Investigating the acceptability and accuracy of cervical screening and self-sampling in postnatal women to coincide with the 6-week postnatal check-up

调查产后妇女进行宫颈筛查和自我采样以配合产后 6 周检查的可接受性和准确性

• 批准号: MR/X030776/1
• 负责人: Joanne Morrison
• 金额: $ 37.39万
• 依托单位: Taunton & Somerset NHS Foundation Trust
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2024
• 资助国家: 英国
• 起止时间: 2024 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FX030776%2F1
• 关键词: Investigating; acceptability; accuracy; cervical; screening

The NHS Cervical Screening Programme (NHS CSP) has been hugely successful since introduction in 1998 in the UK. However, in 2018, screening rates were at a historical low, with screening rates down to 50% in some areas, especially in younger women & new mums, despite cervical cancer peak incidence occurring in this 25-35 year age group. The peak incidence of cervical cancer coincides with the time when women are having children. During pregnancy and the postnatal period, women have multiple interactions with healthcare professionals and discussions regarding screening for a range of conditions. Pregnancy provides an ideal opportunity to inform, educate and facilitate the uptake of cervical screening. In a previous quality improvement study, we improved the screening uptake rate in our local postnatal population by 8% with educational packages aimed at pregnant women and midwives. As part of this work we conducted a number of focus groups, seeking ideas from key stakeholders. One idea, generated by new mums, young women with cervical cancer, GPs and practice nurses, was that cervical screening should be performed at the 6-week postnatal check up. This check up is well-attended by women, & means that they do not have to find time a few weeks later to prioritise their own healthcare in a separate appointment. Finding time to attend appointments was a key limiting factor identified by new mums & women with cervical cancer. Another factor was a reluctance to have a vaginal examination, which urine self-testing might improve.Currently postnatal screening is performed after 12-weeks postnatal. This is on the basis of one study of conventional cervical screening ('Pap' smear), when cells from wooden slides were spread directly onto glass slides by the smear-taker. However, we now use liquid-based cytology (LBC), where cells collected on the cervical screening brush are transferred into a pot of special collection liquid, before being transferred to a slide in the lab, using specialist equipment. These LBC samples are much clearer and easier to examine under a microscope. This means that blood from periods or postnatal bleeding/discharge, called lochia, is less of a problem compared to old-style 'Pap' smears. We have also recently changed to primarily testing for high risk Human Papilloma Virus (HR HPV) on this LBC sample, with cytology only performed for those with HR HPV detected. However, despite the lack of evidence to support the current cervical screening schedule, this 12-week time-point remains, until we have data to support a change to combining cervical screening with the 6-week postnatal check up appointment.We will ask several questions, to help design the best future, much larger study that will be needed to confirm that a 6-week check is safe and improves screening uptake.1. What are pregnant women and new mums' views on screening at the 6-week postnatal check?2. What are pregnant women and new mums' views on self-testing at the 6-week postnatal check?3. Will women attend for a 6-week cervical screening test in a feasibility study and, if they do, would they be willing to have a repeat test at 12-weeks to allow direct comparison?4. Will it be feasible to randomise women individually to either 6- or 12-weeks tests, or would we need to design future studies differently, e.g by randomising screening times by GP practice or regionally?5. How well does self-testing with urine samples compare with LBC samples in postnatal women?We hope these data will inform how to plan a larger study to test the effect of changing to 6-week postnatal testing within the NHS Cervical Screening Programme on the accuracy of testing and ability to prevent cervical cancer, and see whether this improves cervical screening rates in postnatal women.

自1998年在英国介绍以来，NHS宫颈筛查计划（NHS CSP）就非常成功。但是，在2018年，筛查率的历史低点，尽管在这个25-35岁年龄段的年龄段中发生了宫颈癌的发病率，但在某些地区，尤其是在年轻妇女和新妈妈中的筛查率降至50％。宫颈癌的峰值发生率与妇女生育孩子的时间一致。在怀孕和产后期间，妇女与医疗保健专业人员有多次相互作用，并就筛查各种疾病进行了讨论。怀孕提供了一个理想的机会，可以为宫颈筛查提供信息，教育和促进。在先前的质量改进研究中，我们将本地产后人口的筛查率提高了8％，旨在针对孕妇和助产士的教育包。作为这项工作的一部分，我们进行了许多焦点小组，寻求主要利益相关者的想法。一个新妈妈，宫颈癌，GPS和实践护士产生的一个想法是，应在6周的产后检查进行宫颈筛查。此检查是由妇女备受关注的，这意味着几周后她们不必找到时间就可以在另一次任命中优先考虑自己的医疗保健。找时间参加约会是宫颈癌新妈妈和妇女确定的关键限制因素。另一个因素是不愿进行阴道检查，尿液自我测试可能会有所改善。目前在产后出生后进行了12周后进行筛查。这是基于一项对常规宫颈筛查（'PAP'涂片）的研究，当时木质载玻片的细胞通过涂片直接传播到载玻片上。但是，我们现在使用基于液体的细胞学（LBC），其中将颈筛刷上收集的细胞转移到了特殊收集液体的锅中，然后使用专业设备将其转移到实验室的幻灯片中。这些LBC样品在显微镜下更清晰，更容易检查。这意味着，与老式的“ PAP”涂片相比，时期或出生后出血/排出（称为lochia）的血液少是一个问题。最近，我们还改用了该LBC样品上的高风险人乳头状瘤病毒（HR HPV），仅针对检测到HR HPV的患者进行细胞学。然而，尽管缺乏支持当前宫颈筛查时间表的证据，但这个为期12周的时间点仍然存在，直到我们有数据来支持将宫颈筛查与6周的宫颈检查后检查的更改，我们将提出几个问题，以帮助设计最佳的未来，需要进行更大的研究，以确认6周的检查是安全的，并改善了Safe safe safe safe safe safe safe safe sexs sexsece uptake.1。孕妇和新妈妈在6周的出生后检查中对筛查的看法是什么？2。在6周的产后检查中，孕妇和新妈妈对自我测试的看法是什么？3。妇女会在一项可行性研究中参加为期6周的宫颈筛查测试，如果这样做，她们愿意在12周进行重复测试以进行直接比较？4。单独将女性随机化为6周或12周的测试是可行的，还是我们需要以不同的方式设计未来的研究，例如通过GP练习或区域性地将筛查时间随机筛选时间？5。与尿液样本相比，在产后女性中与LBC样品进行的自我测试的表现如何？我们希望这些数据能够告知如何计划一项更大的研究，以测试NHS颈椎筛查计划中为6周的产后测试的效果，对测试的准确性和预防宫颈筛查的能力，并查看这是否可以提高颈椎筛查率。