Information for health professionals

About the Programme

• Overview of CervicalCheck
• Integrating practice and clinic re-call systems with CervicalCheck  
• Rationale for screening women aged 25 to 60
• Cessation of opportunistic smeartaking
• CervicalCheck Eligibility Framework
• Smeartaker co-ordination and smeartaker training

Overview of CervicalCheck

• The National Cancer Screening Service (NCSS)  launched a national, population-based, quality assured cervical screening programme in September 2008
• Screening is recommended 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
• The Programme, CervicalCheck - The National Cervical Screening Programme, will be made available to 1.1 million women in Ireland over a five-year screening interval (based on Target Population in Census 2006) and it is expected that this will amount to approximately 300,000 smears a year
• CervicalCheck has developed a secure register (list) of eligible woman aged 25 to 60 nationwide through up-to-date information sourced from the Department of Social and Family Affairs
• Over each three year screening round, CervicalCheck will send an invitation by post to women on this list who have never had a free CervicalCheck smear test
• Results are provided to women by the Programme office within four weeks of having their smear test taken and every test is screened twice by two separate cytologists
• The vast majority of tests - approximately 90% will be negative or normal
• A screening programme must be organised and of equal benefit to the entire screening population
• Available resources must be used effectively to the equal benefit of the entire screening population
• The successful introduction of an organised, well-managed, National Cervical Screening Programme has the capacity to reduce current incidence rates from cervical cancer among women in Ireland by up to 80%. There are approximately 76 deaths from cervical cancer annually in Ireland
• Quality assured colposcopy services are available for women who may require follow-up treatment
• On 1 September 2010 CervicalCheck entered its third year of operation and final year of its first three year screening round. To coincide, the programme moved to the third phase of encouraging participation among women wth the introduction of direct programme entry (by smeartakers) of new eligible women. This will be in addition to our ongoing call, re-call letters of invitation
• A smeartaker (GP or Practice Nurse) will be able to facilitate a smear test for new eligible women without the woman having a letter of invitation, during the normal course of a consultation or by recruiting the woman directly
• A woman's eligibility for a CervicalCheck smear test can be checked online under the 'Check Woman's Eligibility' tab on the left hand side of this page

Integrating practice and clinic re-call systems with CervicalCheck

Practices and clinics that have operated their own cervical screening re-call systems for women can integrate these systems within the CervicalCheck national re-call process with the following steps:

• Identify and communicate with those women that are due for practice or clinic re-call       
• Advise (or assist) those women that have not yet had a CervicalCheck smear test to check that they are on the CervicalCheck register (how to do this is described below) 
• Advise those women to answer ‘No’ to the registration question ‘Have you had a smear test within the last three years?’ so they will be issued with an early CervicalCheck letter of invitation 
• Advise those women to make a cervical screening appointment upon receipt of their letter of invitation

 A woman may register or update her details with CervicalCheck by: 

•         Completing the online self registration form at www.cervicalcheck.ie

                         or

•          Completing the printed Self-registration form Freepost, available from Inform Systems Telephone: 061 338580

                     or

•          Telephoning CervicalCheck (Freephone 1800 45 45 55)

Once a woman has had her first CervicalCheck smear test, CervicalCheck will issue a letter to advise the woman that her result is available from her smeartaker and when her next smear test is due.

The due date of a woman’s next smear test is based upon the management recommendation accompanying the cytology result.

Using the above steps, women who are due for practice or clinic re-call and that have not yet had a CervicalCheck smear test will be able to attend for a free smear test. This will be on foot of a CervicalCheck letter of invitation at a time consistent with the practice or clinic re-call interval.

 Rationale for screening women aged 25 to 60

• 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.
• Opportunistic or excessive screening can be harmful, particularly to those aged under 25 by causing:
  • Psychological distress
  • Unnecessary strain on colposcopy services
• 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 one under the National Cervical Screening Programme.
• 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

 Cessation of opportunistic smeartaking

• Screening is for asymptomatic women.
• A smear test is a screening test - 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 will be discouraged once the National Cervical Screening Programme is available to women aged 25 to 60 nationwide.
• A smear test is a screening test, not a diagnostic test and can delay diagnosis of gynaecological cancer if used inappropriately. 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.

CervicalCheck Eligibility Framework

• CervicalCheck - The National Cervical Screening Programme has developed a framework for smeartakers which provides clinical guidance on eligibility criteria and referral pathways. Please click on the link below to download a copy of the framework.
• CervicalCheck eligibility framework

  Smeartaker co-ordination and smeartaker training

• TheSmeartaker Co-ordinator can address any queries smeartakers may have and can be contacted by emailing stcoordinator@cervicalcheck.ie or by telephone: 061 406500.
• Queries regarding smeartaker training and resources can be directed to the Smeartaker Training Unit by emailing stu@cervicalcheck.ie or by telephone: 061 406564.