Cervical screening services review
9th October 2023
The Southern Health and Social Care Trust provides a Cervical Cytology Service as part of the Northern Ireland Cervical Screening Programme. The screening programme looks for changes in cells which, without treatment, could develop into cancer.
In July 2022, senior laboratory staff notified the Trust’s management team that they had concerns about performance in some steps of their laboratory’s screening system. To fully investigate these concerns, the Trust commissioned the Royal College of Pathologists (RCPath Consulting) to undertake an independent assessment of its cervical screening services from 1 January 2008 and October 2021.
The RCPath Risk Assessment Report published today found that whilst the majority of negative results issued by the laboratory were correct, a significant number of women are likely to have had negative screening results from the Southern Trust laboratory which would have been identified as potentially abnormal by other laboratories.
Therefore as a precautionary measure, the Southern Trust is to review the records of about 17,000 (Seventeen Thousand) women screened during the period in question. The purpose of the review is to look again for abnormalities to double check that the correct information was provided.
In the majority of cases, we will be able to review the previous smear, which is stored in our laboratory, but in some cases, we will invite women to attend for a further smear test. The Trust is writing to all women whose records will be reviewed with further information. There is no need for women to contact their GP to make an appointment for a smear test unless they have recently received an invitation to attend for one as part of the routine screening programme.
Northern Ireland has an excellent cervical screening programme. The effectiveness of the programme here is reflected in cervical cancer case data, with 8.8 cases/100,000 person years in Northern Ireland compared with 11.35 cases/100,000 in the Republic of Ireland and a global average of 13.3 cases/100,000. Over 1.9 million smears have been reported in Northern Ireland since April 2008.400,000 of these were reported by the Southern Trust.
It is important to emphasise that cervical screening is not a diagnostic test. The smear test collects a sample of cells which are checked for pre-cancerous changes which can then be treated, therefore avoiding the changes going onto become cancerous. While a very successful preventative programme, cervical screening cannot detect all potential abnormalities.
Dr Stephen Austin, Medical Director for the Southern Trust, explains: “This report has identified performance issues in our laboratory and we have been working with colleagues in the Public Health Agency (PHA) on a series of actions to improve both service provision and oversight.
“The Southern Trust is very conscious of the anxiety this report may cause to women. As Medical Director, I apologise on behalf of the Trust for what has happened.
“Today we are issuing personal letters to all of the women potentially affected. The vast majority of women screened by the Southern Trust over this period will be unaffected and therefore if you do not receive a letter from us, your records have not been identified as needing review. A Freephone Helpline has been set up to answer questions or concerns. The Freephone number is 0800 9520255 and it will be available Monday to Friday from 9.00 am-6.30pm, and from 10.00am – 4.00pm on Saturday 14th and Sunday 15th October 2023.”
Dr Austin added: “The RCPath report contains a number of recommendations. The Trust fully accepts these and we are working with the PHA and Department of Health to implement them in full and at pace. Most of the recommendations have already been implemented and work is well under way to implement the remaining recommendations.”
Dr Joanne McClean, Director of Public Health at the PHA, urged women who are invited for cervical screening to attend their appointment as normal: “Cervical screening has proven to be very effective at detecting early abnormalities which, when treated, can prevent cancer and save lives. It will continue to do so if those who are eligible attend for screening when invited.
“A cancer could also develop between screening tests, or there is a small chance that the test misses some changes to your cervix. No matter what age you are, if you are concerned about symptoms such as abnormal bleeding, or pain or discomfort in the lower pelvis, you should seek advice from your GP, even if you attend regularly for screening.”
Work is ongoing to finalise the full introduction of primary HPV testing into the cervical screening pathway in Northern Ireland. This will be a major improvement to the screening pathway and is a key recommendation of the RCPath report.