Topic outline

  • CervicalCheck Update for Health Professionals July 2018

    In response to queries from health professionals the following information may be helpful for use in practice

    • Cervical screening does not look for cancer it is looking for abnormal squamous cells that if left untreated may turn cancerous. Cervical screening, as stated in all the literature provided for women is not 100%, and women should be advised of this.

    • A screening programme like CervicalCheck could reduce the number of cases of cervical cancer by as much as 80% over time

    • The programme commenced in 2008 and does not have any information about screening tests or cervical cancers prior to this time.

    • 80% of cervical cancers are squamous in origin with usually a pre-invasive phase which makes regular screening useful for this type of cancer.

    • Cervical screening is inefficient at preventing adenocarcinoma

  • Policy

    • An additional (repeat) free CervicalCheck screening smear test is available to eligible women until 31/12/2018 if they have concerns relating to their cervical screening.

    • As with all smear tests each women must give written informed consent

    • It is policy that the patient information leaflet (attached to each cytology referral form) is given to each women after she has been counselled

    • Currently and until further notice ‘Cytology’ is the primary screening test in primary care

    • Benefits and limitations should be addressed when counselling women 

    • Dr Scally recommendations that medical records should be made available to women. Learn  More: Scoping Inquiry into CervicalCheck Screening Programme – Progress Report - - June2018

    • The HSE has been working with the National Cancer Registry of Ireland and the Department of Health to identify any other women who had cervical cancer since 2008, who may also have had a CervicalCheck test, but were not included in the CervicalCheck audit. We are working with the department of health to enable the contract for the review to be signed and commenced. This will involve a review of the previous screening tests of women with cervical cancer, and will be carried out under the auspices of the Royal College of Obstetricians and Gynaecologists with expert input from the British Society for Colposcopy and Cervical Pathology. The HSE will agree a communication process with this International Clinical Expert Review Panel for those women identified by the National Cancer Registry matching process.

    Learn More

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  • Laboratory

    • Each cytology laboratory engaged by CervicalCheck is accredited and each test is screened by two cytologists

    • The laboratory where each test is screened is identified on each screening laboratory result communication to the smeartaker.

    • CervicalCheck does not have a facility for review of slides from the past unless as part of a cancer audit process

    • There is no facility to review, comment or make recommendations for non-programme ie. private tests

    • Under no circumstances should the contents of a sample vial be ‘divided’ and sent to two different laboratories. This is likely to result in a suboptimal screening test.

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    • HPV Testing

      • HPV primary test will likely require that cytology be the second test where HPV high risk is detected. It is therefore vital that smeartakers are diligent in taking a good quality sample from a well visualised cervix.

      • HPV triage for the management of low grade abnormalities has been used since 2015. The presence of high risk HPV correlates well with abnormal cytology. A negative HPV test correlates well with normal cytology. Insert guidance note

      • The HPV test helps to determine the recommendation to be assigned with the result by the laboratory. This recommendation will be for routine screening if HPV is not detected, and will be refer to colposcopy if HPV is detected. Learn More (Guidance note 14)

      • Women who are referred to colposcopy with low grade cytology and HPV detected will have a colposcopy and/or a biopsy. If there is no CIN present, these women will be discharged for a smear test in 3 years (regardless of age), or as per colposcopy clinic recommendation. If there is CIN present, these women will be managed in colposcopy until they can be discharged

      Learn More (Guidance note 7)

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      • Results and Follow Up

        • Turn-around time from the laboratories is currently 8-10 weeks for most tests taken since April 2018

        • CervicalCheck is working to re-establish the 4 week turn around (previously 94%)

        • Transformation Zone (TZ) cells are not required to be present to deem a smear test as adequate. An absence of TZ cells does not affect re-call in an adequate negative smear test. If a negative result is given, the routine re-call recommendation should be followed. TZ cells may be difficult to sample in postmenopausal women.

        • Smeartakers should be aware that evidence of TZ sampling is considered to be a measure of smeartaking competency.

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        • Symptomatic Women

          • Smeartakers should be familiar with the appearance of normal anomalies eg. eversions and nabothian follicles. The cervix image library is a valuable reference point

          • Screening is not diagnostic and after clearly visualising the cervix an assessment as to whether there is cause for concern can be made. The cervix image library  is a valuable reference point

          • Ticking the suspicious cervix box on the cytology referral form will automatically generate an urgent referral to colposcopy and be aware that this causes overload of the colposcopy service and extended appointment waiting times

          • Genuine concern at the time of test taking is a valid reason for contacting local colposcopy unit however unnecessary referrals cause distress to women

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