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Cervix Screening Programme

What is cervical screening ?
·      Cervical screening is not a test for diagnosing cervical cancer. It is a test to check the health of the cervix, which is the lower part of the womb (often called the neck of the womb).
·      For many women the test results show that everything is fine.
·      But for around one in 20 women, the test shows changes in cells that can be caused by many things.
·      Most of these changes will not lead to cervical cancer.
·      For women above 30 cervical screening may include testing for the human papillomavirus (HPV). Certain types of HPV can cause abnormal changes in the cervix.
What is HPV ?
The human papillomavirus (HPV) is a very common infection and most women get it at some time in their life. There are many types of HPV, and some types can cause abnormalities in the cervix. In some cases these abnormalities may, if left untreated, go on to develop into cervical cancer. Not all
 
abnormalities develop into cancer however, and in many cases HPV clears up by itself.  This is why HPV testing is not undertaken below the age of 30.
HPV is easily transmitted during intimate sexual contact between partners. This includes intimate contact between men and women, and between partners of the same sex. The virus shows no symptoms. This means you or a partner could have had the virus for many months or years from a previous relationship, without knowing it.
Why are women offered cervical screening ?
Cervical cancer can often be prevented. The signs that it may develop can be spotted early on so it can be stopped before it even gets started.
Many of those who develop cervical cancer  have not been screened regularly. Not going for cervical screening is one of the biggest risk factors for developing cervical cancer.
Should all women have the test ?
We initially offer the test to all women aged between 25 and 35, and will extend the age range later, but cervical cancer is more common if you:
 
·       smoke;
·      first had sex at an early age;
·      have had several sexual partners or have had a sexual partner who has had several other partners; or  
·      take immunosuppressant drugs (for example, after an organ transplant).
 
 
The incidence in the Maltese Islands has been low, but younger age groups are sexually more active.  We are already seeing an increase in the incidence of cervical among the younger ages.
 
Cervical screening under the age of 25 is not recommended, and is considered to do more harm than good.
Ask your family doctor for advice if you:
 
·      have had a hysterectomy;
·      have never had sex with a man or woman; or
·      you are not sure whether you still need to be tested.
 
What is the NSP Cervical Screening Programme ?
The programme makes sure that if you are aged between 25 and 35, you will automatically receive an invitation. We will get your name from national datasets. Your personal information - such as your name, contact details, age, gender, ID number, results of your screening tests, and the name of your doctor is protected by law under the Malta Data Protection Act. (This means it is important that the Screening Centre at Lascaris always has your correct name and address)
 
After your first cervical screen, you will receive invitations every three years. When you reach the age of 50 you will be invited every 5 years.
Who will carry out my test ?
A doctor or nurse will carry out your test. If you would prefer to see a female member of staff, or would like someone with you, please ask when you make your appointment.
 
Will I have to undress ?
We will ask you to undress from the waist down, but if you wear a full skirt you will not have to remove it.
What happens during the test ?
The doctor or nurse will ask you to lie down on a couch. They will then gently put a small instrument, called a speculum, into your vagina to hold it open.
Then, they will wipe a small brush-like device over the cervix to pick up some cells.
They will put these cells into a small container of liquid, and send it away for the cells to be transferred onto a slide and examined under a microscope.
The test takes just a few minutes.
Does the test hurt ?
You might experience some discomfort or pain – try to relax by taking slow, deep breaths as it may hurt more if you are tense. If it is painful, tell the doctor or nurse straightaway as they may be able to reduce your discomfort.
 
 
What about HPV testing ?
We are starting to introduce HPV testing as part of the cervical screening programme. HPV can cause abnormal changes in the cervix. If your screening result shows borderline cell changes or mild abnormalities (known as mild or low-grade dyskaryosis), an HPV test may be carried out on the sample of your cells taken during screening. This will help us decide if you need any further investigation, or if you can simply go back to routine screening in three or five years’ time (depending on your age).
When should I have my screening ?
You should not be tested during your period so try to make sure you get an appointment before or after your period is due. The best time is in the middle of your cycle.
Can I have sex before the test ?
If you use a spermicide, a barrier method of contraception, or a lubricant jelly, you should not use these for 24 hours before the test as the chemicals they contain may affect the test.
When do I get my results ?
When you have the test, the doctor or nurse will tell you how, where and approximately when you will get your results. Make sure you have received this information before you leave the surgery or clinic.
 
 
What about my HPV results ?
If you have a screening result showing borderline cell changes or mild abnormalities, then your screening sample may be tested for HPV. If your sample is tested for HPV, then you will get this result at the same time as your screening result.
How reliable is cervical screening ?
Early detection and treatment can prevent around 75% of cancers developing but, like other screening tests, it is not perfect.
It may not always detect early cell changes that may lead to cancer. Abnormal cells on your slide may not be recognised because:
·      sometimes they do not look much different from normal cells;
·      there may be very few abnormal cells on the slide; or
·     the person reading your slide may miss the abnormality (this happens occasionally, no matter how experienced the reader is).
 
About one in 20 tests have to be taken again because:
 
·      you may have an infection which needs treating before a clear slide can be made; 

·     the cervical cells on your slide may have been hidden by blood or mucus;

·      there may not have been enough cervical cells on your slide to give an accurate assessment;
·      your sample may not have been properly prepared; or
·      the slide may have been broken.
 
Screening isn’t used to investigate cervical symptoms. If you have any unusual symptoms, such as bleeding after sex or between periods, you should see your doctor as soon as possible.
What does it mean if I am called back for another screening test ?
This usually means that your sample did not show up clearly, so we need to take another one. This is called an ‘inadequate result’.
On the other hand, screening may have found some small changes in the cells of the cervix. If abnormal changes (known as dyskaryosis) are detected, you will have what is called an ‘abnormal result’. If you have borderline or mild changes found at screening, you may be asked to come back again after six months for a repeat test. This is routine for any woman with borderline or mild changes if their screening sample hasn’t been tested for HPV. Your results letter will let you know if you need to come back for another screening test.
Can anything be done about abnormal changes ?
Yes. Your doctor or nurse will explain what needs to be done. They may simply ask you to come back for more cervical screening tests, because the abnormal cells may return to normal by themselves.
However, they may ask you to go to a clinic or hospital for a closer examination which is called ‘colposcopy’.
Treatment, if it is needed, is a minor procedure and is usually done in a walk-in clinic. This means you will not have to stay overnight.
Can cervical screening prevent cancer ?
Yes. Regular cervical screening is the best way to detect changes to the cervix before cancer develops. Early detection and treatment can prevent cancer developing in around 75% of cases. Screening can also find cervical cancer early on, when treatment is more likely to be effective.
 
 
 
What happens to my screening sample once it has been looked at ?
The laboratory that looks at your sample will keep it for at least 10 years. They can then compare your latest result with the ones you have had before. This is to make sure that you get any treatment you may need. They may review all screening records, including your sample, as part of our aim to offer a quality service and to help increase the expertise of specialist staff. This means that staff who work elsewhere in the health service may need to see your records.
We will offer you information about the review of your case if you want to know it.
Summary
To help you decide whether or not to come for cervical screening, the main benefits and difficulties of cervical screening are explained below.
·     Cervical screening reduces the risk of developing cervical cancer.
·     Due to cervical screening, cervical cancer is now an uncommon disease in this country.
·     Cervical cancer rates in many countries have halved since the 1980s, largely due to most women
      regularly having cervical screening.
·    In around one in 20 tests, the cells cannot be seen properly under the microscope and the test must be taken again.
·    The test can show minor abnormalities in cervical cells which would have cleared up on their own, and women would never have known about them if they had not been for screening. It is not yet clear which minor abnormalities will develop into cancer and which will not. Many women worry when a minor abnormality is found.
·    Cervical screening does not pick up every abnormality of the cervix.
·    Regular cervical screening can prevent around 75% of cervical cancers
developing, but it does not prevent every case.
·    Some women find having the test an unpleasant experience.
 
 
More information and support
 
If you have any questions about the service, you can:
 
·    Ask your Family Doctor
 
·    Contact a local health clinic
 
·    Visit our website at
 
·    or facebook page
 
·    or email at
ccsp.meh-health@gov.mt
 
 
Ċentru Nazzjonali għall- Screening
17, Xatt Lascaris,
Il-Belt Valletta, VLT 1921
MALTA
 
 
Tel: 00356 21227470
(8am to 4pm Monday to Friday)
 
2122 7470/1 /Cervical Screening