04 September 2008 : The vaccination programme to protect against HPV16 and 18 is beginning to be rolled out across Wales and Scotland this autumn as secondary schools begin the new academic year.
All 12 and 13-year-old girls (school year 8) in Wales – some 20,000 in total – are to be vaccinated against the human papilloma virus (HPV). A two-year catch-up vaccination campaign starting in autumn 2009 will also offer protection to about 40,000 other girls up to the age of 18.
The Welsh news makes no mention of a previous headline from the Department of Health that 17-and 18-year-olds are to be included this year. Scotland has already stated its intention to include these older girls in the first year of its programme.
28 August 2008 : The 48th Annual Scientific Meeting of the BSCC will take place in Liverpool on Monday 14th September 2009.
More details to follow.
27 August 2008 : The Pathological Society and the British Society for Clinical Cytology come together for a two-day symposium on 8-9 January 2009.
The programme and registration form can be found in the document library.
http://www.clinicalcytology.co.uk/resources/resources.asp
21 August 2008 : The Federation for Healthcare Science (FHCS) - the body which represents healthcare scientists in the UK - has issued a critical report on the government''s proposed Modernising Scientific Careers (MSC) programme.
http://www.fedhcs.net/statement_msc.htm
11 August 2008 : The U.S. Food and Drug Administration has cleared for marketing a test which uses DNA microarray technology to identify the tissue of origin in malignant tumours.
The accuracy of the test is similar to that achieved by expert pathologists using current standards of practice.
The director of the FDAs Center for Devices and Radiological Health said: ''With the help of microarray technology, [scientists] will be able to classify these types of cancers in a standardized non-reader dependent manner based on the patterns of gene activity in the tumor cells.''
http://www.fda.gov/bbs/topics/NEWS/2008/NEW01870.html
07 August 2008 : The British Society for Clinical Cytology is again able to support nominations for national Bronze, Silver and Gold Clinical Excellence Awards in England and Wales. We are also able to support applications for Scottish merit awards via SACDA and details of the Scottish merit awards can be found on their website www.sacda.scot.nhs.uk.
The BSCC is allowed to support only a limited number of nominations. ACCEA set quotas for Bronze, Silver and Gold awards based on the number of eligible consultants within the Society. The BSCC is keen to support its members as effectively as possible in achieving higher awards. Full details of eligibility, etc can be found on the ACCEA website: www.doh.gov.uk/accea. It is understood that the forms for 2009 will be available on the ACCEA website in September but if in the meantime you wish to begin working on your submission a ‘working copy’ of the 2008 forms is attached to this email. ACCEA advise that it will be possible to cut and paste your work across to the new forms without difficulty.
If you are applying for a National Award in 2009, you should self nominate and send your completed application electronically to ACCEA or SACDA by the relevant closing date, which this year is 19 December 2008, five weeks earlier than in previous years.
If you would like the BSCC to consider your application in its ranking process, then please send a copy of your completed application to Christian Burt at the Society headquarters (mail@bscc.net.uk) by midnight on Friday 24 October 2008 - late submissions will not be considered under any circumstances. If the results of the 2008 awards have not been announced by this date, members should apply again but can withdraw their application if they gain an award in the previous round. The submission should be accompanied by a personal statement of not more than 250 words giving evidence of how you have contributed to cytology and/or the Society at regional, national or international level. The BSCC Higher Awards Committee will use these documents to prepare appropriate citations and submit a ranked list of names and supporting citations to the ACCEA.
Please do not hesitate to contact me if any further clarification is required. Tel 0114 2713728. Email: John.H.Smith@sth.nhs.uk
Dr J H F Smith
Chair, BSCC Higher Awards Committee
Editors note: there are four forms to accompany this item, entitled Clinical Excellence Awards Scheme. These can be found in the document library at
http://www.clinicalcytology.co.uk/resources/resources.asp
05 August 2008 : The research and academic subcommittee of the BSCC has introduced a grant scheme to help fund research projects of value to the society. The application form can be found in the document library in the resources section.
http://www.clinicalcytology.co.uk/resources/resources.asp
05 August 2008 : Beating Cervical Cancer webinar - experts discuss NEW information
How effective are HPV (Human Papillomavirus) vaccination and screening programmes in the global fight against cervical cancer? The cost of HPV vaccination and delivery costs are often cited as a barrier to implementing vaccination programmes how can this be overcome, particularly in developing regions like Latin America, the Caribbean and Asia Pacific?
These questions and more will be discussed by some of the 120 leading experts who have contributed to ICO Monograph Series on HPV and cervical cancer: general overview, Latin American and Asia Pacific Reports.
The Webinar will be broadcast live from the UICC (International Union Against Cancer) World Cancer Congress in Geneva.
Audience URL to register:
http://w.on24.com/r.htm?e=114926&s=1&k=77783110EE83BF2C33BCB7DBC0BA01BD
24 July 2008 : The national vaccination programme against HPV is being extended to offer protection to an additional 300,000 girls aged 17-18, starting in September.
This is in addition to the routine vaccination of girls 12-13 years old and will save up to 400 lives for each year of girls receiving the vaccine.
23 July 2008 : The Department of Health has issued a new leaflet explaining the changes we can expect to see in the education and training of NHS scientists in the years ahead.
Despite the recent introduction of the City and Guilds Diploma in Cervical Cytology, Cytopathology will not be immune to the changes being proposed in Modernising Scientific Careers. The aim is to have a common UK-wide training framework and robust registration arrangements. NHS scientists will enjoy better career opportunities and employers and patients will have the peace of mind that the NHS has a well trained and motivated scientific workforce which is fit for purpose.
BSCC members can be certain that Council is in constructive dialogue with the Department of Health and this will help ensure the best possible outcome for Cytopathology in the UK.
14 July 2008 : The 5th CSO Conference will take place at the Holiday Inn Regents Park, London, on the 25th and 26th November 2008.
Plenary sessions include:
NHS: the next 60 years
R&D: the next 60 years
Workshop titles include:
Modernising Scientific Careers
Building your Profile: What can Networks do for You?
Innovation and Technology
Unlocking Cash: Ways to fund Research
The registration site is password protected. The password has been posted on the BSCC forum page.
11 July 2008 : A letter from the Department of Health has announced the commissioning of research on attitudes toward the HPV vaccine among children and primary care givers. The research forms part of the communication campaign supporting the introduction of HPV vaccination for 12 – 13 year old girls (school year 8) in September 2008.
http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Dearcolleagueletters/DH_086059
09 July 2008 : Hot on the heels of the announcement that GSKs Cervarix is the HPV vaccine of choice in the UK is the news that the FDA has rejected Merck''s application for the use of its vaccine, Gardasil, in women up to the age of 45. Gardasil is already approved for women aged 9-26 years.
The reasons for the rejection are unclear and there is uncertainty whether this represents a delay or an outright rejection of further vaccine development.
The FDA has also rejected Merck''s proposal to market Gardasil as a vaccine which protects against non-vaccine HPV types (cross-protection).
http://www.merck.com/newsroom/press_releases/product/2008_0625.html
02 July 2008 : CPA are seeking to recruit Regional Medical Laboratory Assessors. This is an exciting opportunity to take a leading role in maintaining and improving standards in Medical Laboratories in the UK. The closing date for applications is 8th August 2008. Anyone interested should seek further details on the CPA website.
CPA would also be very interested to hear of anyone who wishes to become a peer assessor. Again, details can be obtained from the website.
20 June 2008 : Following a thorough tendering process the Department of Health has awarded pharmaceutical giant GlaxoSmithKline the contract for ''''Cervarix'''', the HPV16/18 vaccine .
The vaccine will be made available to girls aged 12-13 years old from September of this year and from September 2009 the vaccine will also be delivered to girls up to 18 years in a two year catch-up programme.
The cost of the vaccine is commercially confidential. The announcement and funding allocations for PCTs can be downloaded from the DH website.
http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Dearcolleagueletters/DH_085582
17 June 2008 : Then why not register for the 5th International HPV and skin cancer conference in Heidelberg on 22-24 October 2008. There you will learn that HPV-induced cervical carcinogenesis serves as a model for the lesser understood HPV-related non-melanotic skin cancers and head & neck cancers. Speaking on cervical cancer will be CJLM Meijer (Amsterdam) and A Hildesheim (Bethesda). The deadline for early registration is 30 June.
16 June 2008 : The latest data to emerge regarding the duration of protection offered by HPV vaccination was presented at a meeting in May of the European Society for Paediatric Infectious Diseases in Austria. GlaxoSmithKline''s Cervarix vaccine generates sustained high levels of neutralizing antibodies against HPV 16/18 for up to 6.4 years. These results suggest that protection will last even longer, so the study is set to continue for another three years.
http://www.cancercompass.com/cancer-news/1,14173,00.htm?rss=y
16 June 2008 : The deadline for cheap early bookings for this years BSCC annual scientific meeting is rapidly approaching.
Register before 4th July to avoid the late booking fee.
16 June 2008 : The training centres pages have now been fully updated with the latest course details. Click on the link below and scroll to the bottom of the page for links to all UK centres.
http://www.clinicalcytology.co.uk/resources/resources.asp
16 June 2008 : Although yet to be endorsed by the NHSCSP, the proposed changes to terminology in cervical cytology have been published in this month''s issue of Cytopathology.
Briefly, the recommendations are to
• retain the term dyskaryosis.
• switch to a two-tier system of reporting dyskaryosis, with a single category of high-grade dyskaryosis replacing the existing categories of moderate and severe dyskaryosis.
• replace the existing categories of borderline nuclear change (BNC) with koilocytosis and mild dyskaryosis with a single category of "low-grade dyskaryosis".
• retain the term ?glandular neoplasia.
• rename the category of severe dyskaryosis ?invasive to high-grade dyskaryosis ?invasive.
• subclassify borderline change into three groups:
o Borderline change, high-grade dyskaryosis not excluded
o Borderline change in endocervical cells
o Borderline change, not otherwise specified (NOS)
The proposed system moves closer to the Bethesda system (TBS) and the recently published European Guidelines, allowing easy translation of internationally published papers, but would maintain control and flexibility of the classification.
The following link requires a subscription to Cytopathology.
http://www.blackwell-synergy.com/doi/full/10.1111/j.1365-2303.2008.00585.x
16 June 2008 : The Department of Health is planning radical changes to the education and training of healthcare scientists in the NHS in a five year project aptly named "Modernising Scientific Careers". Very little information is available at present but detailed proposals are due to be announced very soon. The general idea is to have a joined up training scheme with a generic programme for career levels 1 to 4 and a graduate level entry point for career level 5. This will be followed by a rotational training programme in one of the three healthcare science divisions leading to registration as a healthcare scientist after three years. Specialist training will occur as part of the rotation and trainees will be able to express a preference for their intended career (e.g. cytopathology). However, trainees may be allocated to a different career according to workforce needs.
It is difficult to comment further or to react to the proposals until more detail is known.
http://www.fedhcs.net/msc_news_mar08.doc
12 May 2008 : A reminder that the NAC Annual Conference and AGM will take place on Friday 4th july to Sunday 6th July at Keele University. The BSCC is sponsoring workshops on Friday 4th July and the President of the BSCC, Dr John Smith will be opening the trade show on the Friday and and speaking on the Future of Cytology on Saturday 5th.
Full details at the link below.
12 May 2008 : The text of a letter from the Chief Medical, Nursing & Pharmaceutical Officers providing information about the introduction of human papilloma vaccine into the national immunisation programme is now available at the link below.
The letter draws attention to a useful website where further information can be found. The url is
http://www.immunisation.nhs.uk/hpv
The Scottish equivalent of the above website can be found at
http://www.healthscotland.com/health/topics/immunisation/HPV.aspx
29 April 2008 : The Wellcome Trust’s History of Twentieth Century Medicine Group are holding a "Witness Seminar" entitled :
History of cervical cancer and the role of the human papillomavirus, 1960–2000
on Tuesday 13th May 2008, 2.00 pm – 6.00 pm,
at the The Wellcome Trust, Gibbs Building,
215 Euston Road, London NW1.
For fuller details follow the link below.
http://www.ucl.ac.uk/histmed/library/080513
25 April 2008 : The NHS Cervical Screening Programme have just published a document "Achieving a 14 day turnaround time for results by 2010".
Extracts from sections 2, 3, 4 & 5 of this giving the evidence base for the target, details of help from NHS Improvement , practical details and other actions are given below.
"Evidence base
Implementation of Liquid Based Cytology (LBC)
LBC is key to achieving the new 14-day TAT due to the decrease in workload from the reduction in inadequate amples and the improved speed of throughput through laboratories. The NICE Technology Appraisal (TA) of
LBC was published in October 2003. At the time, we said it would take up to5 years for full national implementation due to the major retraining issues. By November 2007, 88% of laboratories in England had converted to LBC. All PCTs have indicated that they will have introduced LBC by October 2008
in line with NICE/DH guidance. SHAs may wish to ensure that this takes place.
The benefits of LBC are already becoming apparent. Of the four million tests taken each year, the number of inadequate tests fell from 370,000 (9%) in 2004-05 to 173,000 (4.7%) in 2006-07. As a result around 200,000 women did not have to attend a repeat test, with all the anxiety that this involves for women, the additional expense for the NHS and the unnecessary workload for the programme.
ScHARR Option appraisal: Assessment of a seven-day turnaround for the reporting of cervical smear results
ScHARR were commissioned by NHS Cancer Screening Programmes to undertake the above OA following the manifesto commitment. Five cytology laboratories around England were studied in detail and the information provided was validated nationally through questionnaires sent to a sample of 25 further laboratories. This data was used in addition to research papers and other literature to inform a discrete event simulation model representing a typical laboratory.
The model was implemented using the Simul8 package. The conventional Papanicolau smear and LBC method of screening were both simulated in the Cervical Screening Process Model and a number of options for change were evaluated.
The OA said that in order to achieve a major reduction in result TATs, a combination of several of the options considered is required. The options considered were as follows:
i. Limit processing of samples to only those women eligible
within national standards
ii. Implement an electronic link from the laboratory to the call
and recall office
iii. Despatch results letters by first class post on Monday,
Tuesday and Wednesday mornings
iv. Workforce redesign – training of Advanced Practitioners
v. Merge workload from small laboratories
The OA concluded that implementing options i,ii, iii and iv in medium sized laboratories using LBC would achieve around 46% of results being returned within seven days and over 95% in two weeks. However, in small laboratories without LBC staining machines it may not be feasible to process results within seven days and would take three weeks to return 95% of results. By implementing the above options and merging workload of smaller laboratories it is estimated that around 45% of results could be returned within seven days and over 95% within two weeks.
One of the major causes of delay is samples getting from the sample taker to the laboratory. The OA assumed that there is one van collection each day transporting the samples from the GP surgery to the hospital. In developing their plans to deliver the new 14-day TAT, SHAs and their stakeholders are
advised to review sample collection methods.
The following discusses the options in more detail.
i. Limit processing of samples only to those women eligible within national standards
ScHARR recommended that local screening programmes should not process samples taken from women who fall outside the programme (ie only screen women aged 25 to 49 every three years and women aged 50 to 64
every five years). Many women are currently screened “opportunistically” outside national standards. Currently 24.7% of samples are provided by women and their doctors at an inappropriate interval in the call and recall
programme. Some units already strictly adhere to this policy, and show it can be achieved. Initial national costs would be £100,000, with potential savings of over £10 million per year.
In discussions with stakeholders, there was some concern about the reaction of the service to not processing out of programme samples. The Advisory Committee on Cervical Screening (ACCS) has recommended that there should be a flexible period of six months prior to tests becoming due at
which samples can be reported. Evidence from local screening programmes who operate strict policies on reporting out of programme samples has shown that primary care practitioners soon cease sending inappropriate samples for reporting. Local education programmes for GPs would be an important part of this initiative.
ii. Implement an electronic link from the laboratory to the call and recall office
ScHARR reported that currently results are recorded on paper and on the computer system. Implementing a lab link would mean that it would no longer be necessary to spend time and money recording results by hand. It would also reduce the potential for discrepancies between the computer and paper records. National initial costs would be £1.5 million (or £500,000 if a webbased IT system was developed), with savings of around £200,000 annually.
iii. Despatch results letters by first class post on Monday, Tuesday and Wednesday mornings
ScHARR commented that currently negative results are dispatched by second class post, usually only on a Monday alone to ensure that results are not received at the weekend. By sending them by first class post on Monday,
Tuesday and Wednesday mornings they should still be received before the weekend. This would cost around £400,000 per year.
iv. Workforce redesign – training of Advanced Practitioners
ScHARR recommended that at least one Advanced Practitioner (AP) should be trained up at as many labs as possible. There is currently a shortage of pathologists and this delays the reporting of abnormal samples. The role of the AP is relatively new and allows the cytologist to carry out the
pathologist’s part of the process, hence the sample spends less time waiting at this stage. National initial costs would be around £400,000, but savings of over £8 million per year could be made.
v. Merge workload from small laboratories
In order to maintain efficient utilisation of staining machines for LBC, workload from small labs could be combined or transferred to larger labs. There will be initial costs involved with this reconfiguration, but there is the potential for medium and long term cost savings. ScHARR recommended the minimum number should be 35,000 tests per year.
The 2006 report of the Independent Review of NHS Pathology Services, chaired by Lord Carter, highlights the importance of reconfiguring pathology services to improve efficiency and effectiveness and securing the benefits
achievable through economies of scale. The evaluation of Phase 2 of the review, which will make further recommendations for service reconfiguration based on data collected from twelve pilot sites, will report shortly to DH.
Streamlining local administration of the service
In addition to the OA from ScHARR, NHS Cancer Screening Programmes commissioned Beaumont Colson Ltd to review the local administration of the NHS CSP. There is currently wide variation and duplication in the administration of the programme in some areas, particularly around local
call/recall offices. This OA recommended the streamlining of call/recall offices. This rationalisation would bring the cervical programme more into in line with the breast screening programme and the new bowel screening programme.
Fewer larger offices would be able to offer support to women in a way that is not possible with a larger number of smaller offices running multiple policies. For example, helplines and translation services could be offered, and advice could be given on where cervical screening is accessible for disabled women or available out of normal working hours.
SHAs are advised to decide on the number of screening offices that are appropriate to service the screening programme for their local populations. This could be one or more per SHA, depending on the local circumstances and the effectiveness of current practice. There are obvious financial savings to be made with such rationalisation, and there are clear benefits of all PCTs within an SHA operating a single policy and adhering to national guidelines. Such rationalisation would also help in achieving the 14-day TAT.
Modernising colposcopy
Achieving the 14 day TAT will impact on colposcopy services, at least in the short term. To overcome this local services are advised to adopt direct referral from the laboratory to colposcopy, rather than referral via the woman’s GP. Local services are also advised to review policies relating to surveillance of low-grade disease, post-treatment follow-up, treatment policy, and adherence to national guidelines to respond to the increased workload. A national model has been developed and distributed to assist local services in
assessing alternative policies.
Support from NHS Improvement (formerly the Cancer Services Collaborative: Improvement Partnership)
The Cancer Reform Strategy stated that the Cancer Services
Collaborative: Improvement Partnership (CSCIP), now NHS Improvement, will offer focused service improvement resources across the cervical screening pathway to support the delivery of faster turnaround times.
NHS Improvement is a national NHS-funded programme designed to drive improvements in the way cancer services are delivered to patients. The programme is designed to provide a practical approach to support local clinical teams to look at their own services and make significant improvements
for patients by redesigning the way that care is delivered. This in turn will support the delivery of the Cancer Reform Strategy actions. The CSCIP has some noted successes, particularly in the delivery of the cancer waiting times targets.
The NHS Improvement Pathology Service Improvement team will support process improvement for a number of local teams to use Lean improvement methodology to achieve or surpass the new 14-day TAT in line with the 2005 commitment Evidence from testing the lean improvement methodology has demonstrated that a 50% reduction in turnaround times can be achieved without significant additional resources
(see www.pathologyimprovement.nhs.uk)
A collaborative approach will be used allowing teams to network and share best practice. We aim to ensure local ownership and sustainability of improvements by clinical teams. A three year programme of work in three phases is envisaged, working with 20 to 30 sites per phase. The approach will be to ensure local ownership by clinical teams as a way of guaranteeing sustainability.
In order to achieve the maximum effectiveness of this support, which will be funded centrally, a number of criteria have been developed. These are:
i) Laboratories must process over 35,000 samples annually
ii) There must be explicit support from the host Trust
executive team
iii) A whole pathway (end to end) approach will be used,
from samples taken to estimated date of receipt of
result by women
iv) The team must include representatives from primary
care, laboratory and report delivery agency
v) Baseline data will need to be collected, along with
monthly ongoing data collection (date sample taken,
sample arrived in lab, lab report sent, expected date
of delivery)
vi) A workshop approach will be taken, with bimonthly
training and networking for staff
vii) All teams to report progress via web based reporting
system (Rapport)
viii) Initial sites to become exemplar sites of excellence
and share the learning
In the first instance, SHAs wishing to receive CSC-IP support should send expressions of interest to NHS Cancer Screening Programmes, outlining clearly which local services they wish to receive the support and how those services meet the above criteria.
Expressions of interest should be posted or
e-mailed as follows:
Mrs Julietta Patnick
Director
NHS Cancer Screening Programmes
Fulwood House
Old Fulwood Road
Sheffield S10 3TH
e-mail: Julietta.Patnick@cancerscreening.nhs.uk
Expressions of interest should be received by Friday 23rd May 2008 and will be assessed by NHS Cancer Screening Programmes, NHS Improvement
and the Department of Health.
Practical details
Monitoring
In order to monitor the new 14-day TAT, NHS Cancer Screening Programmes and the Department of Health are working with the Information Centre and ROCR to amend Part E of the KC53 return. A new line of “Up to 2 weeks” will be added to monitor time from screening to two new lines measuring the date of dispatch of the results letter and the
date of expected delivery. These measures are likely to come in for the 2008-09.
Those local services receiving NHS Improvement support will need to submit monthly data, as in point v) of the criteria above.
The new 14-day TAT has also been included in the NHS Operating Framework for 2008-09 to 2010-11 as a “vital sign”, and we are discussing with the Department of Health’s Recovery and Support Unit how best to monitor trajectories to meet the 14-day TAT.
Local monitoring is also essential. The Cancer Reform Strategy
(paragraph 3.12) stated that the new 14-day TAT should be monitored locally and commissioners should intervene if the 14-day TAT is not being met.
Funding
No central funding is available to support the new 14-day TAT. All appropriate funds have been allocated in PCT baselines. The ScHARR OA said that major financial savings can be made by adopting the proposed actions to achieve the 14-day TAT with minimal initial investment.
The support of NHS Improvement will be funded centrally, but local services will be expected to cover any service expenditure locally.
Other cervical screening actions in the Cancer Reform Strategy
In redesigning their services to achieve the 14-day TAT, SHAs and local screening services will wish to take into account the other cervical screening actions outlined in the Cancer Reform Strategy. These are:
• Reducing the variation of coverage between PCTs
• Action to tackle the falling participation of younger women aged 25 to 35"
http://clinicalcytology.co.uk/resources/pdf/14dayturnaround.pdf
07 January 2008 : Members of the Society will be saddened to hear of the sudden death, on 6 December, of Dr Alistair Robertson, of Dundee. He was a longstanding supporter of the Society and will be sadly missed. His obituary, as published in the Scotsman, can be accessed from the link below.
http://news.scotsman.com/obituaries/Dr-Alistair-Robertson.3611457.jp
21 December 2007 : Although it dates back to July of this year the story found at the link below may still be of interest.
Edward Duvall
(Webmaster)
http://www.eveningecho.ie/news/story/?trs=mhkfqlmhojmh
21 December 2007 : Dear BSCC member
The STOP Cervical Cancer Petition calls on the European Parliament, the European Commission and national governments to implement organised cervical cancer screening programmes equitably across Europe. It was launched to show politicians that Europeans take cervical cancer prevention seriously and that they should therefore also take it seriously. However, it will only do this if it gets a large number of signatures, otherwise it will show the politicians that this issue they can safely forget about.
The implementation of organised cervical cancer screening programmes is supported by the BSCC and we ask Society members to consider signing the petition via the link below
With kind regards,
Dr Mina Desai
Chair, BSCC Council
http://www.CervicalCancerPetition.eu/
21 December 2007 : For details of the Cancer Reform Strategy click on the link below.
On 4 December 2007 Mrs Julietta Patnick, Director, NHS Cancer Screening Programmes wrote,
"Dear Colleague
Cancer Reform Strategy
The Department of Health has today published the Cancer Reform Strategy. This document sets out the future direction for cancer services over the next five years, including the NHS Cervical Screening Programme. It can be downloaded from the web (see link below).
The section most directly relevant to cervical screening is section 3.7 to 3.17. However, screening and vaccination are also mentioned in the foreword from the Prime Minister and in paragraphs 2.44 and 2.45. Large parts of chapter 6 on inequalities are relevant and there is an Equality Impact Assessment published alongside the strategy document. This is also available on the web (see below*). You may also be interested in the sections identifying information gaps (8.14), on commissioning (box 47) and research (11.34). Paragraph 4.8 clearly brings patients from the screening programme within the ambit of the 62 day target.
For the cervical screening programme, the main immediate target will be achieving the two week turn round, from a woman having a sample taken to her having her result, by 2010. Further guidance on the 62 day wait target will be issued by the Department of Health early in 2008.
I hope this is helpful.
Yours sincerely
Julietta Patnick CBE"
*http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsLegislation/DH_081005
21 December 2007 : The Health Commission has announced a consultation exercise on its proposals for assessing NHS Trusts in 2008/2009. For a copy of the press release, the text of the proposals, and details of how to comment on them click on the link below. The consultation exercise ends on 12 March 2008.
01 November 2007 : The 2006/7 stats bulletin has been released and can be accessed via the link below
It shows that as of 31st March 2007:
Coverage has declined slightly from 79.2 per cent in 2006 to 79.5 per cent last year. It was 82 per cent in 1997.
Coverage was 80 per cent or higher in 71 of the 152 Primary Care Organisations (PCOs) in 2006-07
3.4 million women (all ages) were screened, the majority after a formal invitation from the screening programme, a of 6.7 per cent from 2005/06
laboratories examined 3.7 million samples about 8 per cent fewer than in 2005-06 ( 4 million). This is partly due to the fall in inadequate samples as liquid based cytology continues to roll out
the number of women (25-64) tested outside the screening programme in 2006-07 fell by 5.2 per cent from last year to about 668,800, this is the lowest figure for at least the last four years.
Results were available for 48 per cent of women within 4 weeks, and 74 per cent within 6 weeks, this is the highest level ever recorded. As a comparison last years figures were just 32 per cent and 56 per cent respectively
the percentage of inadequate samples this year has fallen substantially from being consistently over 9 per cent since recording started in 1998, to 7.2 per cent last year to the lowest figure ever recorded: 4.7 per cent. The main reason is the introduction of LBC as a method of taking samples.
17 October 2007 : The British Society for Clinical Cytology is again able to support nominations for national Bronze, Silver and Gold Clinical Excellence Awards. We are also able to support applications for Scottish merit awards via SACDA and details of the Scottish merit awards can be found on their website www.sacda.scot.nhs.uk.
The BSCC is allowed to support only a limited number of nominations. ACCEA set quotas for Bronze, Silver and Gold awards based on the number of eligible consultants within the Society. The BSCC is keen to support its members as effectively as possible in achieving higher awards. Full details of eligibility, etc can be found on the ACCEA website: www.doh.gov.uk/accea. Application forms are now available.
If you are applying for a National Award in 2008, you should self nominate and send your completed CV questionnaire (CVQ) electronically to ACCEA or SACDA by the relevant closing date.
If you would like the BSCC to consider your application in its ranking process, then please send a copy of your CVQ to Christian Burt at the Society headquarters (mail@bscc.net.uk) by midnight on 30 November 2007 - late submissions will not be considered under any circumstances. If the results of the 2007 awards have not been announced by this date, members should apply again but can withdraw their application if they gain an award in the previous round. The submission should be accompanied by a statement of not more than 250 words giving evidence of how you have contributed to cytology and/or the Society at regional, national or international level. The BSCC Higher Awards Committee will use these documents to prepare appropriate citations and submit a ranked list of names and supporting citations to the ACCEA.
Please do not hesitate to contact me if any further clarification is required. Tel 0114 2713728. Email: John.H.Smith@sth.nhs.uk
Dr J H F Smith
President BSCC
20 September 2007 : Following the recent election three new members of Council were announced at the AGM on the 18th September. These are
Mr Andrew Evered
Ms Margaret Middleton
Mrs Christine Payne
Congratulations to all three.
20 September 2007 : Following the 2007 AGM we are please to announce that the new officers, who will serve until 2010 are
President - Dr John Smith
Chairman - Dr Mina Desai
Vice Chariman - Mr N Dudding
Honorary Secretary - Dr Tom Giles
Treasurer - Dr Neil Anderson
Honorary Meetings Secretary - Dr Ashish Chandra
24 August 2007 : After much discussion and debate Council has produced and forwarded a formal response to the Carter Report to the Cytopathology Sub-Committee of the RCPath for consideration by the committee and dissemination within the College itself.
Members can access the document via the link below.
http://www.clinicalcytology.co.uk/resources/pdf/carterreport.pdf
14 August 2007 : As first outlined in the March addition of Links Cancer statistics were recently publsihed for 2004.
It shows that there were 2,221 newly reported cases of cervical cancer in 2003/4 with most of these in the 35-39 age group. Interestingly there were 47 below the age of 25.
Figures also show that overall rate is now 8.7 per 100,000 with the highest rates been observed in Yorkshire/ Humber and East Midlands.
Full details are available from the link below.
http://www.statistics.gov.uk/downloads/theme_health/MB1_35/MB1_No%2035_2004.pdf
19 July 2007 : As many of you will know there has been recent debate about routine bi-directional screening of SurePath cervical cytology samples following guidance issued in one NHS Region that this was mandatory. Mrs Julietta Patnick, Director, NHS Cancer Screening Programmes, subsequently sought the advice of the BSCC and the society established a sub-group of Council to consider this issue. In correspondence from Tripath to the BSCC it was made clear that the guidance that samples should be screened bi-directionally screened applied only to the learning phase of LBC implementation.
Correspondence received from Julietta Patnick in March of this year stated that she now considers this matter closed. Neither the NHSCSP nor the BSCC require laboratories using Surepath LBC to carry out bidirectional screening as routine practice.
05 July 2007 : BSCC Council has formerly responded to NHSCSP document 28 on the audit of invasive cancers.
The letter from the Chairman to Julietta Patnick can be accessed through the members only section of the resources page on the link below.
http://www.clinicalcytology.co.uk/resources/resources.asp#06
05 July 2007 : The RCpath have issued a response on the JCVI decision to give the green light to vaccination against cervical cancer.
It can be found on the College site on the link below.
http://www.rcpath.org/index.asp?PageID=474
29 June 2007 : The BBC website was today running a story on the improvements in sensitivity noted by Diana Davey and her colleagues in Sydney using the Cytyc automated imager.
The results published in the BMJ show an improved high grade pick up rate of 1.3%.
The BBC link is; http://news.bbc.co.uk/1/hi/health/6248964.stm
Further details are on the BMJ site, on the following link;http://www.bmj.com/content/vol334/issue7608/press_release.dtl#1
http://www.bmj.com/content/vol334/issue7608/press_release.dtl#1
21 June 2007 : Further to the announcement from the JCVI the DoH have issued the following press release;
HPV vaccine
Cases of cervical cancer will be reduced by up to 70 per cent with the introduction of a new vaccine into the national immunisation programme.
The Department of Health has agreed, in principle, to accept JCVI advice that HPV vaccines should be introduced routinely for girls aged around 12-13 years, subject to independent peer review of the cost benefit analysis.
Funding for this will be considered in the context of the Comprehensive Spending Review.
Human Papilloma Viruses cause 99 per cent of invasive cervical cancer. The vaccine protects against the viruses responsible for about 70% of cases.
Routine vaccination of girls could start as early as autumn 2008. Details of the programme will be finalised over the next few months, following further advice from JCVI and discussions with the NHS on the implementation of the programme.
Public Health Minister Caroline Flint said:
"Cervical cancer is the second most common cancer of women worldwide. In the UK alone, the lifetime risk of developing cervical cancer is one in 116.
"It is great news that vaccines have been developed that protect women against this form of cancer and I am delighted to announce that we intend, in principle, to introduce an HPV vaccine into the national immunisation programme.
"The benefits of introducing this vaccine will be felt by women and their families for generations to come. In England, 2221 new cases of invasive cervical cancer were diagnosed in 2004 alone. In addition around 200,000 women in England are identified through the cervical screening programme (smear tests) as having a pre-cancerous change.
"This vaccine will prevent many women from catching the HPV virus in the first place, potentially saving hundreds of lives.
"A significant amount of planning is required before we can introduce the immunisation into our programme. We are still working on the details and logistics, and will work closely with the NHS to ensure the vaccination can be delivered effectively. However, we are hoping that girls will start being vaccinated from as early as 2008."
The highly successful and comprehensive cervical screening programme (smear tests) will continue after an HPV vaccine has been introduced. This is because of the gap between the age of vaccination and age of first screening. Also, screening will be required as the vaccine does not protect against all HPV types that may cause cervical cancer.
ENDS
For enquiries please call 0207 210 4850.
NOTES TO EDITORS
1. The Joint Committee for Vaccination and Immunisation (JCVI) has advised that HPV vaccines are clearly beneficial. It has commissioned a cost-effectiveness analysis which will be the subject of an external peer review. The JCVI is expected to make their formal recommendation to the Government at their next meeting on 17 October 2007.
2. The JCVI provides the Department of Health with independent expert advice on all vaccine issues.
3. Human papilloma virus is a sexually transmitted virus that causes 99 per cent of invasive cervical cancer.
4. To ensure maximum benefit and protection from this vaccine, it would be necessary to administer it before the onset of sexual activity.
21 June 2007 : The Joint committee on vaccination and immunisation panel (JCVI) has given the green light for the introduction of vaccination of 12 year old girls against HPV in England.
Whilst accepting the advice the DoH said it would have to investigate whether the introduction was financially viable. A statement from them said the programme would have to undergo an independent peer review of the cost benefits and that funding would have to be considered in the context of the comprehensive spending review.
Scotland says it will introduce its own programme by late 2008.
The JCVI did not, however, call for a catch up programme which would have included vaccinating some older girls, perhaps upto the age of 16.
There are two vaccines to choose from Gardisil, marketed by Merck and already available and Cervarix, expected to become available later this year. Both are expected to prevent around 70% of cancers, suggesting that some form of screening programme will have to continue for many years to come. Gardisal has the added advantage of being effective against HPV types 6 & 11, meaning that it should prevent many of the cases of gentital warts that currently cost the NHS around 23 million pounds per annum.
Further information is available from the BBC website link below.
http://news.bbc.co.uk/1/hi/health/6768427.stm
08 May 2007 : It is with great sadness that Council wish to advise members of the Society that Dr Darrel Whitaker passed away on 23rd April 2007.
Dr Darrel Whitaker was a Consultant Cytologist in the Anatomical Pathology Department at PathCentre, the Western Australian Centre for Pathology and Medical Research. He was one of the most recognised cytologists in Australia and earned an International reputation for his work on the mesothelium and the cytology of malignant mesothelioma. Below is an extract of a citation from Dr Greg Sterret on the occasion of his elevation to a Life Member ship of the Australian Society of Cytology. He was quite an achiever.
“ Darrel was born in the United Kingdom in 1940 and did his early Medical Laboratory training in the early 1960’s in the Pathology Department of the Royal Halifax Infirmary where he was in charge of Histopathology and Cytology. His initial training in Cytology began in 1964 under the tutelage of the expatriate Australian pathologist Gladstone Rule Osborne at the Derby Royal Infirmary. In the early years Darrel’s education in Cytology was gained through attending meetings of the British Society of Clinical Cytology (BSCC) where it was his good fortune to be exposed to the key figures in British cytology and he considers them his mentors. He has fond memories of “Dr Joe Bamforth the grandfather of British cytology and pioneer of respiratory cytology, the erudite Erica Wachtel, the enthusiastic gynaecologist Dr Stanley Way, the dickie-bowed Rolf Schade of gastro-cytology fame, the debonair academic Dr Arthur Spriggs, the flamboyant Dutchman Dr Lopez Cardozo and the pioneer of urine cytology J.G.S. Crabb”. Other mentors were Drs Blanche Butler, Dr Gordon Canti and Betty Attwood. Names recognised today for their text books and publications.
The Halifax laboratory was one of two units selected by Her Majesty’s Government for a pilot study of the national recall service in cervical cytology. This laboratory pioneered factory screening and such names as Marks & Spencers and Mackintoshes (of Quality Street chocolate fame) became a regular source of Pap smears to that unit. The latter factory was widely accepted, as accompanying the Pap smears, were brown paper bags full of chocolates. At this time as a member of the Sub Regional Committee on population screening (1960-1973) Darrel gained experience that was invaluable when some years later he was involved in helping set up a recall scheme in Western Australia.
Darrel was also fortunate to work on one of the pioneer automation systems, the Vickers Autoscan cytoscreening system which used a 16mm film tape to accommodate a 1 metre long x 1mm wide cell monolayer. This was analysed using a photo multiplier to recognise abnormal findings.
When Darrel emigrated to Australia in 1973 with his wife and young family the Wittenoom asbestos mine had been closed for seven years and the Western Australian community had begun to feel the impact of asbestos related diseases. For Darrel the Sir Charles Gairdner Hospital with its strong respiratory medicine influences became another place of learning with exposure to all forms of respiratory disease including “the great mesothelioma experience”. After Darrel’s arrival, the pathology service gradually took up exfoliative. In 1977, Darrel published a paper in Acta Cytologica “Cell Aggregates in Malignant Mesothelioma”. This was one of only a few reports describing criteria used in the cytological diagnosis of mesothelioma and was one of the first in the cytology literature describing features seen in mesothelioma by transition electron microscopy. Since that time he has continued with his colleagues to contribute to the understanding and diagnosis of this occupational malignancy. Darrel’s impressive research output on this subject as author or co-author includes 3 books, 12 book chapters and 55 articles in National and International Journals. His ability as a researcher and clinical cytologist has led to his being invited to speak at many local, national and international conferences including the International Academy of Cytology and the British Society of Clinical Cytology.
As a teacher Darrel began as a part time lecturer in cytology at the Percival Whitely College in the UK. On arrival in Perth he began lecturing at the University of Western Australia and the Western Australian Institute of Technology. He continues to be a lecturer in cytology and an examiner in post graduate studies that include examiner in Master of Science Department of Anatomical Pathology University of Western Australia, supervisor of honours and PhD students and examiner for AIMS Fellowship exams. He was involved in the planning and introduction of the Diploma Course in Cytology and in establishing a traineeship scheme for cytotechnicians in Western Australia.
Darrel has been the recipient of a number of Research grants and for outstanding work in the scientific field he has had a number of prestigious awards bestowed upon him. They include the International Cytotechnology Gold Medal awarded by the IAC in1986, the Ames Award by Australian Journal Medical Laboratory Science in 1979, NHMRC travelling Fellow (1990), Churchill Fellow (1990), AIMS Saal/Foley Lecturer (1996) and best proffered paper at two Australian Society of Cytology Annual Scientific meetings. In 1999 his published works gained him Membership of the RCPA.
Today Darrel shares the clinical responsibilities for the operation of the cytology service within the Department of Anatomical Pathology. He is part of the diagnostic team as well as consultant to other teaching hospitals, and private cytology services. Since 1987 he has been a member of the RCPA Mesothelioma Panel and provides an expert opinion on the cytological diagnosis of mesothelioma. He has been a NATA assessor in cytology since 1990.
Darrel first became associated with the IAC when as Registrant No.18 he successfully sat the very first IAC examination in London. Since that time he has become a Fellow of the IAC (1977) and been a member of the Cytotechnology committee (1977-1995) and the International Award committee (1986-).
Perhaps his best known forum has been the Australian Society of Cytology where he has served on numerous state and federal executives and many committees relating to education. With Professor Robert Barter he was instrumental in prompting the formation of the Western Australian Branch of the ASC in 1974 and was elected to the inaugural Branch committee a position he held until he was elected National Secretary in 1985. Other positions he has held are WA State Councillor, member Board of Examiners (1993-1996), Chairman of the Education committee, Board of Education and Continuing Education Committee. As chairman of the education committee he was involved in the establishment the Board of Education and the CEC Registry. Darrel has recently retired from the Board of Education.
Not only has Darrel been a full and active member of the Medical Scientific profession he also finds time to support youth through his leadership of the scout movement. He was appointed as Chief Commissioner and State Chairman for Western Australia in the 1980’s and in 1998 he was awarded the silver Kangaroo for services to Australian Youth. Darrel is an avid reader and cricket buff. He is a keen gardener and rose grower and his spare time is devoted to cultivating his ‘back yard’ which overlooks Lake Goollelal in the Yelongonga Regional Park in WA. In his busy life he gives highest praise to time spent with his wife, children, and 5 grand children.
Darrel’s professional achievements and his positive approach are an inspiration to his colleagues. “
I knew him fairly well in the old days, as he studied with us for a while in Birmingham, where the “Vickers Automated Cytology Machine” was developed and piloted, and only caught up with him a few years ago when we shared a teaching platform and a drink or two in Eastbourne, when he was on his sabbatical. A true Pioneer, he will be sorely missed.
Dennis Williams
Birmingham 2007
26 March 2007 : Available to view or print in PDF format. Please follow the link below.
http://www.clinicalcytology.co.uk/resources/pdf/nhspublications.pdf
11 February 2007 : Cervical screening hit the news again on Friday following the publication of a letter by our Chairman and President in the BMJ. Titled "women under 25 should be offered screening" it outlined the view that the decision not to offer screening to those under 25 would do little to help the problem of falling coverage in young women.
Further details can be obtained via the link below.
http://www.bmj.com/cgi/eletters/334/7586/172
01 February 2007 : The long awaited statement on reporting of non gynaecological cytology by non medical staff has now been published on the College website. The proposal is that in future, holders of the IBMS diploma in Expert practice are considered competent in the pre-screening of, and may report negative diagnostic material from, the following systems/specimen types:
i) Urine cytology
ii) Sputum, bronchial washings/bronchoalveolar lavage and bronchial brushings
iii) Serous cavity effusions and peritoneal washings
Holders of the preceding IBMS Certificate in Diagnostic and Interpretive Cytology will also be considered to be qualified at this level.
Further details are available from the College website on the link below.
http://www.rcpath.org/index.asp?PageID=1305
30 January 2007 : The new HPV today has been posted on the website in the Documents section of the Resources page. You must be logged in as a BSCC member to see it.
Jump to the resources section to download the latest HPV today:
http://www.clinicalcytology.co.uk/resources/resources.asp#06
28 December 2006 : The long awaited NHSCSP document on how to carry out our invasive cancers audits has now been published and is available on the NHSCSP website on the link below.
Document 28 outlines how each aspect of the audit should will be carried out and links in with the earlier publication on the disclosure of results.
http://www.cancerscreening.nhs.uk/cervical/publications/nhscsp28.html
21 December 2006 : Fewer women are having to return for repeat cervical screening because their first test was inadequate, according to latest statistics from The Information Centre for health and social care.
Inadequate results are those where the test has to be repeated as the first cannot be read and can occur because of blood or other material being present in the sample. However, analysis of data from the NHS Cervical Screening Programme reveals that the introduction of liquid-based cytology (LBC) to replace conventional pap smear tests is significantly reducing the number of inadequate tests.
For the first time since 1998 the percentage of inadequate tests, among women aged 25 to 64, has fallen from nearly one in 10 (9 per cent) to 7.2 per cent (nearly 250,000) of the 3.4 million samples analysed by laboratories* in England in 2005-2006. In total laboratories examined 4 million samples during the year, supplied from all sources and for women of all ages.
The NHS Cervical Screening Programme began the introduction of LBC, a new way of preparing samples for examination in the laboratory, in 2003, following a recommendation from NICE. By August 2006, LBC had been introduced at over 50 per cent of laboratories responsible for analysing cervical screening samples. National coverage is on track to be completed by 2008.
Julietta Patnick, Director NHS Cancer Screening Programmes, said: "These figures are extremely encouraging as they show that women are already benefiting from the new LBC technology.
"Not only is the number of inadequate tests falling, reducing anxiety and the number of repeat tests required, but women are also getting their results faster. Almost a third of women - 32 per cent - are now receiving their results within four weeks."
The percentage of women offered their first appointment for a colposcopy within four weeks of referral remains unchanged from the previous year at 43 per cent. For women with moderate or severe cell changes (dyskaryosis categories), 71 per cent were referred within four weeks compared with 68 per cent in 2004-05.
During 2005-2006, 3.36 million women were screened, an increase of 2.4 per cent on the previous years figure of 3.28 million. This rise can be attributed to the fact that the number of women within the target 24 to 65 age group is increasing. However, coverage has actually dropped to 79.5 per cent, a drop of 0.8 per cent on the previous year and 0.5 per cent below the target of 80 per cent of women within the 24 to 65 age range.
To read the publication go to http://www.ic.nhs.uk/pubs/csp0506
Mrs Julietta Patnick CBE BA(Hons) FFPH
Director
NHS Cancer Screening Programmes
Fulwood House
Old Fulwood Road
Sheffield S10 3TH
http://www.ic.nhs.uk/pubs/csp0506
12 October 2006 : members who attended the AGM will already be aware that Council proposals to create one class of membership were succesful.
As of now the category of extra-ordinary membership has disappeared and both BMS and Medical members will come under the category - ordinary membership.
Proposals to reduce the number of Council meetings from four per annum to three per annum were also succesful.
Full minutes from the AGM will be posted in the next few days.
12 October 2006 :
The following guidance was issued to all screening offices on the 6th October.
It appears to indicate that laboratories should no longer report "infections" but is clearly aimed at screening offices rather than laboratories and leaves the decision at a local level.
Cervical Screening Call / Recall System
Infection Reporting in Result Letters
Date of issue: 6 October 2006
Introduction
1. Historically it was considered good practice for incidental infections noted in cervical cell samples to be reported by the laboratory. Details of infections were then included in the result letters sent to women. This is no longer considered good practice.
Requirements
2. The National Screening Committee has advised that incidental infections are not relevant to cervical screening and need not be reported by the laboratory. If by local agreement the laboratory decides to report infections where present, this information should be sent to the sample taker for further action as appropriate.
3. There have been a number of problems related to the identification and coding of infective organisms, the transmission of the coded data to the Primary Care Organisation (PCO), and subsequent interpretation and use of this information. It is preferable that laboratories do not send infection codes with cervical screening results to PCOs.
4. References to infection should no longer be included in result letters. It should be noted that the national model result letters do not include information about infections, and the covering e-mail sent with the letters on 17 June 2005 specifically stated that it was not good practice to mention them.
Implications and Recommendations
5. PCO screening staff are advised to disregard infection codes if they are provided by the screening laboratory.
6. As some results are received electronically, either directly from a laboratory or where results are transferred in from another PCO, it is understood that some infection codes will continue to be recorded inadvertently. To ensure that all women receive an appropriate result letter, it is necessary to complete every page of DD Screen 9 on the NHAIS system, using the same letter codes for results with and without infections.
7. Where local screening policies are amended as a result of this directive, screening departments should formally notify all laboratories which send results to that department of the change.
8. QA teams should also be advised if screening policies are changed significantly or if there are any anticipated side-effects of the change.
12 October 2006 : The first vaccine against cervical cancer was licensed for use in Europe yesterday (25th September) This will mean that it will be available in Britain within weeks, but not on the NHS.
The vaccine, given the tradename Gardasil, is extremely effective and could prevent three-quarters of cervical cancers.
Getting its Eurpean license means it can be prescribed in Britain, but the Department of Health said it had no time-scale for the vaccine to be made available on the NHS.
21 September 2006 : Madam President and members of the BSCC, it is my pleasure to update you on Society and Council activities during the past year which fall into seven broad categories, namely: the consolidation and full implementation of the revised administrative arrangements; the proposed changes to the Statutes; the revision of terminology for cervical cytology; assessment of adequacy of cervical liquid based cytology preparations; the revision of the code of practice; the Society response to the Carter Report; and, lastly, initial preparations for the 17th International Congress of Cytology in Edinburgh in 2010.
Due principally to the tireless industry of Gillian Woods, supported by Nick Dudding and Kathryn Hawke, we have now fully implemented the revised administrative arrangements that I outlined at the AGM in 2005, in order to secure a comprehensive reliable membership database and a central point of contact for all matters relating to Society activities. Linked to this has been the further development and re-launch of the website in January under the expert guidance of Dennis Williams to provide the most rapid and efficient means of dissemination of information and consultation with the membership. Throughout the last 9 months we have published on the website items of interest and importance to the cytology community and sought the views of the membership on draft documents such as the revised code of practice. To date the response to such consultation has been rather limited and disappointing, but I emphasise that this is the principal way in which Council will seek your views in future and it is your opportunity to influence policy documents and Council responses to matters of national importance. Council are the elected executive of the Society and we hope that through wide consultation with the membership we can with confidence represent your views as the voice of cytology in the UK. Dennis Williams completes his term of office on Council at this AGM, but has kindly agreed to remain as webmaster until the summer of next year. It would be remiss of me, therefore, to let this AGM pass without formally publicly thanking Dennis for his enormous contribution to the Society and to wish him well for the future. We shall now be seeking a successor in the hope that a suitable individual can be appointed soon, allowing for a period of overlap with Dennis and a smooth transition.
Earlier this summer, you will have received a document detailing the proposed changes to the Statutes that I outlined at the previous AGM and subsequently a postal ballot on these proposals. The result of the ballot will be announced later in this meeting.
Yesterday Dr Karin Denton presented the proposed revised terminology in cervical cytology, representing the views of a working party of Council which she has chaired over the past year. The terminology is applicable to both conventional smears and LBC preparations and has been a development of the work that followed the BSCC 2002 terminology conference. The draft document will now be sent for comment to all the moderators of the 2002 conference and to the relevant professional bodies for information and it is hoped that it will be published in due course in Cytopathology. Members should note that it has been developed in close collaboration with the British Society for Colposcopy and Cervical Pathology and implementation is under discussion with the NHSCSP.
In October last year, in response to a Health Technology Assessment programme request for formal proposals for research on adequacy of LBC specimens, Dr Mina Desai formulated a protocol for a multicentre study. This proposal, and a separate proposal by Dr Lesley Turnbull, was short listed for further development and costing by the HTA Commissioning Board. Subsequently Drs Desai and Turnbull agreed to submit a joint bid on behalf of the Society, which has been well received by HTA, and subject to a few modifications we are hopeful of a positive response and commissioning later this year. This proposal will require the collaboration of a number of laboratories representative of practice in the UK and Council seek your support to conduct seminal work in this area.
The BSCC Code of Practice was last published in 1997 and Council agreed some time ago that it was in need of revision. The updated final draft modules on exfoliative cytology and fine needle aspiration cytology, which were made available for comment on the web site at various stages of development, will be presented by Dr Ash Chandra later during the ASM. Council will seek formal endorsement by the Royal College of Pathologists. There has been close liaison with the College during drafting and the College is keen that these documents will parallel the ‘tissue pathways’ under development for histopathology and become the definitive guidance on practice for all clinical cytology laboratories in the UK. To date we have done little work on the two other modules concerned with cervical cytology and general laboratory staffing and accommodation, pending full implementation of LBC in the cervical screening programmes, Agenda for Change, and cervical cytology automation. However with completion of LBC implementation due for 2008, plus A4C now well established, I expect the code of practice working party to begin to consider these other modules in the near future.
Council welcome the publication of the Report of the Review of NHS Pathology Services in England chaired by Lord Carter of Coles and note the emphasis placed on involvement of pathologists in service commissioning and strong clinical leadership, whilst building on existing Department of Health initiatives. We shall be formally responding via the Royal College of Pathologists.
Lastly, as many of you will have heard yesterday, initial preparations for the 17th International Congress of Cytology in Edinburgh in 2010 are well in hand. Meeting Makers, a Scottish based company with considerable experience of hosting large international meetings in the Edinburgh International Conference Centre, have been appointed as our professional conference organiser for this event and a limited company – cytology 2010 – established with a board drawn from an employee of Meeting Makers and the current Chairman of Council and BSCC Treasurer. Promotion of the meeting will commence at the 16th International Congress of Cytology in Vancouver in May next year and immediately thereafter our web site will go live. We have an outline budget deliberately based on a relatively modest attendance and which will result in only a small increase in the attendance fee compared with Vancouver.
I am sure you can see from the above topics the various ways in which the Society is making a significant contribution to the development and maintenance of standards of practice in cytology. I would not have been able to report to you in this way today without the industry and support of all the officers and members of Council, to whom I extend my grateful thanks for another productive year. I have already mentioned Dennis Williams, and this year Ray Lonsdale and Paul Cross also complete their term of office as Council members. To all three in particular I give particular thanks.
Finally, on behalf of the Society I extend our sincere thanks to Dr Alistair Williams, the local organising committee, all the local volunteers, and In Conference Ltd for organising this most informative and enjoyable Annual Scientific Meeting. The Society last met in Edinburgh in 1988 and I was intrigued to see that the venue this time is one of the few universities offering undergraduate and postgraduate degrees in brewing and distilling – very appropriate for the capital of Scotland and the fruits of which some of us were sampling last night at the City Chambers: to the City of Edinburgh and our other sponsors, especially Cytoimmun, Cytyc, DiagnoCure Inc., Medical Solutions plc and Olympus UK Ltd, I extend our grateful thanks.
Lastly I offer on your behalf a warm welcome to all our guest speakers and thank them for their contributions. I hope that they will be joining us at the Society Dinner this evening.
12 September 2006 : The new HPV today has been posted on the website in the Documents section of the Resources page. You must be logged in as a BSCC member to see it.
Jump to the resources section to download the latest HPV today:
http://www.clinicalcytology.co.uk/resources/resources.asp#06
15 August 2006 : Please note that the latest draft of the Code of Practice for Non Gynaecological Cytology is now in a printable pdf file and can be accessed in the Resource Section. Any comments should be addressed to Dr Ashish Chandra directly (ashish.chandra@gstt.nhs.uk), preferably by 31 August.
02 August 2006 : Click on this link for the full PDF file (94 pages) of this important document for the future of Pathology services in England.
18 July 2006 : The search is on for this year's award-winning projects and initiatives in
the allied health professions and health sciences UK awards. With 9
categories and up to £15,000 in prizes, these awards are unique in
recognising and promoting excellence in these professional groups across
England, Northern Ireland, Scotland and Wales.
Building on the success of the 2005 awards, Chamberlain Dunn announce the
support of all four health departments and key sponsors NHS Employers, NHS
Connecting for Health and AMICUS.
This year's competition offers plenty of chances to reward and publicly
recognise your team, indeed your profession's achievements, including two
new categories 'Working across boundaries' and 'Promoting healthcare
science'.
Further details on how to enter are available form the link below.
http://www.health-workforce.com/htm/e20060703.569998.htm
20 June 2006 : The FDA in the USA have now formally approved the quadrivalent GARDASIL vaccine for HPV subtypes 6,11,16 & 18 for use in the battle to prevent cervical cancer. It will be interesting to see what sort of vaccination programme emerges. Precisely who will be targeted; from what age will vaccination commence; and how much will it all cost. This link below will give more information.
http://www.rxpgnews.com/cancer/article_4306.shtml
01 June 2006 : Please find the long awaited document giving 'best practice' advice for dealing with patients that develop cancer whilst in screening programmes. This first part deals almost entirely with the psychological and medicolegal aspects of the disclosure process. The METHODOLOGY of how to do an audit, however, remains as yet unpublished. I do so hope it arrives soon. Meanwhile you can lodge any comments on this current document for discussion on the Forum. I am sure people will have a lot to say on this thorny topic.
http://www.clinicalcytology.co.uk/resources/pdf/cs3_disclosure_on_audit_results.pdf
25 May 2006 : Dr Desai, chair of the BSCC sub group looking at adequacy, has applied on our behalf for a resarch study grant from Health Technology Assessment to carry out a Multicentric prospective trial into specimen adequacy with both systems of LBC. Our application was one of two shortlisted along with an application from Dr. Turnbull's at Liverpool. After further discussions it was agreed that Dr. Turnbull and the BSCC would submit a final joint application to HTA and at present we are waiting to hear the outcome.
02 May 2006 : The BSCC working group, chaired by Dr Karin Denton has continued to work on developing an updated terminology for dyskaryosis. To date several principles have been agreed;
This is the BSCC classification and it is up to the BSCC to amend or update it as the society decides
We need to work in close partnership with the NHS CSP and the BSCCP to ensure other organisations we work with are consulted and satisfied with any changes. We need to give them time to plan implementation
The basic principle of the BSCC classification will remain intact and the term "Dyskaryosis" will be retained
The areas under consideration for change are
High grade dyskaryosis, nomenclature
Borderline change, subdivision and nomenclature
Borderline change with Koilocytosis, nomenclature and management
Both the BSCC and the BSCCP have surveyed their members on aspects of the proposed changes
The proposals will be presented to the society at the Anual Scientific Meeting in September 2006
03 February 2006 : May I recommend a visit to one of the most interesting and informative current information sites for Exfoliative Cytology? Andrew Evered has worked tirelessly to load his Welsh Cytology Training School site with some really interesting cases, and it is a must for all working cytologists at any level. I cannot recommend it highly enough. The quality of the graphics is a joy to behold.
You should be aware that this is an Intranet site, and as such cannot be accessed by common search engines on the world wide web.
http://howis.wales.nhs.uk/sites3/page.cfm?orgid=378&pid=5475
30 January 2006 : Hi, welcome to the new look website. We have listened to your comments and tried to make the site a whole lot easier to navigate, and to load it with up-to-date and interesting features and articles. Later we hope to add an Educational platform, where interesting cases can be posted and discussed.
The Code of Practice for Non Gynaecological Cytology is already listed in its Draft form, and the moderator, Ashish Chandra, has asked for comment via the Forum Discussion facility, which is now fully within the Site, and so doesnt require any further logging on.
I would be very pleased to hear your comments about the Site. We will always try to accommodate your concerns wherever possible. Finally, we do hope you enjoy the facility and become a regular visitor.
Dennis Williams (Web Manager)
19 January 2006 : It is with pleasure that I invite all members for their comments on the revised BSCC Codes of Practice (COP). The first in this series is the COP on Fine Needle Aspiration. This document has had input from many experts in the field and awaits your comments and suggestions before the final version is made available for publication.
The COP is expected to be a bench-book in every cytology lab, offering useful advice to the lab and also users of the FNA service. Although comprehensive in some aspects, the COP is not intended to be a substitute for the reference text book. It provides a manual of standard practice in the cytology laboratory and may be referred to when writing protocols.
Please post your comments on the website forum by 31 March 2006 for consideration by the authors.
You can do this by accessing the Forum Button from the Home page portal.
Ashish Chandra
http://www.clinicalcytology.co.uk/resources/fna.asp
24 November 2005 : Although you may not yet have received your hard copy the 2004/5 statistical bulletin is now available through the NHSCSP website. As ever it makes very interesting reading.
Although laboratories in England screened 0.2% less samples than in 2003/4 we continue to screen over 4 million samples each year. Worryingly, however, coverage has fallen again and is now only just above the 80% target figure at 80.3%. Despite our interest in LBC, HPV testing etc this probably is the major challenge that the screening programme faces at the present time.
Of those we reported 3.2% were reported as showing borderline change, 1.7% as mild dyskaryosis, 0.6% as moderate, 0.5% as severe and 0.1% as glandular neoplasia. The resulting new standard ranges showing a reassuring narrowing to 3.2 - 7.29% for low-grade abnormalities and 0.8 - 1.3% for high grade changes. Interestingly a standard range was not set for inadequate samples this year reflecting the increased variation as laboratories start to enter LBC conversion.
The high grades continue to peak in the 25 - 29 age group though opponents of the new screening intervals will note that there is still a significant number to be found in the 20 - 24 cohort.
Unfortunately the benefits of LBC have yet to be realised with only 29% of result letters sent by PCO's being sent within four weeks, down from 38% in the previous year. This will undoubtedly fall however as LBC conversion progresses.
Outcomes following referral show that we continue to perform well on the prediction of high grade disease with 75% of those referred to Colposcopy with a high grade abnormality having CIN II or worse. PPV's varied between 52 & 95% with the standard range remaining the same at 75 - 87%.
Colposcopy clinics saw 124,000 new referrals in 2004/5, 78% because of us. 155 of these women were offered an appointment within two weeks and 43% within four weeks. One depressing statistic was the number of wasted appointments with only 67% of follow up appointments being attended. "See and Treat" remains relatively popular with 44% of women referred as a result of a high-grade smear having an excision whilst 37% had a diagnostic biopsy. For those attending as a result of a low grade abnormality only 7% had an excisional biopsy on first visit however.
The full bulletin is on the NHSCSP website and you can access it via the following link:
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