Provision of cervical cytology at genitourinary clinics is acceptable and worthwhile practice

Background: Since the NHS national cervical screening program began in the late 1980s the incidence of cervical cancer has halved however it remains the 11th commonest malignancy in women and the commonest in those under351. In England cervical screening saves around 4500 lives per year and prevents up to 3900 cases of cervical cancer annually in the UK1. As sexual health services move toward an integrated model of care then provision of cervical smears, whether opportunistic or routine, should be within the remit and capability of UK GU clinics

Methods: Over a 16 month period (April 2012–August 2013) offers of cervical smears were made, when appropriate, to women attending a DGH GU clinic. A routine offer was made if she had received a calling letter from the screening program or was due her annual check if HIV positive2. Opportunistic offers were made if she was 25 or over but never previously had a smear or were found to be overdue from their history. Smears were performed by trained staff–both nurses (band 6/7) and doctors (SAS/Consultant)

Results: A total of 100 smears were performed–61 by nurses, 39 by doctors.10 presented specifically for a smear including 2 HIV positive women. 81 were picked up opportunistically with 9 unclear from the notes. 75 smears were reported as normal, 11 abnormal, 6 rejected, and 8 outstanding for now. Abnormalities detected: borderline changes, high-risk HPV (6); low-grade dyskaryosis, high-risk HPV (3) and mild dyskaryosis, high-risk HPV (2). All abnormal smears were from women who had either never had a smear or were overdue (6 months–9 years) from their last. Rejected smears were due to either incorrect labelling or insufficient sample

Conclusion: It has traditionally been felt in GU that provision of cervical smears should be left to primary care however our results show that a significant amount of undiagnosed pathology can be picked up by our service. If indicated from the sexual history then an offer of a smear should be made whilst women are attending for whatever GU reason particularly if a speculum speculum examination is warranted. Care must be taken in selecting women appropriately and ensuring that GP details are taken and route of dissemination of results explained, ie, separate from GU results. Referral pathways should be in place and we recommend a database is set up to ensure results are acted upon appropriately. Additional burden of work appears to be minimal