Last week we looked into the criteria needed for a screening programme to be put into place. Now we’re going to look a little bit more into the conditions that are screened for within the UK and what is involved in the testing.
Breast cancer screening is offered to all women who are ages between 50 and 70 in the UK. However this is in the process of being extended to women aged 47-73years old. Women within this age period are offered screening every 3 years. This is the screening that is offered for the general screening programme. Those that are at higher risk of breast cancer, for example if they have a strong family history, are offered screening prior to this age.
This screening test involves a mammogram which is basically a x-rays of the breast from two different angles.
To understand breast cancer first of all we need to understand the the main parts of the breast itself, the 3 parts that you need to be aware of are:
- the glandular tissue, which makes milk in lobules of alveolar cells
- the stroma, which contain the adipose (fat tissue) and ligaments which attach to skin and pectoralis muscles.
- the lymphatic vessels, these drain lymph from the breast draining into the axillar (arm pit)
Uncontrolled growth in the epithelial cells in breast, the alveolar cells. Often breast cancers don’t produced any symptoms until the cancerous cells have spread to surrounding tissue. This is why breast cancer is part of a national screening programme as early detection and treatment can prevent the cancer spreading to other tissues . Look out for our upcoming blogs to learn more about breast cancer.
Cervical cancer screening if offered to women that are between 25-64 years old, 25 to 49 year olds are offered screening every 3 years where as those that are 50 to 64 years old are screened every 5 years. The screening test involves what’s known as a cervical smear, this is where the cervix is examined and a brush rotated around the area to gain some cells so these can be tested for changes.
With cervical cancer being the second most common type of cancer in women worldwide this feeds into the need for screening as we discussed in our last blog post. Most commonly these cancers are squamous cell carcinomas that arise from infection with certain strains of human papillomavirus (HPV), stains 16 and 18. Therefore the risk factors for cervical cancer are the same as those for contracting HPV; early onset of sexual activity, multiple sexual partners, history of STIs and immunosuppression.
The cervix has various different epithelial linings. On the outside (vaginal) side of the cervix there is squamous epithelium, within the cervix and cervical canal there is columnar epithelium. In between these two areas there is a transition zone where there is a mix of squamous and columnar cells.
There are various stages to cervical cancer, including a precancerous form, cervical intraepithelial neoplasia (CIN), which can be detected within the smear test. This achieves another one of the criteria for a national screening programme, the fact that an earlier stage can be detected and therefore treated. Cervical carcinoma often doesn’t present till at an advanced stage where symptoms include vaginal bleeding and pelvic pain.
There are various outcomes of the smear test and these are used to determine the need and urgency for treatment:
Negative – inform patient and the smear is repeated in 3 or 5 years time depending on age of the patient
Borderline changes in squamous cells - refer to colposcopy but can also repeat the text in 6 months prior to refer, depending on local policy.
Mild dyskaryosis (mild cellular changes) – either refer straight away to colposcopy or repeat smear within 6 months, depending on local policy
Moderate and severe dyskaryosis – refer to colposcopy.
Colposcopy is a procedure in which a gynaecologist visualises the cervix and adds agents to the cervix in order to get a better idea as to if there are any abnormal cells within the cervix. If there is an area of abnormal cells this can be treated with what is known as a large loop excision of the transformation zone (LLETZ) procedure. This involves the surgical removal of the abnormal area through a heated metal loop. This removed section can then be tested and by doing so can identify if there is a risk more abnormal cells may remain within the cervix.