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Regular screening best weapon to stop cervical cancer in its tracks

Experienced research nurses, Tina Pritchard and Donna Roberts explain how research at  Saint Mary's Hospital is supplementing regular smear tests in the fight against cervical cancer.

Did you know that cervical cancer is the third most common cancer in women?
Over 3,000 women are diagnosed in the UK each year, but since routine screening was introduced by in the 1980s, rates of cervical cancer have halved in women who attend their regular smear appointments.


Rates of cervical cancer halved as a result of regular smear

In the UK, women aged 25-64 years are invited to have a cervical screening examination, usually either every three or five years depending on their age.  Research nurse, Donna describes the procedure: "A smear test takes a sample of cells from the cervix and checks them for abnormalities in the laboratory. Changes to cells on the surface of the cervix are common and treatment is generally straight forward. The standard clinical treatments for dealing with abnormal cervical cells are generally straight forward and can be provided in the clinic. They include LASER therapy, loop excision, cryotherapy (freezing treatment) and cold coagulation (heat treatment).

"Most cervical cancers are caused by high risk types of the human papilloma virus (HPV)," adds Donna who specialises in colposcopy.  "HPV can cause the cells to become abnormal over time (pre-cancerous cell changes). The colposcopy examination allows the cervix to be examined in more detail and treatment for the abnormal cells can be performed if necessary."

Saint Mary's Hospital recently introduced new  Zedscan technology, to provide more accurate detection of significant changes than standard colposcopy. This technology also means that we can provide greater reassurance for those women that do not need treatment. TRUSTECH our innovation service provider has been working with gynaecologists, the company Zilico and the Greater Manchester Academic Health Science Network to evaluate and introduce the technology into the NHS.

Women at Saint Mary's Hospital are also currently involved in an international study, which is evaluating the effectiveness of a HPV vaccine, in women diagnosed with specific high risk types of HPV infection. Tina, whose role is funded by the National Institute for Health Research (NIHR), explains:

"There are HPV vaccines already available to reduce the risk of HPV occurring, as part of the NHS Childhood Vaccination Programme.  This new vaccine, which is potentially a very exciting development, is different as it is intended to clear the infection in women with HPV and reduce the risk of their condition progressing to cervical cancer."

Survival outcomes for women with early cervical cancer are good

Although smear abnormalities are quite common, these days very few women develop cervical cancer thanks to them being picked up by the smear test and treated early.  In the small number of women who are unfortunate enough to get cancer, survival outcomes are generally good, so our research is now focused on improving quality of life.

Where cancer is identified, doctors may recommend a hysterectomy, where the whole of the womb is removed.  Through our research we are currently investigating an alternative approach to hysterectomy through the SHAPE study, which is funded by Cancer Research UK and supported by the NIHR.

The SHAPE study is investigating whether an ordinary or "simple" hysterectomy and removal of nearby lymph glands in the pelvis, could be an alternative to the more extensive or "radical" hysterectomy and pelvic gland removal, which has been the more traditional treatment for women that have early cancer of the cervix.  There is already some evidence that the "simple" type of hysterectomy is as good as the traditional treatment for small and very early cancers. Doctors believe that by doing a less extensive hysterectomy women may recover better with fewer long term side effects and a better quality of life overall and the study will investigate this.

"We recommend that women attend for regular cervical screening when they are invited which is usually 3-5 yearly.  Women should also visit their GP promptly if they have any abnormal discharge or bleeding.  Cervical screening and HPV testing has revolutionised gynaecological care for women over the past 30 years, and we are proud to be working at the forefront of improving outcomes further through research."

Tina and Donna.