Module 4: Cervical and breast screening

We are going to look at cervical and breast screening. The main focus will be on cervical screening as breast screening will be covered in more depth in your campus based learning block during the all day Interdisciplinary Women's Health seminar series.

You will also have already gained both practical experience of speculum examination and covered the importance of communication and interpersonal skills in your GTA (Gynaecology Teaching Associates) teaching.  It is sometimes more difficult for males to obtain experience in intimate examinations of women and it is important that clinicians always have a chaperone present during these. As students you must always have a senior staff person present when doing intimate exams. When you do get the opportunity during this attachment to examine women make sure that you document what you have done in your log book in clinical examinations area.

You might also like to have a look again at your GTA booklet which is available on Canvas GTA Booklet.

What causes cervical and breast cancer? We don't really fully understand the answer to that question for breast cancer but we will be looking at some of the risk factors. However we now know that most cervical cancers are caused by oncogenic subtypes of Human Papilloma Virus (HPV). The subtypes mainly implicated  are 16 and 18. We will be looking at some of the research around this during this week and talking about the HPV vaccine.

We are due to have a change regarding cervical screening in NZ- from 2020 NZ will change how it goes about cervical screening. It will now be 5 yearly instead of 3 yearly and will look for oncogenic HPV as the first screening tool. More information about this is available on the NSU website at HPV primary screening. 

Screening programmes for both cervical and breast cancer are in place in New Zealand. We will also be looking at the National Screening Unit website to give us further information

If you would like to have a look at a brief review of the first 10 years of cervical screening then Cervical screening in New Zealand - a brief statistical review of the first decade gives a good overview. 

The earliest cervical screening programme was started in Norway in 1959. Although cervical screening was being promoted in New Zealand in the 1950's the actual National Cervical Screening Programme (NCSP) wasn't launched until 1990. Since then there has been a 40% decrease in the incidence of cervical cancer.

Screening for breast cancer is carried out by BreastScreen Aotearoa and commenced in December 1998. In the first two years more than 58 per cent of eligible women have had mammograms through BreastScreen Aotearoa (BSA). During the same period 1184 cancers have been detected through the programme.

There are obviously some criteria that need to be met before implementing a screening programme  for a disease. This table below gives you the WHO criteria.

Cervical screening fits the WHO screening guidelines. Cervical cancer is preceded by cellular changes which can be detected by taking a sample from the cervix. Treating the abnormalities leads to the reduction in cervical cancer. With screening the chances of getting cervical cancer decreases to 1/570 women from 1/90 women without screening. Similarly with screening the chances of dying from cervical cancer decreases to 1/1280 women from 1/200 women without screening.

Objectives

Cervical Screening Guidelines

Readings