This document discusses cervical cancer screening practices at a women's health center in Liverpool, Australia. It notes that the cervical cancer rate is one of the lowest in developed countries due to screening, but that rates are higher for disadvantaged and immigrant women. The nurse practitioner provides cervical screenings and sees many newly arrived immigrants. Barriers to screening include lack of female practitioners, judgmental attitudes, and inflexible equipment. The women's health center aims to address these through a women-centered approach with privacy, informed consent, and culturally sensitive care. The document calls for further research on women's experiences at such centers and discussions around workforce funding and skills.

1. Cervical screening: does it really matter?
Building on Feminist Best Practice
Ms Jo Perks
Women’s Health Nurse Practitioner
Liverpool Women’s Health Centre: Sydney

2. Womens Health Centres
 Grass roots primary health care
 Leichhardt Womens Community Health Centre
the first centre established in Australia in 1974
 Liverpool Womens Health Centre in 1975
 There are 23 centres across NSW – Women’s
Health NSW is the peak body
 Non government organisations funded by NSW
Ministry of Health
 Meet the needs of disadvantaged and
marginalised women

3. Liverpool Womens Health Centre

4. Nurse Practitioner Role
 Clinical
 Health Education
 Health Promotion
 Advocacy
 Referral
 Management
 Leadership

5. Nurse Practitioner Stats 2011 - 2012
Clinical Presentation Sexual & Reproductive Health 2011/2012 Total= 3,316
8
6
6
10
21
13
2
1
3
566
20
35
2
234
11
259
7
1
32
4
249
129
7
646
29
9
36
5
19
1
15
163
13
54
15
499
21
165
0 100 200 300 400 500 600 700
Vuvla/Vag
UTI
Urinary Incont.
Urinary
Thrush
Termination
Preg test
Preg other
preg options
Preg ectopic
Preg antenatal/prenat
Preg AI
Post termination
Post natal check
PMS
PCOS
Pap smear
Ovarian Ca
Miscarriage
Mentruation
Menopause
IVF
Infertility
Hysterectomy
HRT
Gynae general
Gestational diabetes
Endometriosis
Contraception gen.
Contraception emergency
Cervical Ca
Breast surgery
Breast other
Breast lumps
Breast feeding
Breast exam
Breast diagnostics
Breast cancer

6. Cervical Cancer
 Cervical cancer is the third most common cancer
diagnosed in women worldwide
 Australian age –standardised incidence rate (4.9
cases per 100,000 females) is one of the lowest
among developed countries
 Mortality rate 1.4 deaths per 100,000 females
FPNSW (2011). Reproductive and sexual health in NSW and Australia: differentials, trends and
assessment of data sources. FPNSW: Sydney

7. Cervical Cancer
 In NSW from 2004 to 2008, women born in the
UK and Ireland had the highest age standardised
incidence rate of cervical cancer followed by New
Zealand born women and North European
women
 Cervical cancer incidence by area of socio
economic disadvantage was highest in the most
disadvantaged.
FPNSW (2011). Reproductive and sexual health in NSW and Australia: differentials, trends and assessment of
data sources. FPNSW: Sydney

8. SSWAHS Cervical Screening Rates
 SSWAHS - 58%
 Liverpool LGA – just over 50% (Womens Health
SSWAHS)
 Liverpool LGA is a fast growing area of Sydney
where newly arrived refugees are settling.
 Liverpool Women’s Health Centre main referral
point for newly arrived women (under screened
and first pap tests)
FPNSW (2011). Reproductive and sexual health in NSW and
Australia: differentials, trends and assessment of data sources.
FPNSW: Sydney

9. NSW Cervical Screening Program
 Campaigns
 Data
 NSW Pap Test Register – opt off system

10. NSW Cervical Screening Program
 Where will the women turned away go for
screening?

11. What’s feminism got to do with it?
 Informed choice and accurate information
 Preventive Screening – is it power and control of women’s
bodies? – dominant doctor/patient relationship
 An abnormal result – what does it mean for a woman who
has had regular pap smears with negative results – worries
about the abnormal body and cervix!
 What about new technologies – HPV screening, Liquid
Based Cytology – cost?
 Holistic care

12. Anecdotes
 Woman told by her female GP that she couldn’t
do a pap test because of her weight – 106kg!!
 Woman told by another female GP that she didn’t
have the necessary equipment to do a pap test!
 Do you have any stories to tell?

13. Women’s Health Centres and
Cervical Screening
 Women only space
 Female practitioners
 On time appointments
 Highly skilled staff
 Non judgemental
approach
 Sensitive to issues
identified – history
taking
 Adjustable bed - WWD
 Self insertion of
speculum
 Privacy
 Informed consent – Pap
register etc
 All results given –
negotiated with woman
as to how she gets her
results
 Women feel
comfortable
 Equipment

14. Partnerships
 FPNSW – GP Training. Liverpool Women’s
hosted training in February 2013
 Medicare local – the NP is now a member of the
women’s health committee
 Womens Health Nurses
 Womens Health Centres

15. Proposed research
“What is the cervical screening experience of
women attending a women’s health centre
with care provided by a nurse practitioner”
 Retrospective study
 All first time clients for pap test July 2011 to June
2012
 Booked in to see NP
 Telephone interviews of random sample

16. Issues for this conference to consider
 Workforce and funding
 Burnout
 Referrals - maybe up skilling
of other professionals is
better
 The nurse practitioner is
unable to access a Medicare
provider number due to
funding models. Discussions
have been had with local
members of parliament to no
avail
 The nurse practitioner is
unable to prescribe the first
dose of vaginal oestrogens
and other hormone
therapies. Vaginal
oestrogens are helpful for
postmenopausal women
(More comfortable and
accurate pap test) – Cx
cancer is more common in
older women!
 The pap test is just the
beginning – what about the
follow up and referrals for
abnormalities?

17. Questions?