 • 116,000 smears • 9.9% abnormal (excluding unsatis) Unsatis rate approx 2.5% 1309 smear in <20s Why? 1 revealed severe dyskaryosis Negative 90.1 Borderline 6.2 Mild 2.3 Mod/Severe 1.2 Incidence of Cervical Cancer GG&C Age range 2007 2008 20-29 7 9 30-39 29 21 40-49 20 14 50-59 3 11 60-69 5 5 70-79 2 2 80+ 1 3 67 65 2004-8 36 women aged 20-24 diagnosed in whole of Scotland, 1 aged 15-19 (1471 in total) Cervical Cancer Incidence (European Age Standardised Rates) Females of All Ages, Scotland 1975 - 2007 20 17.3 18 16 EASR per 100,000 14 12 10 Baseline 1986 8 6 8.9 4 2 0 1975 1977 1979 1981 1983 1985 1987 1989 1991 Year 1993 1995 1997 1999 2001 2003 2005 2007 Comparison with HPV 6/11 C h art 4: N e w d iag n o se s o f g e n ital warts in 16-45 ye ar o ld s b y ag e an d g e n d e r, 600 1998 Ma le s 550 Fe m a le s 500 N um be r of dia gnos e s 450 400 350 300 250 200 150 100 50 0 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 Age Comparison with HPV 6/11 Chart 4: New cases of genital warts in 16-45 year olds by age and gender 2008 Males Females 600 550 500 Number of diagnoses 450 400 350 300 250 200 150 100 50 0 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 Age Ectopy Cervical Cancer And again Do’s and Don’ts • • • • • PCB in young women Heavy bleeding during smear taking DO take a Sexual history DO take a chlamydia/GC swab DO treat chlamydia & review before referral. • Do consider changing contraceptive method if on COCP/condoms Do’s and Don’ts • • • • ECTOPY Do refer if symptomatic Do refer if concerned re appearance Not if asymptomatic Other cervical appearances Other cervical appearances • • Prolapsed fibroid polyp • • • Nabothian follicles/cysts • Normal finding • No action required • • • • • Cervical polyps Removal?..symtomatic/other Easy to remove…in surgery? Yes if small, polyp forceps and silver nitrate sticks • Not in pregnancy! • • Chlamydial cervicitis • Screen, treat and review • • • Herpetic cervicitis • Not seen often as may have external lesions • Unwell, highly symtomatic…not consistent with cancer • Can cause frank necrosis • Treat and review • • • • Cervical wart Treat external warts Stop smoking Review after resolution of others…refer if still present • No others, young review in 3/12 • No others over 30 refer • • Endometriotic nodule • Do nothing unless symptomatic Questions?