Chapter 3 Answers to discussion questions

The cervical screening process

3.1 Discuss the basic factors which must be considered when configuring and implementing a screening programme.

How common is the target condition? Is there recognized treatment/management of the target condition? You need to identify your target population and how you will invite them for screening. What screening test are you going to use, where will you perform the screening test, how often will you need to test, and will this be acceptable to those being screened? Are special skills required to perform the screening and treatments? How will the screening be funded?


3.2 Describe the aims of cervical screening and the rationale of how this is achieved.

What condition/disease are we screening for? Who do we screen? What tests can be used to screen? What treatments/patient managements/ancillary tests can be used? What benefits for the target population are we trying to accomplish by doing this?


3.3 Describe the ways in which HPV testing can be used in cervical screening.

  • A method of triaging low grade abnormalities in cytology primary screening
    • Refer to colposcopy (pos) or return to routine screening (neg)
    • Fewer repeat samples
  • A method of assessing the success of treatment for CIN/CGIN - Test of Cure
    • Fewer repeat samples
    • Reassurance of successful treatment
  • A primary screening tool
    • Sensitive but poor specificity
    • Requires further triage - cytology/genotyping/molecular
    • Allows self sampling - possible increase in coverage


3.4 Describe the roles of the various agencies involved in the NHS Cervical Screening Programme.

Consider the following in your response:

Who includes, invites, and monitors the screening histories of the target population? Who performs the sampling and how is this performed? Who performs the sample analysis and what does this involve? How are diagnostic samples taken and analysed? What treatments are available, who performs them, and do they require analysis?