National Cervical Screening Program Update - PowerPoint Presentation

Slide1

National Cervical Screening Program Update

Tuesday, 15 May 2018

Contents

2

1.

National Cervical Screening Program (NCSP): Update

Cervical screening for women under 25 years

Cervical screening for women aged 70 years and older

Clarification of cervical cancer symptoms

NCSP promotion in General Practice

Self

-

collection

Toolkit for under-screened

and never-screened women

2.

National Cancer Screening Register (NCSR): Update

Release 2 update

Accessing test results, screening histories and participant follow-up

Update on screening correspondence

3.

Further information and contact

National Cervical Screening Program: Update

3

Cervical screening for women under 25 years

Background

Some women under the age of 25 will present expecting a routine Cervical Screening Test, having previously had Pap tests. It is important that these women are aware that

cervical screening is no longer recommended in asymptomatic women under 25 and that Medicare does not fund routine cervical screening in this group.

Cervical cancer in women under 25 years of age is rare, and screening has not changed the incidence of cervical cancer or mortality from this disease in this age

group in Australia since 1991.

It

usually takes 10-15

years

for a persistent HPV infection

to develop into cervical cancer.

Commencing

screening at age 25 will reduce the investigation and treatment of common cervical abnormalities that would usually resolve by themselves.

National Cervical Screening Program: Update

4

Cervical screening for women under 25 years

When to have a Cervical Screening

Test

Routine cervical

screening commences

at the age of

25

in the renewed

National Cervical Screening

Program (NCSP), or two years after the last Pap test.

If

a woman

has

previously had a Pap

test with a normal result:

before 23

years old, she should get screened at

the age of 25.

at 23

years or

over,

she should get screened two years after her last Pap test

.

If a woman has not previously had a Pap test, she should commence screening at the age of

25.

If

at any

age

a woman has

symptoms (

e.g

. unusual or persistent vaginal bleeding (post coital, unexplained inter-menstrual or any post-menopausal), discharge (offensive and/or blood stained), or deep persistent

dyspareunia), she

should

discuss these with

a

healthcare

provider immediately.

If

a woman has

had

an abnormal test result, she should continue to follow her healthcare provider’s advice.

National Cervical Screening Program: Update

5

Cervical screening for women under 25 years

Current statistics

Data collected by the National Cancer Screening Register (NCSR) shows that there has been a decrease in the rate of women under the age of 25 presenting for routine cervical

screening,

since the renewed program went live on 1 December 2017.

The

adjacent graph depicts the ratio of routine cervical screening for women under the age of

25

for every 1,000 cervical screening tests

received by the NCSR.

Targeted communications

While it was anticipated

that some women under 25 years of age would still present for routine cervical screening under the renewed Cervical Screening

Program, a

larger than expected number of samples from individuals under 25 years

have been

collected

for laboratory testing.

To reinforce the messaging regarding eligibility for routine cervical screening, a set of targeted communications has been developed, including electronic direct mail to healthcare providers via peak bodies and PHNs, reminders included in the monthly NCSP newsletter sent to PHNs and peak bodies, letters sent by the President or Vice-President of healthcare provider peak bodies, and a social media campaign targeted at women under the age of 25 (see adjacent table).

Social media campaignInfluencerEngagementBrittney-Lee Saunders60K views, 61 commentsThe Unrefined 979 likes, 22 comments Stella Badenoch 209 likes, 8 commentswethe_wildones3.1K likes, 24 comments ACCF13 to 28 likes for 4 postsSjana Elise Earp 30.1K likes, 172 comments

176K

125K

607K

1.5K

53K

10.5K

105K

5.4K

539

810

169K

1.4M

National Cervical Screening Program: Update

6

Cervical screening for women under 25 years

Usability testing of communications activities and communications materials has been performed across participants of the NCSP, with a focus on women under the age of 25 and healthcare providers.

Usability testing identified specific areas where women under the age of 25 remain confused. For instance:

whether they should get the Pap test,

the Cervical

Screening Test, or

both

h

ow

the two tests are

different

w

hat

the Cervical Screening Test is

for

t

imeframes

about when to start

testing

whether it is safe to be tested less frequentlywhether they could choose to test before 25implications of being sexually

activehow the HPV vaccination affects the timing and/or necessity of being testedimplications of previously having an abnormal test result, and implications of pregnancy.In order to address these gaps, further updates to the NCSP website (www.cancerscreening.gov.au/cervical) will be made in the upcoming weeks, and informed via the monthly NCSP newsletter.We encourage healthcare providers to direct their patients to the NCSP website (www.cancerscreening.gov.au/cervical) for more information on the program.

National Cervical Screening Program: Update

7

Cervical screening for women aged 70 years and older

Between the ages of 70 and 74, participants are encouraged to participate in routine cervical screening.

If a woman’s Cervical Screening Test result shows that no HPV infection is present, then she can

safely stop screening and exit the National Cervical Screening Program. If HPV is detected the woman should be followed up in accordance with the

National Cervical Screening Program: Guidelines for the management of screen-detected abnormalities, screening in specific populations and investigation of abnormal vaginal bleeding

(

2016 Guidelines)

.

Women can choose to continue screening beyond 74 years of age, but will not receive reminders from the National Cancer Screening Register to screen. However, reminders for follow-up will be sent if an abnormal test result is received.

Women aged

75

and over are eligible for Medicare rebates if they are asymptomatic and have waited the appropriate timeframe between screening tests (

i.e

. four years and 9 months for

clinician-collected

Cervical Screening Tests and seven years for

self-collected

Cervical

Screening Tests).  Women with symptoms suggestive of cervical cancer can be tested at any age through Medicare. 

Women aged 75 years or over who are in clinical management for cervical cancer and/or its precursors should complete clinical management and are eligible for Medicare rebates.

National Cervical Screening Program: Update

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Clarification of cervical cancer symptoms

Background

Some healthcare providers are using

low thresholds to determine whether a woman shows cervical

cancer symptoms.

Pathology

laboratories are getting requests

for

co-tests for

women

with symptoms that are usually not indicative of cervical cancer.

While

women are encouraged to present to their

doctor if they are experiencing symptoms suggestive of cervical cancer,

the information

previously provided

to healthcare providers did not define the appropriate symptomatic

threshold.

This

has led to over-referral of women for co-tests, where a cervical screening test would have been appropriate, if due.In order to address this gap, a set of more specific symptoms suggestive of cervical cancer has been developed and endorsed by the Steering Committee for the Renewal Implementation Project (SCRIP).

Patient presents asContextWhat to write on the pathology request form SymptomaticFor investigation of symptoms e.g. unusual or persistent vaginal bleeding (post coital, unexplained inter-menstrual or any post-menopausal), discharge (offensive and/or blood stained), or deep persistent dyspareunia. “Co-test” or “HPV & LBC”, “Symptomatic” (describe the symptoms)

National Cervical Screening Program: Update

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Pathology

Test Guide for c

ervical and

vaginal testingWhen filling out a Pathology Test Request form, healthcare providers are

required to describe the symptoms in more detail to help pathology laboratories understand why a co-test is requested

.

This information will be updated

on the

NCSP

website (

www.cancerscreening.gov.au/cervical

)

in the upcoming weeks. In addition to this, an item will be included in the May issue of the

NCSP

newsletter on this topic. Other

communications strategies

with

pathology

and healthcare provider peak bodies are being planned.

Symptoms

ThresholdVaginal bleedingpost coital, unexplained inter-menstrual, orany post-menopausalDischargeoffensive, and/or blood stainedPaindeep persistent dyspareunia

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NCSP Promotion in General Practice

Tonic Health Media has been engaged …

.. and their national reach is broad.

Between December 2017 and March 2018 Tonic estimates that the NCSP TVC National Campaign was viewed

2

…

Nationally, from December 2017 to March 2018…

State and Territory breakdown

Their place-based media is positioned in trusted, contextually relevant environments where health and lifestyle decisions are made.

Tonic Health Media is Australia’s largest health and wellbeing media network.

Of all GP Practices in Australia have a Tonic Service in their patient waiting rooms.

4,596 or

58%

Featured in

4,500+

GP Practices, hospitals, pharmacies and healthcare centre waiting areas across the country.

The average uptake of brochures is

24%

or 9.7 brochures per practice. These results are strong and in line with other successful Tonic campaigns.

NCSP brochures (in English) were picked up and taken away.

34,651

1

1

It is important to note that brochure removal is NOT a read rate. Most people will read a brochure and return it to the Health Updates display. The removal rate indicated the content of the brochure has appealed to the patient enough for them to take it with them into their GP consultation or away with them on leaving the Medical Centre.

2

It is important to note that each count may not be a unique view.

TVC Delivery Languages on average achieved an audience of 4 people per play across 355 sites across Australia.

Tonic services include…

Brochure display and distribution, and on-demand TVs in patient waiting rooms.

NCSP videos are playing in

1,708 GP Practices and

brochures

are displayed in 3,576

locations.

Between December 2017 and March 2018 the TVC National Campaign in five languages (Chinese, Vietnamese, Greek, Korean, and Arabic) reached …

State

December - March

Brochures Removed*

ACT

580

NSW

10,810

QLD

6,784

NT

515

SA

2,218

TAS

1,591

VIC

9,541

WA

2,612

27.5 M

times

1 M

people

11

NCSP Promotion in General Practice

.. and their national reach is broad.

Between 17 December 2017 and 18 March 2018 Tonic estimates that the NCSP TVC National Campaign reached…

Their place-based media is positioned in trusted, contextually relevant environments where health and lifestyle decisions are made.

Tonic Health Media is Australia’s largest health and wellbeing media network.

Of all GP Practices in Australia have a Tonic Service in their patient waiting rooms

4,596

or

58%

Featured in

4500+

GP Practices, hospitals, pharmacies and healthcare centre waiting areas across the country

Tonic services include…

Brochure display and distribution, and on-demand TVs in patient waiting rooms

NCSP videos are playing in

1,708 GP Practices and

brochures

are displayed in 3,576

locations

Between 17 December 2017 and 18 March 2018 the TVC National Campaign in multiple language reached …

27.5 M

people

1 M

people

12

NCSP Promotion in General Practice

.. and their national reach is broad.

Between 17 December 2017 and 18 March 2018 Tonic estimates that the NCSP TVC National Campaign reached…

Their place-based media is positioned in trusted, contextually relevant environments where health and lifestyle decisions are made.

Tonic Health Media is Australia’s largest health and wellbeing media network.

Of all GP Practices in Australia have a Tonic Service in their patient waiting rooms

4,596

or

58%

Featured in

4500+

GP Practices, hospitals, pharmacies and healthcare centre waiting areas across the country

TVC Delivery Languages on average achieved an audience of 4 people per play across 355 sites across Australia

Tonic services include…

Brochure display and distribution, and on-demand TVs in patient waiting rooms

NCSP videos are playing in

1,708 GP Practices and

brochures

are displayed in 3,576

locations

27.5 M

people1 Mpeople

National Cervical Screening

Program: Update

13

Self-Collection

Background

Self-collection of vaginal samples for HPV testing is now available under the NCSP for women aged 30 years or over, who have declined to have a cervical sample collected by a healthcare provider, and are either:

overdue

for cervical screening by two years or longer (i.e. four years or more since their last Pap test, or seven years or more since their last Cervical Screening Test), or

have never screened.

Current progress

Currently there is

one large pathology laboratory

accredited

to process self-collected samples.

To assist pathology laboratories to attain accreditation from the National Pathology Accreditation Advisory Council (NPAAC) to perform tests on

self-collected samples, a technical expert committee has been convened under the NPAAC to develop minimum validation standards for laboratories interested in providing this service.  These standards are expected to be approved by NPAAC in the third quarter of 2018.

Prior

to offering self-collection as an option to

patients

,

healthcare providers are

encouraged to check with their pathology laboratory on availability.

National Cervical Screening Program: Update

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Self-Collection

Self-collection suitability

Self-collection is not suitable if a patient:

is under the age of 30

is pregnant, or thinks they might be pregnant

is symptomatic i.e. experiencing u

nusual

or persistent vaginal bleeding

(

post coital, unexplained inter-menstrual or any post-menopausal

), discharge

(offensive and/or blood stained

),

or

deep

persistent

dyspareunia, or

has been exposed to diethyl-stilboestrol (DES) in utero.

Resources

A suite of self-collection resources for healthcare providers including fact sheets, instruction guides in different languages (including Aboriginal and Torres Strait Islander languages) and a quick reference guide are available on the NCSP website (http://cancerscreening.gov.au/cervical

).

National Cervical Screening Program: Update

15

Toolkit for under-screened and never-screened women

This toolkit has been developed to assist

healthcare providers to

engage under-screened and never-screened women in cervical screening, and to support them should they choose to participate. The information is relevant to various healthcare providers including specialists,

general practitioners,

sexual health workers, disability support workers and Aboriginal health workers. The toolkit provides specific information about engaging with different groups of women, including:

Aboriginal and Torres Strait Islander

women

w

omen

from culturally and linguistically diverse (CALD)

backgrounds

w

omen

with

disabilities

p

eople

who identify as lesbian, gay, bisexual, transgender and intersex (LGBTI) and have a

cervix

women who have experienced sexual assaultwomen from remote areasolder womenwomen who experience socio-economic disadvantage, andwomen who have not had the HPV vaccine.The toolkit is on the NCSP website at http://www.cancerscreening.gov.au/cervical-toolkit-under-and-never.

National Cancer Screening Register: Update

16

Release 2 update

The implementation of Release

2 of the National Cancer Screening

Register (NCSR) is on schedule to be completed by 29 June

2018.

This means that all pre 1 December 2017 results will have been migrated from the state and territory registers into the

NCSR to

provide national records for participants of the

National Cervical Screening Program (NCSP).

To ensure

a safety

net is provided as part of the

NCSP,

participant follow-up and correspondence will continue to be delivered by the state and territory registers in conjunction with the

NCSR until

Release 2 is complete

. There

will be no gap in service for

healthcare providers and

participants of the NCSP.Accessing test results/screening historiesHealthcare providers should continue to speak to their pathology laboratory for their patient’s screening test result.The NCSR can provide post 1 December 2017 cervical screening results if required (i.e. if the healthcare provider did not request the test, or cannot access the result from the pathology laboratory).On completion of Release 2, healthcare providers will be able to access national cervical screening records through the NCSR contact centre.Until Release 2 is complete, healthcare providers should continue to contact their state and territory register for screening histories up to 1 December 2017.

National Cancer Screening Register: Update

Follow-up

Participant follow-up is the primary responsibility of the healthcare provider requesting the test. The NCSR and state and territory registers will jointly deliver a participant follow-up safety net function until Release 2 is complete. Participant

follow-up of all results received prior to 1 December 2017 will continue to be provided by the state and territory registers.

The NCSR will follow up all results received post 1 December 2017. At Release 2, the NCSR will

provide safety net functions for the program.

This includes invitations to

screen,

routine reminders, and

follow-up

correspondence to participants and

healthcare providers

; and follow up phone calls to

healthcare providers

(where required).

Update on screening correspondence

To

ensure the

clinical safety of participants of the NCSP, during the transition to

Release 2, both the state and territory registers and the NCSR will send screening correspondence (letters) to healthcare providers and their patients. This means that healthcare providers

or their patients may receive more than one letter. For example, a patient may receive a routine reminder letter when they have had a test since 1 December, and also receive a follow-up letter for an abnormal result. If this occurs, healthcare providers should act on the advice of the most recent cervical screening result. In this example, healthcare providers would act on the follow-up letter.Healthcare providers are encouraged to continue to actively manage their patient’s cervical screening in accordance with the 2016 Guidelines, to update their recall and reminder systems to align with the new cervical screening program intervals, and to send correspondence from their clinical practice systems. 17

Further information and contact

National Cervical Screening Program

For further information on the National Cervical Screening Program, visit our website at www.cancerscreening.gov.au/cervical.Feedback and enquiries can be directed to your local state/territory government cancer screening program area, or to

cervicalrenewal@health.gov.au.National Cancer Screening Register

The telephone number for the NCSR contact centre is 1800 627 701.For further information, please refer to the

Transition Quick Start Guide for Healthcare Providers available on the NCSR website.

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