CERVICAL cancer screening was paused in Ireland for over three months as a result of the Covid-19 pandemic but CervicalCheck is working hard to ensure women are tested in a timely fashion, according to the new clinical director of the programme.
CervicalCheck is the national cervical screening programme, which aims to reduce the number of people in Ireland who develop cervical cancer.
It was confirmed in recent weeks that Dr Nóirín Russell, consultant in obstetrics and gynaecology at Cork University Maternity Hospital (CUMH), is the new clinical director of the screening programme.
Dr Russell works as a Consultant Obstetrician & Gynaecologist and is also the clinical lead for the colposcopy service at University Hospital Kerry.
Speaking to The Echo, the Cork doctor emphasised the importance of the cervical cancer screening service, and how it is adapting to Covid-19.
“Since March of this year, every Irish citizen has been grappling with the fact that every area of their healthcare system – from cancer treatment to mental health to disability services - has been affected by the Covid-19 pandemic,” explained Dr Russell.
“For CervicalCheck, the pandemic brought a pause in screening from the end of March until early July.
“When screening reopened on July 6, we began by prioritising invitations to women who were new entrants to the programme and those who had been waiting the longest, proportionally, for their test,” she added.
“We asked all programme participants to wait until they got their letter to book their test, as this would enable us to process all tests, and organise any follow-up treatment, in a timely manner.” Dr Russell revealed that almost 70,000 letters asking people to book their test have been issued by CervicalCheck since screening resumed in July.
“Yet less than 6,000 of these priority people have actually attended,” she said.
“Women are not coming for cervical screening when invited, and we in CervicalCheck are worried,” she admitted.
There are undoubtedly many reasons why women are not taking up the offer to book their test, Dr Russell explained.
“It may be they are reluctant to enter a healthcare environment for a test that is for people who are presumed well,” she said.
“I want to reassure women that their GP clinics are adhering to the Covid-safe principles of physical distancing, PPE and hand hygiene. I am confident they will be safe when they come for screening, and they should be confident too,” she added.
“Women will also be aware from their invite letter that when they come for screening, we have changed to a new test, called HPV cervical screening.
“They may be worried that screening will be different when they come.
“I would like to reassure women that the way their sample is taken under HPV cervical screening is exactly the same as it was before; it is how that sample is tested in the laboratory which is different.” Dr Russell emphasised that those working in CervicalCheck are excited with the changes to the programme.
“HPV cervical screening is a better way of cervical screening,” she said.
“It prevents more cancers and means some people will have fewer tests.
“If we screen 1,000 people, about 20 will have abnormal (pre-cancerous) cervical cells,” she explained.
“The old test - the smear test - would pick up 15 of these people, and the new test will identify 18 of these people.” Dr Russell added that, while this shows HPV cervical screening is better, there is no screening test that prevents all cancer from developing.
“It is important to emphasise that screening tests are designed for well women,” she said.
“Any woman who has symptoms of cervical cancer is a priority and should be urgently assessed.
“So-called ‘red flag’, symptoms such as irregular vaginal bleeding between periods, bleeding after intercourse or postmenopausal bleeding should never be ignored,” she advised.
“Women with symptoms should not wait for their screening test but should immediately make an appointment with their GP as they may need urgent referral to an expert gynaecologist.” Dr Russell also emphasised the importance of women booking their test when they get their CervicalCheck letter.
“It has always been important that women book their test when they get their letter,” she said.
“This is especially true now, when our healthcare system is adapting to new safety requirements and processes put in place to combat the spread of Covid-19.
“By coming when you are called for your test, we can better manage the many stages in the programme which are now operating at reduced capacity,” she explained.
“This in turn enables us to process your test quickly and arrange any follow-up treatment required.
“When women do not attend when they are invited, this has a knock-on effect on waiting lists down the line.” Dr Russell added that CervicalCheck is working with all service providers to maximise capacity at all points in the screening chain, even in the face of a global pandemic.
“The new normal in the Covid-19 era involves a change in how we provide care,” she explained.
“The reality is that social distancing has a huge knock-on effect on how many patients can be seen within a clinic.
“This is undoubtedly affecting the numbers of patients seen in primary care, yet the aim is at all times patient safety,” she added.
“Covid-19 is also affecting laboratory resourcing, both personnel and equipment), which in turn affects the number of samples that can be processed each week.
“This is not just an Irish problem but is also affecting cervical screening programmes internationally.” Dr Russell explained that colposcopy clinics are working at reduced capacity because of physical distancing and deep cleaning requirements between patients.
“Many clinics are running an empty waiting room policy with increased time between appointments so that women are not waiting together in close proximity,” she said.
“When biopsies are taken at colposcopy clinics, these are examined in detail by histopathology laboratory staff.
“These laboratories have also been affected by new Covid regulations which influence throughput of work,” she added.
While she admitted that current Covid-19 restrictions may result in delays within the service, Dr Russell said that women should not be concerned about the delays.
“Anyone who has not yet received their invitation but are worried this delay in screening will put them at risk of developing cancer can be assured that for the majority of women who are coming for screening regularly, a short delay is unlikely to put them at increased risk,” she explained.
“This is due to the nature of the cervical screening test itself.
“Cervical screening is looking for the presence of the HPV virus, a virus that can cause changes in the body’s cells that can lead to cancer,” she added.
“It takes abnormal cells between 10 and 15 years to develop into cancer.
“However, women should contact their GP immediately if they have symptoms.” Concluding, Dr Russell emphasised the importance of women attending for their cervical screening test as it is the best way to prevent the development of cervical cancer in the future.
“Even though screening will not prevent all cancers, it is the best way to reduce your personal risk,” she said.
“If you are called, please attend on time.
“If not called yet, make sure you are registered with cervical check on hse.ie/cervicalcheck and wait for your letter,” she added.
For information on HPV cervical screening see hse.ie/cervicalcheck. Anyone with queries can contact 1800 45 45 55.