Recommendations

Cervical screening

1.  The move from conventional smear-taking to the new liquid-based cytology (LBC) is well underway and should be implemented in all relevant clinical settings as soon as possible. LBC improves the quality of the cell sampling and reduces the need for a repeat check-up.  

2.  Action to increase coverage (percentage uptake by eligible women for cervical screening should be stepped up through an integrated programme encompassing:

• staff training - receptionists, practice managers, practice nurses, GPs
• improving information systems - introduction of electronic ‘prior notification lists’ (PNLs – sent to practices to check accuracy of the screening invitation list)
• specific work with individual practices on coverage
• advocating opportunistic screening.

3.  The impact of the change in age-range of women invited for screening (raising the starting age from 20 to 25) and the change in the interval between invitations on coverage (from 3 yearly to 5 yearly in women aged 50-64) should be monitored.

4.  The proportion of smears done privately or overseas, and which therefore do not appear in our screening coverage figures, should be ascertained. It is likely that Southwark, with its relatively young mobile population, many of whom come from overseas and return there regularly, has a higher proportion of such smears. This would artificially depress our coverage rate.

Breast screening

1.  A web-based package of sample health promotion materials for breast screening (including our local pre-invitation letter, DNA (did not attend) letter and disclaimer) should be promoted among eligible women in Southwark, particularly those in each postcode batch prior to being sent a screening invitation.

2.  A care pathway for women with a family history of breast cancer should be agreed and implemented.