Freephone information line: 1800 45 45 55

Information for Healthcare Professionals from CervicalCheck - Latest update

(07 Nov 2019)

This is an update for GPs and smeartakers contracted to the National Cervical Screening Programme.

HPV primary cervical screening

Two types of cervical screening test are commonly used: a cytology test (smear test), and the newer HPV (human papillomavirus) test.

The cytology test looks for changes in the cells of the cervix while the HPV test looks for HPV infection.

HPV is a common infection which is transmitted by skin-to-skin contact including sexual contact. In most cases, HPV infection goes away by itself.

However, a small number of HPV types cause cancer. HPV is the cause of most cases of cervical cancer.

Why we’re planning to introduce HPV primary cervical screening

Over the last 10 years, evidence has shown that HPV testing identifies more women with precancerous abnormalities and early-stage invasive cervical cancer. This is why we are preparing to transition to HPV primary cervical screening in the first quarter of 2020.

Once HPV primary screening is introduced, all women who attend for cervical screening will have a HPV test. This will test for a range of HPV types which can cause cervical cancer.

If that test is negative, a woman is discharged back to routine screening.

If the HPV test is positive (approximately 10-15% of tests) the test sample is then sent for cytology.

Preparing for HPV primary cervical screening

We have established a steering committee and a project team. We are now preparing to introduce HPV primary cervical screening. 

This work includes:

  • determination of eligibility
  • development of screening pathways
  • development of colposcopy protocols
  • laboratory configuration arrangements
  • new quality assurance standards
  • new ICT structures
  • training and resources for all relevant health care professionals
  • a new communications strategy to support programme delivery

We will publish updates on this project as it progresses.

 

 

-------------------------------------------------------------------------------------------------------------------------------------------------------

Archive updates for health professionals

Date: 06/08/2019

Cervical screening programme and its recent audit process

General Briefing for GPs and smeartakers

 

Letter to registered smeartakers regarding the cessation of out-of-cycle consultations and smear tests - 4 December 2018

Letter to doctors nurses registered with CervicalCheck - CervicalCheck Update for Health Professionals - 2 May 2018

Information for women who are concerned about their smear test results can be found here >

Smear test result delays

Letter to doctors/nurses registered with CervicalCheck: CervicalCheck Update for Health Professionals - 7 August 2018

CervicalCheck daily reports from the HSE Serious Incident Management Team can be found here

Letter to GPs from HSE and CervicalCheck (pdf) - 9 May 2018 – clinical advice and reimbursement overview

Reimbursement Notice from HSE and CervicalCheck (pdf) - 9 May 2018

CervicalCheck advice and support sheet for women (pdf) - 4 May 2018

This is an update for GPs and smeartakers about the cervical screening programme and its recent audit process. We would specifically like to seek the support of you and your teams in helping women to allay concerns caused by the way this issue has been communicated and how it may be resolved.

The HSE and the CervicalCheck programme has reiterated its deepest apologies to women for any worry caused by this ongoing situation. The HSE is keen to provide reassurance to women who may be affected, and to those involved in their care and from who they may seek advice and support. With this in mind, we have outlined below an overview of what has happened to date and advice for both healthcare workers and women.

Many people continue to have concerns about the CervicalCheck – the National Cervical Screening Programme.

We are particularly aware of the anxiety caused to women because of the delays in getting their smear test results.

We are continuing to manage issues related to the CervicalCheck crisis. Our 3 key areas of focus are to:

  • improve and strengthen our cervical screening programme, including the smear test results delay
  • continue to support women and families impacted by the CervicalCheck crisis
  • introduce a new HPV screening test

We continue to update this website with key information regarding the CervicalCheck crisis for women and healthcare professionals. If your question is not answered by the information below, you can email us at info@cervicalcheck.ie or make a request for a call back here. You can also call us on Freephone 1800 45 45 55 (+353 21 4217612 from outside Ireland).

Here we have information which may answer some of your questions:

Smear test results delay

There is, currently, a delay in reporting smear test results.

In the past, you would get your smear test result within 4 to 6 weeks of your test. Currently, results are taking an average of 6 weeks from the time you have your smear test. In some cases, this is taking longer.  

The delay is because of the increased demand last year for repeat smear tests.

We usually process about 280,000 smear tests each year. Last year, we saw about 370,000 women. This was an increase of 90,000 compared to 2017. This increase was due to understandable concerns about cervical screening.

The delay is affecting both repeat and routine smear tests. We are sorry for this delay. We are working to reduce current waiting times.

We will write you a letter to let you know when your results are available.

If you are waiting for your smear test result, you may get a reminder letter for your next routine smear test before your results letter arrives. You should wait for your results letter to find out what to do next.

We also recommend you check our online register to make sure your contact details are up-to-date when results do become available.

Risk of the results delay to you

Cervical cancer normally takes 10 to 15 years to develop.

While the delay of an average of 6 weeks for smear test results is not desirable, it poses a very low risk to women.

The risk is also low if a woman needs to have a repeat smear test because her previous sample has expired.

We know that these delays are extremely difficult for women. We are making every effort to improve this situation.

It’s important that you continue to attend for a smear test when it’s due.

Repeat HPV tests

Quest Diagnostics, 1 of 3 labs we use, told us last November that some HPV (human papillomavirus) tests were carried out beyond the manufacturer’s recommended time-frame of 30 days. HPV tests have been a routine part of cervical screening tests since 2015.

 When we were told about the issue, we took action to:

  • get all the facts
  • look at the information supplied by the lab
  • review any clinical impact and communicate with women and their healthcare professionals

HPV tests are still likely to be accurate even if carried out after the recommended date. Our clinical team has assured us of this. They believe that the risk of incorrect results is low. But, in order to provide complete reassurance, we have asked some women to go for a repeat cervical screening test.

These tests will be prioritised. This is to ensure a timely response for those women.  Repeat cervical screening tests will be processed within 4 to 6 weeks from the time the lab receives the sample from your smeartaker.

We have contacted all women affected and their healthcare professional. This includes women who do not require any follow up.

Read more about repeat HPV tests here

Supports to 221 women and families

We continue to support the 221 women and families impacted by the CervicalCheck crisis.

This has included:

  • the provision of medical cards
  • the upgrading of eligibility for medical card holders
  • provision of access to a broad range of HSE and HSE-funded supports
  • the reimbursement of expenses and costs

We have recently completed a report about the 221 patient group.

This was developed in conjunction with the 221+ group. This group represent the women and their families. It will help provide future supports for the group. The report provides a summary report on the 221 women.

We also continue to provide the women and their families with access to their cervical screening record, including slides from labs for legal review.

A dedicated Client Services Unit in our National Screening Service manages this process.

Report on the Data Validation Project for the 221 Women Impacted by the Cervical Screening Crisis 

The HSE has published the report on the Data Validation Project for the 221 Women Impacted by the Cervical Screening Crisis.

The purpose of the project was to produce a summary report on the 221 women and their families impacted by the cervical screening crisis.

The intention of this report was to answer two questions that were frequently asked about the 221 women:

  1. what their current state of health is
  2. what resources might be needed to address their ongoing problems

This report does not provide an individual report on each of the 221 women. It is not an audit or a clinical review.

A clinical review is currently being undertaken by the Royal College of Obstetricians and Gynaecologists (known as the RCOG review).

This report does not provide any opinion on the CervicalCheck audit as this was reported upon in the ‘Scoping Inquiry into the CervicalCheck Screening Programme’ by Dr. Gabriel Scally (September 2018).

Whilst the report aims to provide an overall picture of the group of women, it has some data limitations where it was not possible to gather all data. For example, the HSE is not authorized to access data on women who had private healthcare.

Read the report on the Data Validation Project for the 221 Women Impacted by the Cervical Screening Crisis 

Independent Expert Panel Review (RCOG)

The HSE has written to more than 1,000 women or their families who agreed to take part in the Royal College of Obstetricians and Gynaecologists (RCOG) Expert Panel Review of cervical screening.

The RCOG, in the UK, is leading the independent review.

The review was set up by the Department of Health. Its aim is to provide women who took part in CervicalCheck, and who developed cervical cancer, with independent clinical assurance about the timing of their diagnosis and treatment.

The dedicated information line on the RCOG review for GPs is open Monday to Friday, 9am - 5pm and available on Freephone 1800 741 741.

Read more about the Independent Expert Panel Review.

HPV primary screening

We hope to introduce HPV primary screening as soon as possible.

HPV primary screening is a more effective form of cervical screening.

Plans to introduce HPV primary screening have begun. We have looked at HPV primary screening programmes in other countries. Testing of new systems is underway. We are also developing education and training materials.

We have begun the tender process for labs. This will ultimately determine when we can introduce the HPV screening.

Implementation plan for Scally recommendations

The HSE has welcomed the publication of the Implementation Plan for the Scoping Inquiry by Dr Gabriel Scally.

The plan sets out how all 56 of Dr Scally's recommendations will be put in place.

It was published on 11 December 2018.

A senior manager has been put in place to oversee the implementation of the recommendations in Dr Gabriel Scally’s report.

A HSE implementation oversight group has been set up. This is jointly chaired by our Chief Clinical Officer and Deputy Director General - Operations.

A set of 94 actions from the recommendations have been developed. These are our responsibility to implement.

Progress to date includes key appointments and governance changes.

You can read the Implementation Plan for the Scoping Inquiry on the Department of Health’s website.

You can read more about the HSE Implementation Oversight Group and our progress to date here.

Background

A Scoping Inquiry into Cervical Check was undertaken by Dr Gabriel Scally. His report was published in September 2018.

It contained 50 recommendations and 6 interim recommendations.

In response, the HSE established an Implementation Oversight Group. The group worked with the Department of Health and other relevant organisations.

The aim was to develop a plan for putting in place all 56 recommendations.

Governance of Implementation Oversight Group

The HSE has responsibility for implementing 31 of the 56 recommendations.

Along with the Department of Health, we have responsibility for 9 further recommendations.

The Department of Health has had lead responsibility for drafting the Implementation Plan. This is part of its remit as a member of the Cervical Check Steering Committee.

The HSE and the National Cancer Registry of Ireland (NCRI) have also helped develop the plan. They have worked on it along with patient representatives.

HSE Recommendations

We are working with the teams responsible for each recommendation. This is so we can devise detailed action plans for each recommendation.

Each set of actions has a detailed action plan. This includes timelines for starting and completing each recommendation.

This plan is iterative. This means it will be reviewed and improved at each stage. So actions will change as the plan progresses. It is likely the number of actions will grow.

We have 86 actions to put in place. We have assigned or jointly assigned senior staff for each recommendation.

Some of these actions are directly related to the:

  • National Screening Service
  • CervicalCheck programme
  • wider Health Service

More than 70% of the actions begun being implemented before the end of 2018.

Patients Voice

We are committed to keeping patients and service users at the centre of this process. We have been communicating with patient representatives throughout the development of this plan.

Engagement structures are already in place for implementing Dr Scally’s interim recommendations. We are now building on these. These include the public patient involvement (PPI).

Progress to date

There are 86 actions assigned to the HSE. More than 70% of these began by the end of last year (2018).

We have 86 actions to put in place. We have assigned or jointly assigned senior staff for each recommendation.

The HSE has appointed an implementation lead for this project.

Our plan includes working to key milestones and deadlines.

We will publish interim updates on the status of actions within our remit on www.hse.ie

Members of the HSE Implementation Oversight Group

Co-chairs:
Anne O’Connor - Director General (Interim)
Dr Colm Henry - Chief Clinical Officer

Members:
Damien McCallion - National Director, National Screening Service
John Swords - Head of Procurement
Michele Tait - HSE Implementation Lead
Stephen Horan - Implementation Plan PMO HSE
David Walsh - Interim National Director, Community Operations
Paul Connors - National Director of Communications
Dr Kevin Kelleher, National Director of Public Health.
Liam Woods, National Director Acute Hospitals
Dr Peter McKenna, Clinical Lead Women& Infants Health Programme HSE & Interim Clinical Lead Cervical Check Programme

Scoping Inquiry Report

The HSE welcomed the publication of the final report of the Scoping Inquiry by Dr Gabriel Scally and his team. We would like to acknowledge the focus and commitment of Dr Scally and his team and the patient-centred approach that they have taken in this regard.

We are re-iterating our deepest apology to all those women and those families affected.   At the centre of this issue was our failure to communicate with the women who were the subject of the audit.  As Dr Scally noted, and with which we agree, these women should have been informed.   The impact of this failure has been profound both for every single woman and all family members affected.   We further accept that the manner in which women were told was inconsistent and in many instances ill-judged and poorly handled.

Repeat HPV tests recommended for some women 

About 4,000 women have been invited for a repeat cervical screening test (smear test). This is because one of our labs has told us that some HPV (human papillomavirus) tests were carried out beyond the manufacturer’s recommended time-frame of 30 days. HPV tests have been a routine part of cervical screening tests since 2015. 

We have written to women affected by this issue. We have also written to GPs. All letters will be issued by the end of this week (8th February 2019).

Not everyone who is affected by this issue will need to have a repeat test.

Patients who are currently awaiting cervical screening test results are not affected by this issue. If they are affected, we will contact them.

We continue to update our website with information on this issue.

Letter to GPs regarding repeat HPV tests - 24 January 2019

Here we have information which may answer some of your questions:

What has happened?

Quest Diagnostics, one of CervicalCheck’s 3 contracted laboratories, has advised CervicalCheck of an issue in relation to a number of human papillomavirus (HPV) tests that were carried out outside of the manufacturer’s recommended timeframe of 30 days.

These HPV tests were carried out on cervical screening samples which reported low-grade abnormalities, in line with reflex HPV testing which was introduced in CervicalCheck in 2015.

There is no issue with the processing of the cytology slides. The HPV reflex tests in question were carried out on smear test samples processed by Quest Diagnostics between the period 2015 and 2018.

Who will tell patients affected?

All women affected will be contacted by CervicalCheck to inform them of the issue as it applies to them and to advise of the next steps if appropriate.

What is the clinical risk to patients affected?

CervicalCheck’s clinical management is assured that these HPV tests are likely to remain effective outside the manufacturer’s recommended timeframe and that the risk of erroneous results is low. However, as a precaution and to ensure patients’ management recommendations remain appropriate, we have invited some women to attend for a repeat smear test, while of number of rescued samples will re-tested for HPV by the laboratory.

Repeat smear tests will be processed by the laboratory, Quest Diagnostics, as a matter of priority.

See more information further below on whether patient’s management recommendations are likely to change.

How will I know what test to take?

We have written to about 4,000 women and asked them to attend their GP for a repeat smear test. We have issued these women with a separate yellow insert, which they have been advised to bring to their appointment.

This test should be taken in the usual way and dispatched within 5 days of test date as per CervicalCheck’s quality assurance guidelines, along with the paper insert so that the laboratory can identify the sample for priority processing. GP payment will be processed as normal.

What if a patient does not bring the yellow insert to her appointment?

If a patient does not bring the yellow insert, the test should be taken and dispatched in the usual way, as described above. Upon receipt, the laboratory will identify the sample for priority processing.

Are my patients waiting on smear test results impacted?

This issue concerns a number of HPV reflex tests that were carried out on smear test samples beyond the manufacturer’s recommended timeframe during the period 2015 to 2018. These smear tests were processed and reported to GPs and smeartakers and the result letters were issued to women.

The ongoing delay in reporting smear test results is a separate issue. Due to the unprecedented demand for cervical screening in 2018, results are unfortunately taking up to 6 weeks from the time a woman has her smear test. In some cases, this is taking longer. In the past, results would have been available in approximately 4 to 6 weeks. 

It is possible that some women who are awaiting smear test results may have had a previous smear test that was affected by this issue. If so, these women will be contacted by CervicalCheck. In such cases, women’s unreported smear tests are not impacted.

Will patients who have a repeat smear test receive the same result?

Some women may now receive a HPV positive result when their last HPV test was negative. This may be because the virus was dormant at the time the last test was taken; there has been new exposure to the virus; or due to the limitations of all screening tests.

Similarly, some women’s smear test sample may now report low or higher grade abnormalities, as cell changes may have developed during the time since the last smear test was taken or due to the limitations of all screening tests, as mentioned above.

My patient is pregnant or has recently given birth and has been offered a repeat smear test

The CervicalCheck Clinical Management team is confident that the HPV test carried out on your patient’s smear test beyond the recommended timeframe is likely to be accurate.

We are offering some women a repeat smear test in order to provide complete reassurance and to ensure we have an accurate record of their results on file.

If a woman is pregnant or has recently given birth, a screening test isn't usually recommended while they are pregnant. It is recommended that they wait until 3 months after the birth before having another screening test.

The risk to your patient’s health and the health of their unborn child is very low if she decides to wait until 3 months after the birth.

Having a screening test during pregnancy will not increase the risk of having a miscarriage. But, a woman may have slight bleeding afterwards.

If your patient is pregnant and is due to attend colposcopy, she should attend as scheduled. A colposcopy can be done safely during pregnancy.

What is HPV reflex or secondary testing?

Approximately 15 out of every thousand tests processed by CervicalCheck every year display abnormalities or changes in the cells of the cervix. These changes range from low-grade to higher grade. Since 2015, where low-grade changes are detected, samples are automatically tested by laboratories for the presence of the human papilloma (HPV) virus.

HPV is a common virus carried by most of the population. While a woman’s immune system will clear the virus in the majority of cases, certain high risk types of HPV can lead to the development of cervical cancer. HPV testing can identify women at risk, often before cell changes occur, whereas cytology detects changes to cervical cells after they have occurred.

Where a sample with low grade changes is reported as HPV positive, the patient is referred for further testing (colposcopy). Where a sample is reported as HPV negative, the patient is invited to attend routine screening (usually every 3 or 5 years, depending on a woman’s age).

Is HPV reflex testing the same as HPV primary screening?

HPV reflex testing is not equivalent to HPV primary screening. HPV primary screening is a new and more effective method of cervical screening, which has not yet been introduced in

Will the management recommendations of patient affected change?

Quest Diagnostics will be issuing amended results to CervicalCheck and GPs and smeartakers for those smear test samples affected over the coming weeks with a comment explaining the rationale for the amended result.

For those tests originally reported as HPV positive, the result will be amended to ‘indeterminate’ with an additional comment. No further action is required for these women and the recommendation for these women to attend colposcopy is still appropriate. We have written to these women to communicate this.

For those tests originally reported as HPV negative, the result will be amended to ‘indeterminate’. As a precautionary measure and to provide reassurance, we are inviting some of these women to have a repeat smear test. Their recommendation may therefore change.

Most of these women have been asked to attend their choice of registered GP or smeartaker for the repeat smear test. We have written to these women to communicate this.

Some women have attended for further smear tests after this affected test. They will be advised that repeat testing is not necessary. We have written to these women to communicate this.

Women whose HPV tests were done in a colposcopy clinic will receive an appointment to attend for a repeat test in their colposcopy clinic. We will shortly write to these women to communicate this. 

Some women’s samples have been rescued by Quest Diagnostics and their sample will be re-tested for HPV by the laboratory. We will shortly write to these women to communicate this. 

When was CervicalCheck notified of this and what actions did you take?

Quest Diagnostics first advised CervicalCheck of this issue at the end of November 2018. We immediately established an expert clinical team to establish the facts with the laboratory and review the situation. Following a detailed validation process, we identified the cervical screening samples in question and we have started to contact patients and GPs involved.

Where can I get more information?

We issued a general letter on this issue to all GPs on 24 January 2019.

We are currently writing to all GPs with patients affected.

We continue to update our website with information on this issue.

The priority for the HSE over the past number of months has been to support the women and families involved and continue to stabilise the cervical screening programme.  Designated liaison officers throughout the country are in ongoing contact with the women and families directly affected. 

We welcome confirmation by Dr Scally that the current laboratories have and continue to provide services in a quality assured manner.

We are implementing all 50 recommendations and are continuing to thoroughly examine the findings.

Governance

An interim management team has been established with the reassignment of senior staff to key positions while we fill key positions on a permanent basis.

We have recently appointed a Director of Public Health for the National Screening Service, and a Clinical Director and a Laboratory Quality Assurance Lead for CervicalCheck.

A Risk Committee for the National Screening Service, which is independently chaired, has been in place since last year.

An interim Quality and Risk manager was also appointed last year.

Implementation of Dr Scally’s recommendations on strengthening our Quality Assurance processes has begun.

CervicalCheck screening crisis - April 2018 

1.1 What happened?

Approximately 3,000 women have been diagnosed with cervical cancer since 2008. Approximately half of these cases were notified to CervicalCheck. The audit looked at the 1,482 cases which we were notified of.  A clinical audit is used to test and assure the standard of work that is being done by a health service or facility.

The audit initially found that 209 women could have been provided with a different result and recommended earlier follow-up following their screening test.

A further 12 women have since been identified. Their screening test could also have provided a different result and recommended earlier follow-up.

Importantly, this audit was undertaken after the women were diagnosed. CervicalCheck did not withhold information from any woman that delayed their cancer diagnosis. The audit of their previous smears was undertaken in response to CervicalCheck learning of their diagnosis.

It is clear that there has been a very serious breakdown in communicating to the women concerned. They should have been told that this audit was happening and of the outcomes of the audit, but in many cases they were not. 

You can find out more information about the audit in this statement. This statement was published on 1st May 2018, when we knew of 208 cases where women could have been provided with a different result.

We are regularly updating this page and providing information for the public here.

1.2 Information and Support for Women      

Women in Ireland have been understandably worried following the failures in communication about this audit. An information line was provided from April 28th and women were offered the facility to receive a call-back from a member of our clinical staff. This information line, Freephone 1800 45 45 55 (+353 21 4217612 from outside Ireland), continues to be in operation.

Calls have been returned to women following a careful exercise of checking records, data quality and assigning calls to health professionals. The call backs take a period of time as, in those cases where the person has a history of referral for colposcopy treatment or a history of cancer, we are providing a telephone consultation with a healthcare professional.

We are working hard to ensure that everyone who requested a call-back is responded to as soon as possible.

Key points:

  • CervicalCheck apologises unreservedly to you for any concerns or distress encountered as a result of this incident. 
  • Since 2008 over 3 million tests that have been taken in CervicalCheck, 221 of these tests were found to be inaccurate in this current review.  
  • Like all screening tests, cervical screening cannot unfortunately prevent all cancers. While it can detect pre-cancerous changes, it cannot always detect these changes or the presence of cancer if it has already developed.
  • The clinical advice is that women who have had normal test results in the past can continue to participate in the cervical screening programme according to their normal schedule. We are working to provide information to women across a range of channels to assist those whose query can be answered without the need for them to call the CervicalCheck information line.
  • Regular cervical screening is still one of the best ways to prevent cervical cancer.  To date, CervicalCheck has detected over 50,000 pre-cancerous changes in women, reducing their cancer risk by more than 90%.
  • CervicalCheck ensures that the laboratory analysis of our screenings is of the highest possible standard. All our screening tests are analysed in laboratories in Ireland and the US which have reached the highest standards of accreditation by national authorities. The laboratories have robust quality assurance and two screeners examine every test.

1.3 Most frequently asked questions

1.3.1 About the Audit

CervicalCheck carried out an audit of women who had been diagnosed with cervical cancer over the last 10 years. The audit happened after their cancer was notified to CervicalCheck. Not all of these women were told about the audit or that, in some cases, the audit found their screening test could have provided a different result and recommended earlier follow-up.

1.3.2 For women who have had their smear test in the last 3 months

The best advice is for you to continue with your cervical screening as scheduled.

You should wait 3 months before having another smear test. If you are concerned or are experiencing any symptoms you should talk to your GP.

1.3.3 Request for previous screening test to be reviewed/re-examined

We are recommending that you carry on with your next cervical screening as scheduled since your last smear test was normal.

If you are concerned or are experiencing any symptoms such as vaginal bleeding in between periods, abnormal discharge or pelvic pain you should visit your GP.

Please note a gap of at least 3 months is necessary for a rescreen as there will not be enough cells to test.

1.3.4 Can you reassure me that the programme is safe?

We would again like to apologise for any concerns or distress encountered as a result of this issue.

There is no evidence to suggest the clinical elements of the screening programme are faulty. The quality of smear-taking by doctors and nurses is not in question. All of contracted laboratories which currently look for abnormalities in smears have passed all quality control tests and are operating to international standards.

Cervical screening is for women with no symptoms and in the vast majority of cases, results show no abnormalities.  Every test is examined by two trained medical scientists in all of the labs that provide screening service to CervicalCheck.

1.3.5 If asked where their test have been screened/sent to or will be sent to?

CervicalCheck currently uses 3 laboratories to analyse cervical screening tests. It used other laboratories in the past. All laboratories meet CervicalCheck’s quality assurance guidelines and are certified by the relevant national authorities to an international standard. The laboratories have robust quality assurance and two screeners examine every test.

The laboratories currently used are

Quest Diagnostics, Teterboro, New Jersey, USA;
MedLab Pathology, Dublin;
Coombe Women and Infant’s Hospital, Dublin.

If the woman wants to know where her screening was carried out

This information is available on the cytology report.

1.3.6 Explanation of Screening - Limitations

The aim of cervical screening is to determine the presence or absence of pre-cervical cancerous changes. Like all screening programs, the results of cervical screening can never be 100% accurate. Cervical screening is not diagnostic and cannot always detect pre-cancerous changes. Despite its limitations, cervical screening is still one of the most effective ways to reduce your risk of developing cervical cancer.

To date, CervicalCheck has detected over 50,000 pre-cancerous changes in women, reducing their cancer risk by more than 90%.

1.3.7 Concerns from women currently in the care of Colposcopy.

The colposcopy clinics conform to a high set of standards, any queries regarding your specific case should be discussed with your colposcopy clinician.

1.3.8 What is a cervical screening test?

This is a screening test for well women and the vast majority of results show no abnormality. Screening tests are not diagnostic tests but can identify individuals who should have additional tests to determine the presence or absence of disease. Cervical screening does not prevent all cases of cervical cancer. Cervical screening tests, like other screening tests, are not 100% accurate.

1.3.9 Women who have had a hysterectomy

If you have had a radical hysterectomy then there is no need for you to have a smear test. If however you have had a partial hysterectomy then you should participate in the CervicalCheck Programme. You can register online and if you are already registered you can also check the date of your next smear test online here.

Your doctor can advise you what type of hysterectomy you have had and whether you need to continue in the CervicalCheck programme.

If you have any concerns or you have signs or symptoms, such as irregular vaginal bleeding, abnormal vaginal discharge and pelvic pain you should discuss them with your GP.

1.3.10 Pregnancy and cervical screening

I am pregnant and have received a letter, what do I do?

If you are due your routine smear test and you are pregnant, then the smear test can be delayed until three months after you give birth. Simply call the CervicalCheck Freephone and indicate that you wish to defer your routine smear test.

I have had a baby; do I need a smear test?

You do not need a smear test after having a baby unless you are due to have a smear test.

My last result was not normal and now I am pregnant, what should I do?

A not normal result will not affect your pregnancy. If you have had a not normal result and a repeat smear test is due then you can discuss this with your doctor or nurse. If you have been recommended to attend colposcopy you should attend your appointment. You can discuss this with your doctor or nurse if more information is needed.

Can a smear test that is not normal affect my pregnancy?

A not normal smear test has no effect on pregnancy. Occasionally women may have slight bleeding after having a smear test in pregnancy, but a smear test will not increase the risk of miscarriage.

1.3.11 Open disclosure (sharing information)

The HSE supports open disclosure. Information should always be shared with patients relating to their care. It is not in keeping with our policy and is not acceptable to us, that this did not happen in many of these cases. An independent statutory review has now been established. It will look at why this happened and what we need to do to ensure that it doesn’t happen again.

1.3.12 Can I get my result which was negative rechecked?

We are not recommending this. The reason is that while we’re happy to stand over the lab process, and as is stated on all cervicalcheck information letters, results letters and information leaflets, no screening process is 100% accurate. The value of screening tests, which are not the same as diagnostic tests, is to regularly check for a very slow-growing disease, at planned intervals.  Our advice, if people are concerned about their cervical health, talking to your GP.

1.3.14 What is the difference between HPV test and current cervical screening? When will it be introduced? Does it replace smear test?

Cervical smears examine a sample of the cells on the cervix under a microscope, by 2 different people, to check for any abnormalities that can be seen.  Later in 2018, we are adding a new test, where we’ll look at the cells as before, but also test for the presence of HPV virus in the sample. HPV is a sexually transmitted infection that is extremely common, and which causes about 70% of all cervical cancers.  This new screening process will be the same for you – you will visit their smear-taker, and the sample will be collected in the same way, but the testing for HPV will offer an additional level of accuracy and reassurance.

1.3.15 Will the figures for the individual labs be published?

We have published data from the 3 labs we currently use on the HSE website and this indicates that these labs are performing as they should, compared to international norms, and to each other.  The cervical screening programme is safe and effective, and we urge women, despite the poor communications process that has been seen during this audit, to remain within the programme, to continue attending for screening as per their normal schedule.

Other information

We appreciate a large volume of women have attended for repeat screening. The following resources may assist smeartakers:

https://nssresources.ie/pluginfile.php/167/mod_resource/content/2/player.html

https://nssresources.ie/course/view.php?id=42#section-0

https://nssresources.ie/enrol/index.php?id=29

CervicalCheck daily reports can be found here

Information for women concerned about their smear test results can be found here

Download a PDF version of these FAQs here

Update for smeartaker and partner organisations (pdf) - 4 May 2018

Letter to  CervicalCheck colposcopy services (pdf) - 3 May 2018

Letter to GPs and Smeartakers from HSE and CervicalCheck (pdf) - 2 May 2018

Is cuid den tSeirbhís Náisiúnta Scagthástála é CervicalCheck
Bosca Oifig Phoist 161, Luimneach
Saorghlao 1800 45 45 55
CervicalCheck is part of the National Cancer Screening Service
PO Box 161 Limerick
Freephone 1800 45 45 55

Web Design by Webtrade

Is cuid den Rannóg Sláinte agus Folláine i bhFeidhmeannacht na Seirbhíse Sláinte í an tSeirbhís Náisiúnta Scagthástála. Cuimsíonn sí BreastCheck – An Clár Náisiúnta Scagthástála Cíoch, CervicalCheck – An Clár Náisiúnta Scagthástála Ceirbheacs, BowelScreen – An Clár Náisiúnta Scagthástála Putóige agus Diabetic RetinaScreen – An Clár Náisiúnta Scagthástála Reitiní do Dhiaibéitigh.

The National Screening Service is part of the Health and Wellbeing Division of the Health Service Executive. It encompasses BreastCheck – The National Breast Screening Programme, CervicalCheck – The National Cervical Screening Programme, BowelScreen – The National Bowel Screening Programme and Diabetic RetinaScreen – The National Diabetic Retinal Screening Programme.