Bulletin Board

CervicalCheck Bulletin Board for Health Professionals

How does CervicalCheck invite women to be part of the Programme?

CervicalCheck operates an organised call, re-call system of invitation, in line with best international practice. This ensures an effective and efficient population approach to screening that maximises target population coverage.

CervicalCheck has developed a register (list) of eligible women nationwide aged 25 to 60 through up-to-date information received from the Department of Social and Family Affairs, from self-registration and colposcopy details. Over each three year screening round, CervicalCheck will send an invitation letter by post to eligible women on this list who have never had a CervicalCheck smear test inviting them for their free smear test.

In addition to call and re-call letters of invitation, direct programme entry by smeartakers of eligible women who have not yet had a CervicalCheck smear test has been introduced. Smeartakers can facilitate a smear test for these 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 can be checked online under the 'Check Eligibility' tab in this section.

Separately any woman who has not had a smear test in the last three years can opt-in and request an invitation letter from CervicalCheck by registering online at www.cervicalcheck.ie, by completing and returning a Freepost self-registration form, or by calling CervicalCheck on Freephone 1800 45 45 55.

What if a woman has already had a CervicalCheck smear test?

Women who have already availed of a CervicalCheck smear test since 1 September 2008 will automatically be re-called when their next smear test is due.

Smeartakers should also be aware of the following:

The smeartaker should check a woman's date of birth (DOB) before taking the smear test to ensure the sample is for the correct woman
Smeartakers are responsible for giving women their results
Smeartakers are responsible for making referrals as advised by the laboratory

When will a woman be called back after her first CervicalCheck smear test?

Women who join the Programme, regardless of age, will need to have two negative smear test results; three years apart before they move onto a five yearly re-call. Women aged 25 to 44 will be invited for a free smear test every three years and following two consecutive no abnormality detected smear test results women aged 45 to 60 will be invited every five years.

If a woman or her smeartaker is unsure about eligibility for a CervicalCheck smear test, they can check online under the 'Check Woman's Eligibility' tab on the left hand side of this page or contact CervicalCheck on Freephone 1800 45 45 55 for advice.

A woman has presented with an invitation letter and is in one of the following categories; is a virgin, is intellectually disabled, has had a hysterectomy, or is post natal. Is it appropriate to screen at this time and what do I need to do in this instance?

Every woman who receives an invitation letter may not be sexually active. If she has never been sexually active, then the research evidence shows that the woman’s chance of developing cervical cancer is very low indeed. In these circumstances, a woman might choose to decline the invitation for cervical screening on this occasion. If a woman is not currently sexually active but has had partners in the past, it is recommended that she continues screening. Women with intellectual disability should be considered on a case by case basis and the consent process also needs to be considered.

Should women who have sex with women have a smear test?

Yes, screening recommendations do not differ for women who sleep with women or lesbians regardless of their history with men.

A woman has presented with a letter inviting her for a free smear test, she has had a total hysterectomy, what do I do?

Some women who have had total hysterectomies still require screening
The responsibility lies with the clinically responsible doctor to make an informed decision as to whether the woman requires cervical screening
Once the cervix is still insitu (subtotal hysterectomy), cervical screening should continue as normal

I don’t know if the woman has a cervix post hysterectomy, what should I do?

The onus is on the smeartaker to obtain as much information about the procedure as possible. If this is difficult to find, a speculum examination will establish whether the cervix is still insitu. Advise the woman if a digital examination is going to be carried out.

A woman is pregnant and has received a CervicalCheck invitation letter, what should I do?

Unless a pregnant woman with negative history has gone beyond three years without having cervical screening then the test may be deferred. If a previous test was abnormal and in the interim the woman becomes pregnant, then the repeat test should not be delayed but should be taken in mid-trimester unless there is a clinical contraindication. If she has been referred to colposcopy she should attend her appointment.

Can abnormal smear tests affect pregnancy? Does taking a smear test in pregnancy cause miscarriage?

Pregnancy has no adverse effect in the progression of abnormal cells or the development of cervical cancer. Occasionally women may experience slight bleeding after having a smear test in pregnancy but a smear test will not make the woman more likely to miscarry.

A woman has had a miscarriage and has received a letter of invitation, when should I take the smear test?

The woman should wait three months before having a smear test.

Should I take a smear test on women who are post natal?

A woman does not require a screening smear test postnatally unless she is due to have a smear test within her call, re-call recommendations.

A woman is still breastfeeding, is it appropriate to take a smear test?

Once the woman is over three months post natal and she presents with a letter of invitation or requires a repeat smear test due to a previous abnormal smear test result, proceed with the test but document clearly on the Cervical Cytology Form that the woman is breastfeeding.

I need to take a clinically indicated smear test, what do I do?

A smear test is a screening test, not a diagnostic test. If a woman presents with clinical concerns she should be referred to gynaecology for further assessment. The referral should not be delayed by either taking a smear test or awaiting results.

Why do I need to include the Personal Public Service Number (PPS No.)?

Primary Care Reimbursement Scheme (PCRS) requires a PPS No. for payment processing
It is a unique identifier which ensures that the correct result is matched with the right woman

In relation to the CSP ID No. – the more demographics that are on the form, the easier it will be to match the woman.

How early will CervicalCheck accept a repeat smear test for processing?

Never less than three months for an unsatisfactory/inadequate
Never less than five months for a six month repeat
Never less than 10 months for an annual repeat smear test

The Programme intends to return samples taken in less than three months to the smeartaker. These samples will not be processed.

How long before an expiry date should the vials be used?

The vials should be within 10 days of the expiry date to allow for tansit and processing issues.

Why do I have to wait three months to repeat a sample that was expired/ inadequate?

Taking a smear test before three months can result in a sub optimal sample as it may take this length of time for the cells to regenerate on the cervix.

Will women get a reminder for a repeat smear test following an abnormal result?

The result letter advises a woman when she is due a repeat smear test and CervicalCheck does not send a separate letter of invitation. Failsafe reminders will activate if the woman’s smear test/result is not received within two months.

If a woman has a smear test at 57, 58 or 59 years (and has not had a previous Programme smear test) – will she be re-called?

Yes. If the woman is new to CervicalCheck, she requires two negative smear test results three years apart, regardless of age.

I submitted a vial that was expired; I cannot understand why this smear test cannot be processed?

The expiry date on the vial is determined by the manufacturer. In order for this test to be valid under FDA rules the vial must be in date. Legally the result could be queried on an expired vial.

I submitted a sample that was expired; I cannot understand why this smear test cannot be processed?

Section 4.1 Part (e) of the contract: to provide smear test samples only to the designated lab within five working days of conducting the smear test
The test will not be processed if either the vial or sample has expired

What is failsafe?

Failsafe is a written communication (a letter) sent by CervicalCheck to the woman and to the doctor with clinical responsibility in the primary care setting when the woman does not attend for:

Her recommended smear test (following an ‘inadequate’ or ‘not normal’ result)
Her colposcopy referral
Her post colposcopy cervical smear tests

A number of issues have arisen in relation to completion/non completion of the failsafe form. These include:

Returning blank forms with the signature only
Not signing the form
Not recording the date of the repeat smear test
Failure to record efforts made by the practice to contact the woman
Failure to record the referral date and the name of the colposcopy clinic, where the woman is referred to colposcopy
Failure to record gynaecological referral details, where the woman has been referred to a gynaecological clinic
Where the woman has changed GP, failure to record the name of her new GP if known – this will enable the Programme to resend the form to the new GP
Where the woman has had a repeat smear test privately, failure to record details of date and laboratory sent to - failsafe can be closed and no further letters will issue

Why is there a recommendation for ‘refer to colposcopy’ when the result is negative?

If the cytology form details a suspicious cervix the laboratories are instructed to make the recommendation to refer to colposcopy. Clinical suspicion will always override a smear test as it is a screening test with unavoidable false negative/positive results. Smeartakers should not wait for a result before making a referral to gynaecology if there is clinical suspicion.

There is a comment on the report stating that the smear test pattern is predominantly parabasal, what does this mean?

Parabasal cells are immature squamous cells seen on the cervix in the absence of oestrogen. They are often seen in post menopausal or post natal women or in those who are taking a progesterone only pill. It is not a cytological abnormality.

There is a comment regarding endometrial cells seen in a negative smear test, what is the significance of this?

Bethesda requires the laboratory to note the presence of normal looking endometrial cells in an otherwise negative smear test in women over 40 years as there is a very small chance of this indicating endometrial adenocarcinoma. It should be interpreted clinically based on the woman’s menstrual history and examination.

I took a smear test on a 63 year old woman, why does she require another smear test in three years?

Women can only exit the Programme following two negative Programme smear tests regardless of age.

Why is there a recommendation for ‘refer to gynaecology’ on this result when the result is negative?

If the Cervical Cytology Form details abnormal bleeding the laboratory is instructed to make the recommendation to refer for gynaecological assessment (clinical correlation is suggested).

Should I check the result and management recommendations on the result forms?

Yes, it is recommended to check that the text reads correctly on the result and that the management recommendation is correct for your patient’s history.

The smear test report shows TZ cells absent but the woman has still received a normal result with normal re-call – why is this?

An absence of TZ cells does not affect re-call in an adequate/negative smear test
TZ cells are not required to deem a smear test as adequate
If a negative result is given, normal re-call stands
Evidence of TZ sampling is considered to be a measure of competency
It is reassuring to see this evidence and in training our trainees are expected to reach an 80 per cent TZ sampling standard, captured in an audit of a minimum of 30 adequate smear test results
It is more difficult to sample the TZ in post menopausal women
New smear test reports using Bethesda comment on TZ cells
Smear test audits to measure your TZ cell sampling rate are beneficial and a smear test audit tool is available from the Programme office.

What is HPV and is an abnormal smear test result due to sexual activity?

HPV or human papilloma virus is an extremely common virus that is almost always transmitted during sexual intercourse but is also transmitted via skin on skin contact. Approximately eight out of 10 adults have had the infection at some time and rarely produce any effects but about five per cent of women have abnormal smear tests. One to two per cent will develop pre-cancerous cells and a tiny minority of these progress to get cervical cancer despite the efforts of a screening programme. Although HPV is sexually transmitted it is not a sexually transmitted disease that requires a visit to a Sexual Health Clinic. Some abnormal smear tests with mild changes may not be due to HPV but most abnormal smear tests are due to the effects of HPV on the cervix. There is no blame to attach to a current or any other partner or a woman.

What must a GP do when referring a woman to colposcopy?

When referring to colposcopy, the GP must:

Use a Colposcopy Referral Form
Include the smear test report with the referral
Differentiate between AGC/AGH & ASC-US (Glandular BNA and Squamous BNA)

My patient is HIV positive and needs annual cytology, what do I do?

(CervicalCheck Cervical Cytology Form)

Does cervical cancer run in the family?

No. Daughters and other female relatives of women with abnormal smear tests, pre-cancerous cells (CIN) or cervical cancer do not have an increased risk of abnormal smear tests, pre-cancerous cells or cervical cancer.

Is there evidence regarding the benefits of screening for woman aged under 25 years?

See the latest evidence under section ‘Evidence papers and further reading’ – Effectiveness of cervical screening with age. This summarises the work done for the UK Advisory Committee on Cervical Screening and is the most up-to-date evidence base as to why the population programme does not screen women below the age of 25.

However, if a woman under the age of 25 has had a previous abnormal result and she is within the follow-up period, CervicalCheck will process the smear test, manage the woman within the CervicalCheck programme, but payment will not be processed to the smeartaker.

Information for health professionals