Cervical Screening Review
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. Letters have been issued (Monday 9 October) to all women whose records will be reviewed with further information. If you do not receive a letter from us, your records have not been identified as needing review.
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.
A Freephone Information line, which is run by the Trust, has been set up to answer any questions you may have. Telephone 0800 9520255. Monday to Friday, 10am – 4pm. If the line is engaged please leave a short message with your name and contact number and we will get back to you. A dedicated email address is also available firstname.lastname@example.org and will be responded to by the most appropriate person as soon as possible.
Contact on any other numbers which are not the helpline number as outlined above, will not be answered.
Independent report of Trust cervical screening services
A list of Questions and Answers are supplied below. Note, this information is being continually updated to reflect updates to the situation and feedback from the public.
1. How can something like this happen in a hospital for such a long period of time?
The performance of any screener can dip from time to time for a range of reasons. There are systems in place to pick this up and screeners are given annual training to keep their skills up.
During the period 2008 to 2021, some screeners performance did fall below the recognised standard. The underperformance was identified by the Trust at the time and actions were taken to deliver improvement.
The report by the Royal College of Pathologists found that for some screeners, the number of times performance dropped during the period 2008 to 2021 was a concern and they were not satisfied that the actions taken by the Trust were sufficiently robust.
The Trust did take robust action in October 2021 to address screener underperformance. The current review being undertaken as a precautionary measure is to address the risk that some reports during the period 2008 – 2021 may have said negative however they should have been reported as positive. It should be recognised that the risk of this is low.
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 as quickly as possible. Most of the recommendations have already been implemented and work is well under way to implement the remaining recommendations.
2. How will I know if I am part of the review?
The 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.
The Trust and PHA have identified all of the affected women who have received negative or inadequate test results since 2008 and the Trust has written to them advising that they are in the group affected by the review.
About 17,000 women whose smear tests were processed in the Southern Trust’s laboratory are being contacted. If you do not receive a letter from us, it means that there are no concerns with your previous result and you do not need to take any action.
A specialist team of staff will re-examine the previous smear samples in order to confirm that the last results issued were correct.
3. What if I don’t receive a letter?
If you do not receive a letter from us, it means that there are no concerns with your previous result and you do not need to take any action.
4. What happens if my result changes?
We will write to you to let you know the outcome of your smear review once this has been completed. If we identify any issues with your last result, we will contact you about the next steps.
We are committed to ensuring that these tests are reviewed as quickly as possible. We understand that this will be a worrying time for patients and we want to assure you that we will provide you with as much support as possible.
5. What if I have to come back for a repeat smear?
Women who will be invited for an updated smear will have the new primary HPV testing performed which is a more sensitive test than before.
Women who have their slides reviewed, and do not require a repeat smear, will be offered their normal recall within the NI screening programme, which now includes an HPV test.
6. Will it be my GP that will carry out the re test if necessary?
The Trust is contacting 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 one as part of the routine screening programme.
7. I have changed my address so will not receive a letter. How can I find out if I am included in the review?
Please contact the Freephone Information line, run by the Trust, on 0800 9520255. Monday to Friday, 9am – 5pm.
8. Could I have cancer and not know?
Cervical screening does not diagnose cancer. The purpose of your smear test is to identify changes to the cervix which may lead to cancer. These are then investigated and treated if necessary. Please note that the chance of pre-cancerous changes in the cervix at any time remains low and 9 in 10 people have a negative screening result.
Cervical screening looks at healthy women who do not have symptoms of cancer and aims to identify any pre-cancerous changes in their cervix so that further investigations can be arranged. Women are invited every three years between the ages of 25 and 49, and every five years up to the age of 65.
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.
9. I was under age 65 when I was last screened. I am now over aged 65 and no longer part of the screening programme. Will I be re-tested?
Women affected by the review who are now over the age of 65 will still have their slides reviewed and results updated. If the review confirms the original normal result, the Trust will notify them in writing. In this case, they do not need to take any further action and will not receive additional screening invitations.
If any change to their original screening result is found (that is, any abnormality detected), they will be invited for a test called colposcopy (a more detailed examination of the cervix where biopsies may be taken).
10. I have had a hysterectomy and removal of my cervix since my last screen – will I be invited?
No, women who have since had a hysterectomy and removal of their cervix are not at risk of cervical cancer and will not have previous slides reviewed or be invited back for another smear.
11. How long am I going to have to wait for an appointment?
It is anticipated that for the majority of these women, the reviews can be undertaken through re-examination of slides from their previous smear tests. For those women whose previous slides are no longer available, appointments will be arranged in the coming months for a new smear test. The Trust is contacting all women whose records will be reviewed with further information.
12. Can I get my smear test result by contacting the helpline?
No, information line staff cannot access your smear result.
Results are being issued from the laboratory to your GP as normal.
13. Why is it important that women invited for cervical screening continue to attend their screening appointment?
Cervical cancer screening locally has proven to be very effective at preventing cancer and saving lives, and will continue to do so if those who are eligible attend for screening when invited. We urge women who are invited for cervical screening to please attend their appointment.
A cancer could 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.
14. What further action has The Trust taken?
The RC Path independent review was shared with the Trust in summer 2023. The Trust accepts the recommendations and is being supported by the PHA and Department of Health to ensure they are fully implemented. Most of the recommendations have already been implemented and work is well under way to implement the remaining recommendations.
15. If Southern Trust lab has had its accreditation suspended does that mean I will wait longer for my slide to be reviewed?
No the loss of accreditation in Southern Trust has not affected the length of wait for slides to be reviewed as another Trust is undertaking the slide review.
16. I have recently had a smear in the Southern Trust area. If the lab accreditation has been suspended, what will happen to my smear?
If your sample has already been tested for the Human Papilloma Virus (HPV) and it has tested positive it will be redirected to another laboratory in Northern Ireland for priority reporting by cytology. This means that women who are most likely to have abnormal cells can receive their results promptly and, where appropriate, be referred on for treatment as soon as possible. If your HPV result is negative, your risk of cervical cancer is very low and you will wait longer to receive your result. If you have not received a result within 8 weeks it is likely that your sample tested negative for HPV.
If your sample has not yet been tested for HPV, it will be redirected to another laboratory for processing and reporting.
UKAS visited Craigavon Area Hospital laboratory on 20th December 2023. The Southern Trust received formal notification of Reinstatement of Accreditation for Cervical Cytology Services on 22 December 2023.
17. Why are you not reviewing slides for all the women screened through the Southern Trust cervical cytology laboratory?
Cervical screening is a process that involves many steps, and most women will have several smear tests during their lives. The majority of women who have had cervical screening in the southern trust are not affected by any of the processes under review. It is important to inform the women affected by this review, as they have the right to opt out, and we also may ask them to attend for an updated smear. We reviewed all women’s cervical smear histories in the southern trust since 2008 and identified the women in NI who are affected. Women who have not received a letter have not been identified as needing review, as their smear tests have not been affected by the issues.
18. I was identified as having an abnormal smear and underwent treatment in Southern Trust. How do I know I did not undergo unnecessary treatment?
Screening is not a diagnostic test. If abnormal cells are detected as part of a smear, patients are referred on to colposcopy for further assessment. The person who does your colposcopy is an expert who looks directly at your cervix. They may have taken a biopsy to confirm if you definitely had abnormal cells, or if they could directly see abnormalities they may have offered you treatment at that time. Biopsies are different to a smear test and reported in a different part of the laboratory using different processes. There are no concerns with any other parts of the ST laboratories.
19. What proportion of women screened have been recalled?
Around 17,230 smear tests were identified as requiring review out of a total of 419,961 smear records. This equates to around 4.1% of slides taken throughout the review period.
20. What if I decide to go and have a smear test from a private provider?
The Trust appreciates that you may be worried about receiving the letter advising that your last Cervical Smear is going to be subject to a Review however, we would reassure you that not all smears will need to be redone. This is a precautionary review to double check that patients have been given the correct result of their smear. However, it is important that we inform the women affected by this Review, as they have the right to opt out /or pursue other options.
Arrangements are being put in place with other laboratories in Northern Ireland to ensure the smear slides that need to be reviewed can be reviewed as quickly as possible. Therefore we urge all women affected by this Review to wait until this process has been completed by HSC laboratories, there is no need to seek a smear test from a private provider.
HSC Cervical cancer screening has proven to be very effective at preventing cancer and saving lives, and will continue to do so if those who are eligible attend for screening when invited. We urge women who are invited for cervical screening as part of the screening programme to please attend their appointment.
21. Why is a clear smear being kept and stored?
The Trust complies with guidance from the Royal College of Pathologists and the Institute of Biomedical Science regarding the retention and storage of pathological records and specimens including smear slides which are stored in accordance with this guidance.
22. Where are smears stored?
Slides are kept in the Trust laboratory in a separate facility designated specifically for that purpose.
23. I have a cervical cancer. Why have I not been included in this review?
This is a precautionary review specifically designed to identify women who have had a smear reported incorrectly. Women with a diagnosis of cervical cancer are not part of this review. If you have been diagnosed with a cervical cancer, there is an ongoing process to review your screening history. For further information contact The Southern Health and Social Care Trust – Telephone 0800 9520255.
24. My family member died of cervical cancer. Should they have been included in this review?
This is a precautionary review designed to identify living women who have had a smear reported incorrectly. Deceased patients are not part of this review. If you are the family member of a woman who has died of cervical cancer and would like more information regarding their screening history or for further information, you can contact The Southern Health and Social Care Trust – Telephone 0800 9520255
25. I recently had a private smear test which was reported as abnormal. I am not part of the Cervical Review, can I have my previous slides included in the review?
The Trust are undertaking a precautionary review of the results of some patients who had cervical smears analysed by Southern Trust Laboratory between 1 January 2008 and October 2021.
If you do not receive a letter from us, your smear result has not been identified as being reported by one of the underperforming screeners and therefore your previous smear does not require review.
The Trust respects the right of women to seek a smear test from a private provider. However we do not have automatic access to results of smears completed via an external (private) provider and we note that the test undertaken by a private provider.
Cervical screening does not diagnose cancer. The purpose of your smear test is to identify changes to the cervix which may lead to cancer. A cancer could also develop between screening tests, or there is a small chance that the test misses some changes to your cervix. 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.
26. I don’t want to wait. Can I have a smear done privately?
We appreciate that you may be worried about receiving the letter advising that your last cervical smear is going to be reviewed. We want to reassure you that not all women will need a repeat smear as part of this process. The review is precautionary and aims to double-check that women have been given the correct smear test result. For most women, a review of their previous slide will be all that is required.
We respect the rights of women who choose to have a smear test with private provider. You should be aware that private smear results are not usually made available to the cervical screening programme or the health service, and health and care records may not be updated to reflect this. You may still receive invites to participate in the cervical screening programme in future, based on records we have for you. We would encourage you to attend your next screening appointment when invited to do so.
We cannot guarantee that the quality of the service provided by private companies will be to the same standards as the cervical screening programme.
A repeat smear may not be required as part of your review. If a repeat smear is required, it will be provided it as part of the review. Please note, if you decide to have a smear done outside of the review process, through a private company, there is no option to have your costs reimbursed.
If you attend for a private smear test, and wish to opt out of the review then please call us on 0800 9520255 to let us know so we can remove you from any further communication related to the review.
No screening test is 100% effective however evidence shows that cervical screening reduces the risk of cervical cancer and save lives. The test is designed to find cell changes in your cervix which, if left untreated, could turn into cancer. Screening aims to pick up changes to your cells even if you feel healthy and have no symptoms. If everyone eligible for screening attended regularly, around 8 out of 10 deaths from cervical cancer could be prevented
27. Can I decide to opt out of this review?
The Trust appreciates that you may be worried about receiving the letter advising that your last Cervical Smear is going to be subject to a review. We want to reassure you that not all women will need to have a repeat smear as part of this process. This is a precautionary review to double check that patients have been given the correct result of their smear. You have the right to decide to opt-out of this review and your decision will be respected by the Trust. Deciding to opt-out means that the Trust will not review your previous slide and no further action will be taken. If you wish to opt-out, please ring us on 0800 9520255. We will then send you a form to complete so that we can remove you from any further communication related to the review.
Whilst you may wish to opt-out of the cervical review, you may still be offered invitations to attend for future smears as part of the cervical screening programme. We would encourage you to attend these as normal. Screening is the best way for a woman to protect herself from cervical cancer and the Cervical Screening Programme is committed to ensuring that all eligible women who want to take the test can.
If you change your mind at any stage and decide to rejoin the review, please contact us on 0800 9520255 and our team will be only too happy to facilitate this for you.
28. Why did the letter sent to women included in the review state that no further action is required to be taken by them?
The letter advised that no further action needed to be taken by the individual because the Trust and the Public Health Agency were progressing the review and would be in further contact with each individual to confirm next steps in due course. For some that would be to be called for another smear test and for others, to confirm the outcome from the review of their last smear.
29. Is HPV testing now done in SHSCT?
HPV testing is done first then the cytology (microscopic examination of a smear slide) is done. The plan is to move to using primary HPV screening in December 2023 whereby if the “primary” test is negative the second step (cytology) is regarded as unnecessary and results can therefore be provided in a more timely manner.
30. What if I am pregnant and require a smear as part of the review?
If you are currently pregnant, or less than 3 months after the birth of your baby, we will discuss when you can have your smear undertaken, in line with best practice guidance for pregnant women. If you wish to get more information please contact our helpline 0800 9520255
31. I am over 70 years of age – why have I been called for a repeat smear test?
The NI Screening programme ceases at age 65-70 (depending on your individual circumstance).
Therefore if you were at the upper age limit at the time of your last smear and this was over 10 years ago we would not have your slide available for Review. If you are over the age of 70 and meet the criteria for inclusion in the Review we are offering you the choice to attend for a repeat smear.
This is particularly relevant for women who are sexually active.
32. Can I donate blood?
Yes women remain eligible to donate blood whilst awaiting their slide review outcome – providing they fulfil all other criteria on the day of donation.
For more information please visit the Can I Donate? – Northern Ireland Blood Transfusion Service (hscni.net) website under the ‘Waiting for test results or investigations’ tab
Further information/ contact us
A Freephone Information line, which is run by the Trust, has been set up to answer any questions you may have. Telephone 0800 9520255. Monday to Friday, 10am – 4pm. If the line is engaged please leave a short message with your name and contact number and we will get back to you..
A dedicated email address is also available email@example.com
An answerphone is available outside these hours, and you can leave your name and contact number, and a member of staff will return your call the next working day.
How to complain/provide feedback?
Contact The Southern Health and Social Care Trust Service User Feedback team via Phone: (028) 37564600 or Email: firstname.lastname@example.org