Dr. Rebecca Leon

[00:00:00] You kind of know what a normal cervix looks like, and I, and you can’t see me now, but I’m actually putting my hand together like a fist and that kind of, I always describe that as to the patient almost what it looks like.

Dr Sarah Taylor

Oh, I always say it’s a donut end on.

Dr. Rebecca Leon

Hi, this is GPs Talk Cancer, brought to you by GatewayC.

I’m Dr. Rebecca Leon. And joining me through this podcast is Dr. Sarah Taylor. We are both practicing GPs and GP leads for GatewayC. We’re both really passionate about diagnosing cancer early, and we want to use this podcast as a way of sharing some of our clinical experiences with you so you can make it better, faster, and more confident cancer diagnosis in primary care.

So there’s some official stuff to make you aware of. We know this podcast might be of interest to anybody, but it is really aimed at primary care health professionals. And although all patient cases are based on real stories from our clinical practice as GPs, they’re fully anonymised with no identifiable patient data.

GatewayC is funded by the [00:01:00] NHS and is part of the Christie NHS Foundation Trust.

So that’s the formal bit done. Kettle is on and it’s time to start the podcast. And today we’re gonna be talking about cervical cancer. Joining me is Sarah and we also have Dr. Ellen MacPherson. She’s a junior doctor working alongside us with the GatewayC team. How are you Ellen, today?

Dr Ellen MacPherson

I’m good, thank you.

Dr. Rebecca Leon

Good.

Dr Sarah Taylor

And Ellen, we need your weather update because we’re always fascinated by Scottish weather.

Dr Ellen MacPherson

It’s beautiful here today.

Dr. Rebecca Leon

Excellent.

Dr Ellen MacPherson

Sunny blue skies. The sheep are in the fields. It’s great.

Dr Sarah Taylor

It’s not quite like that in Media City. It’s, it’s sunny enough but no sheep.

Dr. Rebecca Leon

So let’s run through some cervical cancer statistics.

As you all know, I do love a statistic. There is over 3000 cases in the UK [00:02:00] diagnosed each year. So not a huge number, but it’s still significant and is actually the 14th most common cancer. What we have to remember though, unlike other cancers, is with cervical cancer, the highest instance is in women aged between 30 and 34.

So, as you know from previous episodes, we’d like to discuss a couple of cases and today, I’m going to be talking about a case that I saw or followed up at the end of last week, and this was one of a patient who presented following an initial telephone consult with a colleague of mine. She was in her early forties and she’d called about six weeks ago. Just to give a bit of a history of this patient, cause it puts things into perspective; she’d had a baby early 2019, no pre or postnatal issues and, she actually quotes, looking back, she’d had symptoms for a while. [00:03:00] And actually, after she’d had the baby, she breastfed for a few months and she said her periods were not what they’d been previously. She was started on the mini pill and she said there were more irregular.

And she also described, spotting in between periods. Otherwise known as inter menstrual bleeding. It wasn’t until she started having post-coital bleeding that she actually got in touch, I think. Discussing it with a friend. The friend says, you know, go, go and have a chat with the doctor. So she spoke to one of my colleagues and it was over a telephone consult, and described some of her symptoms and they felt initially that she should have an ultrasound done and that was organised via the telephone.

And it was also noted that she’d actually had not had cervical screening for, quite a while. And she put that down to being pregnant. And also because of Covid. And she had a follow-up with me. Ultrasound was normal and first thing that I wanted to do [00:04:00] was examine her. Just to also say she’d done some self swabs, which had all come back completely normal.

So, that was reassuring in that point of view, but actually nobody had visually had a look at the cervix. So she came in, examined her, and actually I was concerned. There was an obvious abnormality on the cervix and I referred her for an urgent assessment. And I suppose the learning points from this Sarah, and I’d be interested to know if you would’ve dealt with this same way, was, you know, telephone consults now are a thing and I think they have a real part of general practice.

We are now doing a, a lot of remote consultations. But how important is it to examine?

Dr Sarah Taylor

I think when you, because I know you did the GatewayC module on cervical cancer and that was absolutely the key message that I got from that was that, yeah, you know, it’s very easy to [00:05:00] attribute all of these things to, to, particularly to hormonal contraception.

It’s really common. The POP, you know, the progestogen-only pill absolutely causes so much irregular bleeding, that actually it’s really easy to attribute all of it to that. And I think that actually going ahead and just seeing the patient, I tend probably at the first consultation to bring them in, examine them, take the swabs myself, slightly more accurate if they take, if we take them ourselves.

And then you’ve got an opportunity to visualise the cervix. I probably wouldn’t do a pelvic ultrasound at that stage if she didn’t have pain. Think if she’s got abnormal bleeding, you’re less likely to pick anything up. But, you know, I think that, I think visualising is the important thing. The other thing is also being, you know, thinking about her cervical screening at that stage when she’s symptomatic, it’s not the appropriate time to do it, is it?

Dr Rebecca Leon

It’s not. And, and this lady was a, a real [00:06:00] covid casualty, just because screening wasn’t happening during Covid and she’s probably not really had one since kind of 2017.

Dr Sarah Taylor

Right.

Dr Rebecca Leon

And she said that she’d been sitting on symptoms for a while. So I think you’re absolutely right that if I’d spoken to her during that telephone consult, I probably would’ve actually booked that face-to-face and say, I really want to see you.

I always take swabs myself. I mean the links between swabs. What, what kind of things are we, are we testing for?

Dr Sarah Taylor

I suppose we’re just checking for particularly, chlamydia, aren’t we? Because that’s the thing that can cause inter-menstrual bleeding and post-coital bleeding. So, that’s what we’re checking for.

And I think to be thorough with all of these patients, it’s just always worth checking. That’s certainly my practice, but I work in a practice with an awful lot of young people who are very accepting of us taking swabs all the time.

Dr Rebecca Leon

Yeah. And just to talk a bit about statistics, there’s 3,200 around that number, diagnosed every year in the [00:07:00] UK. It’s actually the 14th most common cancer, and over half of those are diagnosed in women under the age of 45. So we don’t see that. You know, with a lot of our other cancers, we see a huge risk factor is age, but, there is this almost double incidence with cervical cancer. So it’s a proportion, a large proportion are diagnosed, as I say, under the age of 45, but there is another peak incident about 10 years after the menopause.

So this is another group, and this was, I think off air we were talking about your case.

Dr Sarah Taylor

Yeah. It was a much, much older woman who was in her early, mid-seventies, had engaged with screening. But I think if I look back on it probably dropped off around the age of 50, just because she’d been in the same relationship for a long time.

She was asymptomatic. It was, she was, I think [00:08:00] she’d been sterilised, so she wasn’t using any hormonal contraception, had just really, I think, forgotten about it all. And then in her, I think she was about 72, came in having had some abnormal bleeding, vaginal bleeding, which obviously she hadn’t had for about 20 years and was understandably concerned about it.

I think those sorts of patients are much, much easier because it’s a totally abnormal symptom, isn’t it? It’s something that’s a real red flag symptom, bleeding in, vaginal bleeding in a woman of that age who’s not on any sort of, hormone treatment at all. And so I, I referred her straight away. I actually did examine her, but I know that some, you know, it, it is off-putting for some women because they do find it quite uncomfortable.

And I think that with a, I don’t know what you feel, but I think with a post-menopausal bleed I would refer anyway, even if I wasn’t able to examine.

Dr Rebecca Leon

Yeah, absolutely. So women of that age with any, any kind of, postmenopausal bleeding is, as you say, it’s a bit more barn [00:09:00] door. And that would I, I would be sending, for an urgent review.

Dr Sarah Taylor

Can I just go back to your patient?

Dr Rebecca Leon

Yes, of course.

Dr Sarah Taylor

Cause I think one of the issues is obviously, you know, we’ve been GPs for quite a long time, me longer than you, but actually we’ve seen quite a lot of cervixes over the years. And I think there’s a real issue and it’s something I was just going to ask Ellen about, is how many cervixes you’ve seen and how you tell? Because we see a lot of ectropions as well, don’t we? What your level of confidence would be in actually telling what was a normal variant and what was abnormal, and whether you’ve got any resources that you might use to help you with that?

Dr Rebecca Leon

So before Ellen answers this, what is the plural of Cervixes?

Is it cervixi? Is it Cervixes? Or is it just cervix?

Dr Sarah Taylor

I don’t know

Dr Rebecca Leon

Like sheep. Anyway.

Dr Sarah Taylor

Maybe we could look that up during the podcast.

Dr Rebecca Leon

Okay. And we’ll let you know at the end.

Dr Sarah Taylor

Cause it’s obviously the burning question for the whole podcast.

Dr Rebecca Leon

So the answer to [00:10:00] your question, I think you’re absolutely right with all these things. The more you see, the more you know what’s normal and abnormal. And actually, when I was putting together this GatewayC module on cervical cancer, the specialist that I was talking to actually talks through normal and abnormal cervixes. So, you kind of know what a normal cervix looks like, and I’m, and you can’t see me now, but I’m actually putting my hand together like a fist, and that kind of, I always describe that as to the patient almost what it looks like.

Dr Sarah Taylor

Oh, I always say it’s a donut end on.

Dr Rebecca Leon

Donut end on, or I just put a fist and I’ve always kind of just describe where we’re gonna be like examining. Anyway, ectropions, which are so common, and particularly with, when you’re on hormonal contraception, we see it frequently and they can be the cause of bleeding.

And that’s, but this module almost taught me about these other follicles and these other things which are benign, but actually looks very abnormal to the naked eye. But I don’t think gynae would be upset with you for sending this [00:11:00] kind of thing in. I would rather, she’s shaking her head.

Dr Sarah Taylor

I am. Because with my,

Dr Rebecca Leon

Go on with her, with her Cancer Research UK

Dr Sarah Taylor

Yeah. With my Greater Manchester role that there are an awful lot of young women referred with ectropions.

Dr Rebecca Leon

No, I’m not saying, not saying ectropions. No, no. I’m talking about these kind of weird and wonderful.

Dr Sarah Taylor

Yeah. I think anything that looks weird.

Dr Rebecca Leon

What’s they called? Nabothian Follicles. What’s they called?

Dr Sarah Taylor

Nabothian Follicles, yeah.

Dr Rebecca Leon

Those, they, they look abnormal.

Dr Sarah Taylor

So Ellen, how much have you, I don’t know whether, how you’ve made me overthink it. How many abnormal cervix have you seen?

Dr Ellen MacPherson

I don’t think I’ve ever seen a single abnormal cervix. No.

Dr Sarah Taylor

And how, so, how is it taught when you are either at medical school or a junior doctor? Or do you just get taught what’s normal?

Dr Ellen MacPherson

At med school, we’re taught using the terrible models that are, you know, like made of leather.

Dr Rebecca Leon

And with the, and with the speculum.

Dr Ellen MacPherson

Yeah, with the speculum. Yeah. Yeah. And I [00:12:00] mean, they’re horrible because everyone’s put the gel in them and they go all sticky.

Dr Sarah Taylor

I, I examined once at the medical school and I was doing a station where they were doing, speculum examinations, and by the end, by the last student, there’d been that many speculums and that much jelly put in that they were firing straight out of the model.

Dr Ellen MacPherson

Yeah.

Dr Sarah Taylor

And so these poor students were trying to do their exams and these speculums are firing out.

Dr Rebecca Leon

That’s hilarious. It’s like a scene from Austin Powers.

Dr Ellen MacPherson

Yeah. It’s not very realistic.

Dr Sarah Taylor

So, they all look, they all look normal, do they? Or do they not just look like anything?

Dr Ellen MacPherson

Yeah. And then sometimes they’ll show you pictures of what an abnormal cervix looks like as part of the exam, i.e., to have you, you know, imagine, okay, this is what you’ve seen. And then, you know, I’ve, did placements in GP, but, but not for very long. And yeah, so no one ever came in with a, clearly abnormal cervix when, when I was training.

Dr Sarah Taylor

It’s quite an issue, isn’t it? You know, recognising what’s [00:13:00] normal and what’s abnormal on something that you don’t see very often.

Dr Rebecca Leon

Yeah, and I suppose when we talked about prostate last week, it’s the more you feel, the more you know what’s normal and abnormal. And it’s the same, the more you do, the more you experience.

So I suppose we’ll be saying to our staff, our junior colleagues look at as, as many cervix as you can. That’s our strap line.

So I mean, you, you corrected me rightly so about not just referring everything in and, because the service will be saturated and we need to know.

Dr Sarah Taylor

And also I think that what the specialists locally have been saying is that if you send a 26, 27 year old woman in telling her, her cervix looks abnormal, the amount of anxiety and stress that causes to that individual patient is huge. Now obviously if you’ve got a concern about it, that’s absolutely the right thing to do, but if it is an ectropion, then it’s not the right thing to do. And I think we, we, it’s an, [00:14:00] but I suppose the bottom line would be that we do have the benefit of experience, and if anybody is concerned, it’s better to refer and be wrong, then not refer and be wrong.

Dr Rebecca Leon

Absolutely.

Dr Sarah Taylor

So I know that you’ve been reading up about this, so share the details that you’ve got on the risk factors for cervical cancer, because I think it’s a slightly different one from some of the others. And there are things that we can do and we can promote to try and decrease the incidence.

Dr Rebecca Leon

Yeah. So again, the GatewayC module talks a lot about risk factors, but also I, I did a lot of reading on the Cancer Research UK website because, I am interested in educating patients about potential risk factors. So smoking is a big one. Whatever age we encourage our patients to actually stop smoking can improve their chances of not getting cervical cancer.

Dr Sarah Taylor

What about HPV then? Because that’s the real big thing, isn’t it?

Dr Rebecca Leon

It is. So, while I’m on a roll, I just wanna tell you about the other risk factors [00:15:00] and we’re gonna talk about HPV at the end.

Dr Sarah Taylor

Okay.

Dr Rebecca Leon

Very quickly. Family history, always take a family history. Really important. Interesting, women who have had children are at increased risk of cervical cancer.

Dr Sarah Taylor

Is that independent of sexual risk? Is that related to HPV? Do we know or not?

Dr Rebecca Leon

Don’t know.

Dr Sarah Taylor

Fair enough.

Dr Rebecca Leon

A contraceptive pill is also linked. Small risk, but just be aware of it. So it’s just important. But the contraceptive pill could reduce the chances of other cancers.

Dr Sarah Taylor

As does having children.

Dr Rebecca Leon

Exactly. Okay. So, and, and the other big one is attending for cervical screening and the HPV vaccine. And I’ll be talking about the HPV vaccine shortly as the screening programme, but you asked me about HPV. So HPV is a virus. Human papillomavirus, that’s what it stands for. It’s a virus that actually 98% of people in their lifetime will probably, or sexually [00:16:00] active people will come across in their lifetime.

But our natural immune system will actually rid of the virus naturally. There are different types of HPV and the two most common ones that cause 70% of cervical cancer cases are HPV 16 and HPV 18. These are used in the HPV vaccine, which is now given or encouraged for secondary school girls. And also they’re offering it for boys as well because HPV can cause other types of cancers, including penile, anal,

Dr Sarah Taylor

Head and neck, it’s a big one for head and neck.

Dr Rebecca Leon

Absolutely.

Dr Sarah Taylor

We’ve just been doing a, got a module on head and neck with GatewayC.

Dr Rebecca Leon

But HPV in relation to cervical cancer; 16 and 18 are the most common and they cause 70% of cases.

Dr Sarah Taylor

So are, are we optimistic that we will, once we’ve got HPV vaccine throughout the population, particularly boys as well, that we will [00:17:00] eradicate cervical cancer.

Dr Rebecca Leon

Hopefully, and there are certain countries that are also claiming, I think they’re saying by 2030 or 2035, Australia want to rid their population of cervical cancer, but we have to be encouraging people to still present to their cervical screening. So it’s not just, oh, I’ve had the vaccine, therefore I don’t need to attend my smears. That’s not true.

Dr Sarah Taylor

I think we, I think screening is something we need to come back to in a future episode because I think there’s an awful lot of, we can talk about, about trying to increase screening in primary care, how we encourage patients and I think one of the other things that we probably want to touch on today is just the importance of, of the LGBTQ+ community being aware of their risk of cervical cancer, it’s quite a difficult conversation in certain groups of patients. I think there’s still a belief in some lesbian women that they don’t need screening. So I think it’s something we need to

Dr Rebecca Leon

Yeah, I mean this, this, again, I could, I could actually talk about this for the next two hours.

Dr Sarah Taylor

I know I’m not gonna let you though.

Dr Rebecca Leon

I [00:18:00] know you’re not.

Dr Sarah Taylor

But just going back to symptomatic patients, how, you know, if we’ve got a trans patient, where, how do we even begin to think about if they’ve got abnormal bleeding?

Dr Rebecca Leon

Okay. So, we were gonna talk about this on the prostate, but actually we ran out of time.

But again, it’s a, it’s an interesting point. So with, with trans women, if they’ve had surgery, the prostate will still remain. So if you have a trans woman sitting opposite you, this will become relevant to cervix, cervixes, I promise. If you’ve got a trans woman sitting opposite you with urinary symptoms you need to consider, could this be any prostate pathology?

The same will be for a trans man. The cervix in a lot of cases will remain. So it’s really important to ask the patients in, themselves, cause they will know, particularly if they’ve moved practices and you’ve not got the exact [00:19:00] surgical details. So if they present with abnormal bleeding or they present with other symptoms.

Things like abnormal vaginal discharge can also be a symptom of cervical cancer. Then you need to consider could this be an abnormality in the cervix? But again, I really hope if this is a successful podcast series, we will have series two. This will be something that I will be very much gunning about screening and about barriers.

Was there anything Ellen, that you wanted to ask or share?

Dr Ellen MacPherson

The other thing that I think is interesting that I, just while we’re talking about the kind of, real importance of examining people and actually being able to recognise what is a normal and abnormal cervix. And how important that is, is that the cervical screening programme is actually really, really effective and is one of the best tests we have. Its sensitivity and specificity for picking up early cervical cancer is really good.

But the most referrals to secondary care clinics come from clinical concern. And while 80% of people referred via the screening programme end up having cervical cancer, only 8% of people referred end up having cancer if it’s based on clinical concern. So there’s a lot of people being referred, who haven’t probably been examined and it’s kind of causing a strain on services. Whereas rates, the screening programme are dropping and that’s much better at picking up cancer.

Dr Rebecca Leon

Yeah absolutely, I think that’s a really good point. It’s almost like, I think it was mid-sixties at the moment, the average, the national average of people presenting to cervical screening programmes. And we are aiming for over 80. So if we’re picking up more cancers in that way, rather than on clinical examination, I think it’s maybe what we were discussing earlier Sarah, that because people aren’t knowing almost the difference between an abnormal and a normal looking cervix that may think every ectropion is an abnormality. And then referring them in.

So there are a lot of e-learning, but again I go back to it, and I know I was helpful in writing this module, there is a lot of slides to show you. So even if you’re not seeing them, if you do look at a cervix and you’re like oh gosh, I remember that, that’s actually normal or abnormal, so it’s helping us.

Dr Sarah Taylor

I also think that you know, if you’ve got 8% of patients who are being referred who have got abnormalities, then that means that the majority of patients are being accurately referred because we’re referring with, I mean, I know this is looking at pre-cancerous change, but actually, you’re supposed to be referring with a 3-5% pick up rate. So, it’s not bad. So I just think that the, if you think something looks abnormal, you should go ahead and refer.

Dr Rebecca Leon

Yeah okay.

Something interesting is the confusion of, of certain names used for the female reproductive system and I don’t think the program Naked Attraction, I don’t know if you’ve ever seen that, Sarah.

Dr Sarah Taylor

No.

Dr Rebecca Leon

Channel four. This is your homework. I’m gonna have everybody laughing around me. Just watch one series of Channel four, Naked Attraction.

And it’s a dating show where people think it’s okay to date naked no to choose their date naked. They’re basically saying you start it the other way around. [00:20:00] I know. She’s looking shocked.

Dr Sarah Taylor

I’m looking surprised.

Dr Rebecca Leon

So basically, the reason why I’m telling you this is because there’s these booths of people standing there with no clothes on and you go up slowly.

So you start with the legs and they comment on the legs, and then they do the bottom half, and then they do the top half, and then they finally do the face. The reason why this is, and it’s very good television watching. If you’ve had a long day at work and you just need something to like, almost zone out.

Dr Sarah Taylor

I watch netball.

Dr Rebecca Leon

You don’t watch netball on television, do you?

Dr Sarah Taylor

I do. Watch loads of netball on television.

Dr Rebecca Leon

Promise me before the next episode, you’ll just watch one. You and Ben will love it and I’ll tell you, you, you’ve got four series to watch through. Anyway, the point I’m saying to you is when people are describing, oh, I like this about a certain person. I like this certain person. They get, and when I, when I do my cervical cancer talk to medical students and post-graduates, I start with a, a picture of naked attraction. They all laugh because they all watch it and kind of, vagina, [00:21:00] vulva, cervix. Well, you can’t see a cervix, but vagina, vulva, they all get confused with these names because it’s.

Okay so my point after telling Sarah to go and watch Naked Attraction is when somebody is describing any symptoms that they’ve got. They’re labelling the wrong body parts to describe it. So you have to ask the right question.

Dr Sarah Taylor

And I think one of the urologists I spoke to said that women are actually quite bad at telling where they’re bleeding from, and sometimes they get vaginal bleeding, rectal bleeding, and sometimes the urine.

Yeah, Blood in the urine muddled up. And so you can’t always be sure. Which is, I suppose, what we were saying to begin with. It’s really important to examine people because then we can see what’s happening.

Dr Rebecca Leon

There you go. And sometimes I do a little diagram to explain which parts.

Dr Sarah Taylor

I just draw end on donuts to explain.

Dr Rebecca Leon

That’s your cervix. But I’m talking about if you’re doing like back front and middle bleeding, and that’s the kind of thing. Anyway, the point is whether you, [00:22:00] it’s I think today I’m waffling, but, I really wanted to tell you where the name Pap smear came from.

Sarah, would you allow me?

Dr Sarah Taylor

Yes.

Dr Rebecca Leon

So Dr. George Papanikolaou was a Greek doctor and he was born in the late 18 hundreds and he died in 1962 at the age of 78. And he created the pap smear, that’s, well, that’s where it’s named after him. If you want to do a bit more history reading, they think that somebody else did it before him, but he’s claiming it.

It was invented in the 1920s, but first used in 1943 to have a look at the cervix and to take cells to see if they could pick up a pre-cancerous diagnosis. That’s really what the cervical screening is, but interestingly, his wife, Mary, was relied upon to be his first patient. So that is, yes, an interesting fact.

So that’s Dr. George Papanikolaou.

Dr Sarah Taylor

Greek. [00:23:00]

Dr Rebecca Leon

Yes. Greek.

Dr Sarah Taylor

So do we want to come to the learning points from today’s?

Dr Rebecca Leon

I do, because I feel today has been a little bit, because it’s such a meaty subject, I feel we have, there’s a lot to discuss.

Dr Sarah Taylor

There’s a huge amount of discuss

Dr Rebecca Leon

And you are reigning me in a lot today, Sarah.

Dr Sarah Taylor

I am. Yes.

Dr Rebecca Leon

Yes. The body language is raining me in and she’s like, but I think you are absolutely right. I think we need to be very clear about symptomatic cervical cancer and this is what this episode’s been.

Dr Sarah Taylor

Absolutely. I think we need to come back to screening, but we need to dedicate more time to it.

Dr Rebecca Leon

Okay. So I’m gonna talk about the first clinical point is a full and thorough pelvic and cervical examination needs to be conducted in all women presenting with symptoms. Have a look at the cervix. I would say take your own swabs. And if you see an abnormal cervix, they need to be referred on the suspected cancer pathway.

Dr Sarah Taylor

Yep. I agree. And I think that, you know, one of the big problems is that post-coital bleeding is very [00:24:00] common. It’s very, very easy to decide that it’s due to some form of hormonal contraception, because so many women are on hormonal contraception. But actually it’s not all due to hormonal contraception and some of the delayed cases I think are because women have been told just to carry on for a bit and it’ll probably settle.

So I think it comes back to what you were saying that we need to examine.

Dr Rebecca Leon

Examine, take a thorough history. There’s, there’s a lot of risk factors related to cervical cancer. So ask them about family history, ask them about lifestyle, including smoking and this can be an added part of your thinking.

Could this potentially be a cervical cancer?

Dr Sarah Taylor

And then just remember, I think the last thing is that a smear is not an appropriate test to do in a symptomatic patient because it’s a screening test.

Dr Rebecca Leon

And finally encourage patients to go for the HPV vaccine. Particularly younger girls, if they’re umming and arring about it, that actually it’s a potentially preventative cancer in future.

Dr Sarah Taylor

And be grateful we don’t have to [00:25:00] be amongst all of those teenage girls having their vaccines.

Dr Rebecca Leon

Yes. So, This has been, I would say, part one of cervical cancer just because we really wanted to emphasise symptoms and also the importance of examining and seeing as many cervixes as possible.

Oh, have you looked up what’s the plural of cervixes and what does cervix actually mean?

Dr Ellen MacPherson

Cervixes. S C, gosh. C E R V I C E S.

Dr Rebecca Leon

Cervices. Yes. And what does a cervix mean? It means a tunnel.

Dr Ellen MacPherson

Cervix etymology. Latin. The word cervix is derived from the Latin cervical root word cervix, which means neck.

For this reason, the word cervical pertains to many areas where tissue narrow to a neck like passage.

Dr Rebecca Leon

There you go. Like C spine. God that’s confusing. Okay, so cervices and a cervix means a neck. [00:26:00] As a neck of womb. Excellent.

So thank you for listening today. Apologies for being a bit waffly. I’ve got a lot to say.

We’ve also got a free cervical cancer module that we’ve referenced throughout, and you can find that on the GatewayC website. We put all the references to the studies and guidelines that we mentioned in our show notes. We’ve got a few thank yous as well that have carried me along today. A big thank you to Sarah and Ellen for joining me, and thanks to our producers, Louise and Joe.

Louise is with us from GatewayC and Joe from ReThink Audio. Before we go, I wanted to just clear up and discuss the positive predictive value, which is something that we touch on in a few of the episodes. The positive predictive value was used to determine the threshold to encourage clinicians to refer on for a suspected cancer pathway or for urgent tests.

And this was [00:27:00] agreed at 3%. For more information, we have attached the link via the show notes, and this is through the NICE guidelines, and I would encourage all listeners to have a look at this and understand this in more detail. Please do press the follow button so you can get this podcast, direct your feed and we’d love it if you share this podcast with your friends or colleagues.

It really does help spread the word. Thanks. See you next time and bye for now.