Cervical Cytology Review – reports published

11th December 2024

In October 2023, the Southern Health and Social Care Trust (SHSCT) launched a precautionary cervical screening review for 17,425 women. The review was carried out in partnership with the Public Health Agency (PHA) and the purpose was to check that the original screening result which was provided for each woman was correct and offer follow up care for any woman whose result was incorrect.

The Cervical Cytology Review (CCR) is now complete, and two key reports have been published by SHSCT and PHA. The first report details findings from the review and the second report focuses on cervical cancers in the Southern Trust Area and across Northern Ireland. Both reports are available at the bottom of this page or on the Trust dedicated section on the website under Supporting documents or can be found at the bottom of this page. The findings will now undergo independent expert review, with work on this to commence imminently by Allan Wilson* as one of the confirmed members of the review team.

1. Cervical Cytology Review – Activity and Outcome report – key findings

Activity

Total number of women:

In the precautionary review = 17,425
Opted out of the review / did not respond to invites for a smear at a Trust clinic = 1,079 (6.2%)
Therefore – total number with a reported outcome = 16,346 (94%)

Results of slide review and new smears

96% of women who had a slide reviewed had no change to their original result
96% of those who attended for a smear test had a normal result

Key Outcomes

64 women were invited for a gynaecology or colposcopy appointment for further assessment. 11 of these women required treatment – for pre-cancerous cervical cell changes or significant incidental findings**.

2. Cervical cancers in the Southern Trust summary report – key findings

As the main aim of the Cervical Cytology Review was to find women who may have been given an incorrect smear result so they could be offered follow up to reduce their risk of developing cervical cancer, it did not include women who already had a confirmed cervical cancer diagnosis. A separate companion report, ‘Cervical cancers in the Southern Health and Social Care Trust: A summary report’ provides detail of the confirmed cancers reported within the Trust during the period covered by the CCR (i.e. 2008 – 2021). The key findings based on data from the Northern Ireland Cancer Registry show:

No significant difference in the rate of cervical cancers diagnosed in the SHSCT compared with the Northern Ireland average.
No significant difference in the mortality rate (deaths) from cervical cancer in women living in the SHSCT area compared with the Northern Ireland average.
No significant difference in the stage at diagnosis of women living in the SHSCT compared with the Northern Ireland average.
Between 2009 and 2023 there were 207 cases of cervical cancer diagnosed by the SHSCT. The screening history of all these cases was assessed to determine whether, had they not been diagnosed with cervical cancer, they would have been included in the review.
12 (5.8%) of the 207 women diagnosed with invasive cervical cancer by the SHSCT during this time would have been included in the review because their last smear before they were diagnosed was read by one of the screeners. The first of these was diagnosed in 2011 and the most recent in 2021.
All 12 cases were subject to detailed assessment as part of the Audit of Invasive Cervical Cancer. This has identified concerns about the accuracy of the original screening result in 8 of the 12 cases. Five of these 8 are subject to further investigation in line with the regional serious adverse incident (SAI) process.
An additional number of women (<5) who were diagnosed with cervical cancer in other trust areas, would have met the criteria for inclusion in the CCR had they not been diagnosed with cancer. This is because their last smear before diagnosis was reported in SHSCT laboratory as cytology negative or inadequate by one of the screeners identified as underperforming in the RCPath report. These cases are currently being further assessed in detail in partnership with the Trust where they were diagnosed.

Dr Stephen Austin, Southern Trust Medical Director, said: “The Cervical Cytology Review Outcomes report shows that, for the vast majority of the women included in the review, their original result did not change. The purpose of the review was to check that the original result provided was correct and to identify anyone who may have been given an incorrect result. While it is reassuring that the vast majority of previous smear results have been reconfirmed as normal, the review has identified eleven women who are now receiving follow up care from our gynaecology services.

“We acknowledge that the failings in the cervical cytology laboratory extended beyond individual staff members and included system failings. The Southern Trust and PHA are committed to ensuring these failures never happen again.”

“I wish to sincerely apologise again to women and their families for any distress caused by this Review process and the publication of the outcomes report. I really hope that women will have been reassured that either their original result was accurate or that they are receiving appropriate care where that has been required.”

Dr Joanne McClean, Director of Public Health at the PHA, said: “This has undoubtedly been a worrying time for many of the almost 17,500 women affected by the review. This is one reason why it was so important to undertake such a comprehensive and detailed review. We also wanted to take extra care to ensure the result women received was correct so they got the follow up care required. I am very sorry for any distress or worry caused by this review. I would like to thank colleagues in laboratories across Northern Ireland who worked so diligently to help us complete the review in as timely a manner as possible.

“In parallel with the review being undertaken there have been important improvements to the Northern Ireland Cervical Screening Programme. The primary HPV method of cervical screening is now in place in Northern Ireland, which has increased our ability to detect early cell changes that could lead to cancer. Cervical screening saves lives and it is essential that women continue to attend when they are invited. Our screening programme is very effective and the improvements put in place in the last year will make the programme better at finding women with abnormalities which put them at risk of going on to develop cervical cancer. But we will only find these abnormalities in women who attend for screening. I ask all women who are invited to attend for cervical screening to please attend. It could save your life.”