- Overview of CervicalCheck
- Organised versus opportunistic screening
- Screening range - women aged 25 to 60 years
- Eligibility for CervicalCheck screening
- Informed consent
- Screening intervals
- Invitation and re-call of women
- Programme reports and related publications
Overview of CervicalCheck
The National Screening Service (NSS) launched CervicalCheck - The National Cervical Screening Programme in September 2008. CervicalCheck is an organised, population-based, quality assured cervical screening programme.
The successful introduction of an organised, well-managed, national cervical screening programme has the potential to reduce current incidence rates from cervical cancer among women in Ireland by up to 80%. The most recent statistics for cervical cancer in Ireland are provided in the Cancer Factsheet – Cervix of the National Cancer Registry Ireland (NCRI).
CervicalCheck has developed and maintains the secure Cervical Screening Register with the details of eligible woman aged 25 to 60 nationwide. The details of eligible women are sourced from the Department of Social Protection and from women through registration and attendance for smear tests.
Letters of invitation are issued to unscreened women. Letters of re-call are issued to previously screened women after the appropriate interval. Routine screening intervals are every three years for women aged 25 to 44 and every five years for women aged 45 to 60, in line with best international practice.
Letters to advise women when the result of their smear test is available and to recommend their next step within the screening programme are issued within four weeks of having their smear test taken.
Quality assured colposcopy services located in 15 hospitals are available for women who require follow-up investigation and treatment if necessary.
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Organised versus opportunistic screening
A smear test is a screening test. It is not a diagnostic test.
Opportunistic smeartaking is not effective and does not impact on levels of detection of cervical cancer.
Consistent with best international practice, opportunistic screening outside programme screening intervals (e.g. routine screening of pregnant or post-natal women, routine screening of women using contraception, HRT or routine screening of women undergoing investigation for genital infection or for those previously used to excessively frequent screening) is considered inappropriate. Consistent with international best practice, opportunistic screening is discouraged.
If a woman presents to a smeartaker with symptoms suggestive of gynaecological cancer the woman should be referred directly for urgent gynaecological review.
Opportunistic smeartaking is prevalent in post natal follow-up care. This is not the ideal time for effective smear test taking and should be discouraged to correct the inappropriate link between pregnancy and smear tests.
If a woman presents with symptoms suggestive of a sexually transmitted infection e.g. genital warts, she should not be given a smear test but rather referred for a full STI assessment in a GUM clinic. Such presentations are not a symptom of cervical cancer and accordingly a smear test is considered inappropriate and unnecessary and should be discouraged.
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Screening range - women aged 25 to 60 years
International best practice recommends that a population based cervical screening programme should target women aged from 25 or 30 years to 60 or 65 years.
Based on evidence to date, there is no additional public health benefit in starting screening below the age of 25. In women under the age of 25, minor changes in the cells of the cervix are common but invasive cancer is extremely rare. Population based screening in women under the age of 25 may lead to many women receiving unnecessary treatment for lesions that would never have developed into invasive cancer. Once screening begins at the age of 25, lesions that are likely to progress will be screen-detectable. Lesions that regress will no longer be a source of concern. Any woman under the age of 25 who is concerned about her risk of developing cervical cancer or her sexual health should contact her doctor or Genito-Urinary Medicine (GUM) clinic.
There is no firm evidence that indicates the optimal age to cease screening but in most international programmes it is 60 or 65. The natural history and progression of cervical cancer means that it is highly unlikely that such women will go on to develop the disease.
Women aged 60 and over who have never had a smear test are entitled to have a CervicahCheck smear test.
Effectiveness of cervical screening with age: population based case- control study of prospectively recorded data - Article from the Brittish Medical Journal first published in August 2009
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Eligibility for CervicalCheck screening
CervicalCheck has developed a reference framework for smeartakers which provides guidance on the eligibility criteria for women with respect to age, screening intervals, management recommendations and special circumstances.
CervicalCheck eligibility framework
A woman's eligibility for a CervicalCheck smear test may be checked on the website using the Check Woman's Eligibility facility (see the left-hand panel).
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A woman's consent, by signature or by witnessed mark, is required to participate in CervicalCheck. Only the woman herself may provide consent. Consent to participate can never be given by a third party.
Before signing the Cervical Cytology Form, a woman has the right to certain information to allow her to make an informed choice and to give informed consent. This includes an explanation of:
- The smear test
- The possibility that the sample may also be tested for certain types of HPV
- The likelihood and meaning of a normal result
- What it means if recalled for further tests
- When and how the result will be provided
- The importance of having regular smear tests
- The accuracy and limitations of screening tests, and
- If the results are abnormal, the options available, including an assessment of the risks, limitations, side effects and benefits of each option.
A woman must sign the Cervical Cytology Form to take part in the programme and avail of a free CervicalCheck smear test. The Information Sheet for Women (cover sheet of the Cervical Cytology form) must be provided to every woman who attends for a smear test. It explains to a woman how her consent is required to allow her personal details to be shared within the cervical screening programme.
The Information Sheet for Women (cover sheet of the Cervical Cytology form) is available in a number of language translations to faciliate women providing informed consent in advance of a smear test. In addition to English and Irish, translations are available in Arabic, Chinese (Mandarin), French, German, Latvian, Lithuanian, Polish, Romanian, Russian and Spanish.
All information sheets are available to view and download in the Essential documents section (see left panel).
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CervicalCheck operates two routine screening intervals for women with normal smear test results.
Women aged 25 to 44 will be invited routinely for a free smear test every three years and following two consecutive normal smear test results women aged 45 to 60 will be invited routinely every five years.
Women who join the programme when aged 45 or over will need to have two normal smear test results three years apart before they move onto a five yearly re-call.
Women who are recommended for increased surveillance are re-called after one year following a normal smear test result.
Women who receive unsatisfactory results will be recommended for an early repeat smear test after 3 months. The test should not be repeated before 3 months. This is the minimum repeat interval, to allow time for the cells of the cervix to graw back after a smear test.
Following a smear test, CervicalCheck sends a letter to the woman advising her of her recommended next step in the screening programme. The recommended next step may be: routine screening, annual screening, early repeat (in 3 or 6 months), or to contact her smeartaker to discuss her result and recommendation.
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Invitation and re-call of women
CervicalCheck is a population-based cervical cancer screening programme which operates an organised call, re-call system of invitation.
Unscreened women and the call, re-call system
CervicalCheck sends an invitation letter by post to every eligible woman on the Cervical Screening Register who has never had a CervicalCheck smear test. The letter invites her to make an appointment with a registered smeartaker for her first free smear test. If the woman does not attend for a smear test, she is sent up to two reminder letters.
If an eligible woman has not yet had a CervicalCheck smear test and has not received a letter of invitation from the programme, she can attend a registered smeartaker for her first CervicalCheck smear test.
Eligible women must be normally resident and have a postal address in the Republic of Ireland.
Screened women and the call, re-call system
When a woman has attended for a CervicalCheck smear test and receives a negative result (no abnormality detected), CervicalCheck will send a letter of re-call in advance of the woman’s next smear test due date. If the woman does not attend for the recommended smear test, she is sent up to two reminder letters.
When a woman has attended for a CervicalCheck smear test and receives an early repeat recommendation, the letter following her result will advise her to make an appointment for the early repeat smear test (in 3 or 6 months).
Women and smeartakers can check if a women is eligible for a free smear test and when her next smear test is due using Check Woman's Eligibility in the left hand panel or by contacting CervicalCheck on Freephone 1800 45 45 55.
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Programme reports and related publications
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