Screening process
1. Examination by the registering gynaecologist
The woman is examined by her registering gynaecologist during her regular preventive checkup. Cervical smear test is part of this examination. For women aged 35, 45 and 55, the presence of HPV is also tested in the cervical smear.
The gynaecologist sends the cervical smear together with the accompanying form to an accredited cytology laboratory.
The accredited cytology laboratory then performs a standard examination of the sample, according to defined methods. The result of the examination (according to the standard classification Bethesda 2001) is sent back to the registering gynaecologist; this must be done not later than 3 weeks after the day of cervical smear test.
Based on the results of cytological examination, the registering gynaecologist decides on what to do next.
2. Negative result
In case of negative result of cervical smear test, the client is recommended to attend another screening examination within a preventive checkup after one year (see Figure 1).
Figure 1: Scheme of cytological examination. The registering gynaecologist sends a sample of cervical smear to the accredited cytology laboratory, and gets back the result within three weeks. In case of negative result, the client is recommended to attend another preventive checkup after one year.
3. Repeated smear
In case of other than negative result of cervical smear test, the registering gynaecologist is obliged to send repeated smear or histology result to the laboratory within a defined time period, depending on the seriousness of the first cervical smear result. If the gynaecologist fails to do so, the laboratory inquires of him.
The following table summarizes time periods after which the laboratory inquires* of the gynaecologist, depending on smear test resul:
| Smear test result | Inquiry* after ... |
|---|---|
| Normal | --- |
| Inadequate smear | 4 months |
| ACS-US | 7 months |
| ASC-H | 4 months |
| LSIL | 7 months |
| HSIL | 4 months |
| HSIL - invasion cannot be excluded | 4 months |
| Squamous cell carcinoma | 4 months |
| AGC-NOS | 4 months |
| AGC-NEO | 4 months |
| Adenocarcinoma in situ - AIS | 4 months |
| Invasive adenocarcinoma | 4 months |
| Other malignant tumours | 4 months |
| Other | Facultatively |
*Only if the gynaecologist fails to send repeated smear or histology result to the laboratory.
The result of histopathological examination is sent back to the centre which requested this examination. The registering gynaecologist must also be informed about the result. If results of the histopathological examination are not delivered in time, the gynaecologist is obliged to inquire himself and to report this failure to the Cervical Cancer Screening Committee at the Ministry of Health. Based on the result of histopathological examination, the gynaecologist decides on possible treatment of the patient.
The gynaecologist then sends his report to the accredited cytology laboratory, which subsequently enters these data into the database.
Figure 2: Schematic representation of follow-up of any patient in which other than negative smear test result was found.