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Last Updated: Sunday, 27 August 2006, 23:50 GMT 00:50 UK
Less worry for cervical screening
By Emma Wilkinson

Liquid-based cytology
Practice nurses no longer "smear" cells on a slide
As most women will tell you, having a smear test is an uncomfortable and unpleasant experience.

For one in 10 women the process becomes doubly stressful when they have to repeat the test just weeks later because the slide was "unreadable".

Studies have shown that having an unreadable or inadequate smear result is just as worrying as being told the results are abnormal.

But a new screening method is dramatically reducing this uncertainty.

The NHS began to roll out liquid based cytology or LBC in the cervical screening programme in 2003 with the hope of being fully up and running by 2008.

Every single lab using liquid based cytology have reduced their inadequate rate
Julietta Patnick

In January this year, a large review of evidence by Australian researchers published in the Lancet cast doubt over the programme after concluding that there was no evidence LBC reduced the number of inadequate slides.

However, experts argue that the figures from the UK speak for themselves.

Currently about 50% of women in England are screened this way and laboratories that have switched to the new method are reporting a huge drop in the number of inadequate slides - with only one in 50 women having to come back and have the smear done again.

With four million women screened annually, this could eventually result in 320,000 fewer women having to undergo a repeat test every year.

In fact, the impact is already being seen in Scotland where LBC has been in place for two years - experts there estimate that in 2005, 20,000 women were spared a repeat test.

How does LBC work?

Instead of the old method of scraping off some cells from the cervix using a spatula and "smearing" them onto a slide that can be looked at under the microscope, the sample is taken using a plastic brush which is then placed in a vial of fluid.

Anything that sounds as if it's not right will worry people however much you reassure them
Sara Richards
Primary care nurse

The smear feels exactly the same for the woman, but for the staff in the laboratory the sample of cells is much easier to analyse.

When practice nurses or GPs smeared cells on a slide using a spatula, lots of other types of cells would also be transferred making it difficult to see if there was any abnormalities and sometimes there would not be enough cells on the slide for the laboratories to make a proper assessment.

But with LBC all the cells from the cervix are preserved in the fluid and can be separated out before being put on the slide making abnormalities much easier to spot.

Although LBC is easier for laboratories, the data on whether it will help to pick up more abnormalities is unclear.

Dr Anne Szarewski Clinical Consultant and Honorary Senior Lecturer at Cancer Research UK Centre for Epidemiology said: "Even if LBC is no better at picking up abnormalities, just reducing the number of inadequate smears makes the change worthwhile.

"Women always think we are trying to hide something from them - women who have an inadequate smear are always terrified.

"If you spend a month psyching yourself up for the test and then you get a letter saying you have to come back there's going to be a proportion of women who are so fed up they won't come back and another group who are so anxious they go into denial."

Research published in 2004 found that compared with normal test results, women with inadequate smears had higher anxiety, were more concerned about their results, perceived themselves to be at a higher risk of cervical cancer and felt less satisfied with the information they had received.

Success rate

Julietta Patnick, director of NHS cancer screening programmes, is equally enthused about the potential of the new technique to reduce the hassle of screening for women.

"Every single lab using liquid based cytology have reduced their inadequate rate - and we were starting from a very high rate of unsatisfactory slides.

"It's dropped from 11% to around 2% - women are not having to repeat the test."

She added that women who have three inadequate tests in a row are sent for a coloposcopy, where the cervix is examined through a magnifying device, causing even more anxiety - and that this is now far less likely to happen.

The new technology is expensive and the NHS plans to spend 10 million updating the programme but they hope the reduction in the number of tests will balance the budget.

Another advantage of LBC is that tests for infections such as chlamydia and gonorrhoea can be done from the same sample.

Sara Richards is a specialist primary care nurse in East Berkshire.

"We're in the process of changing to LBC and I'm co-ordinating the training. It looks like it's going to be very good."

She added that the technique was much easier for nurses to use than trying to juggle carrying out the test with preparing a slide in a short timeframe.

"It will lessen their anxiety and in turn make the patient less anxious.

"Women do worry, anything that sounds as if it's not right will worry people however much you reassure them."

Dr Szarewski added: "If you had a very low rate to start with it's not going to improve much, but our experience in the UK is that it does improve and it is worth it."


SEE ALSO
Advance could boost smear tests
14 Oct 05 |  Health
Figures show better smear testing
30 Jul 04 |  Scotland

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