Cork expert: 'Restarting cervical screening is not like flicking a switch'

Cork expert: 'Restarting cervical screening is not like flicking a switch'
Dr Noirin Russell, a consultant obstetrician and gynaecologist at Cork University Maternity Hospital.

STAFF involved in CervicalCheck screening want the service to restart but only when it is safe to do so, according to a Cork consultant in gynaecology and obstetrics.

Dr Nóirín Russell is a member of the perinatal medicine team at Cork University Hospital, which provides care for women with high-risk pregnancy.

She is also the clinical lead for the colposcopy service at University Hospital Kerry, a pathway of CervicalCheck screening in Ireland.

CervicalCheck testing has been paused since March, when it was halted amid the spread of Covid-19.

In response to the calls to recommence cancer screening, a spokesperson for the HSE said the health service is treating it as a priority and that restart dates for screening are to be announced by the end of this month.

The spokesperson explained there is to be “extensive modifications” made to screening units and once approved, screening invitations will be issued on a phased basis according to priority.

Speaking to The Echo, Dr Nóirín Russell explained the steps needed for CervicalCheck to resume safely and effectively.

“Restarting cervical screening is not like flicking a switch,” she said.

“It is a complex screening programme with many interrelated parts in the care pathway.

“The ‘new normal’ in the Covid-19 era involves a change in how we provide care, as social distancing has a huge knock-on effect on how many patients can be seen within a clinic,” added Dr Russell.

“It is necessary, first and foremost, to provide a clinical environment that women feel safe to attend with adequate numbers of smear takers in the community — practice nurses and general practitioners — to provide an equitable service across the country.

“There must be enough medical scientists and cytologists available to read the screening tests.

“Next, there must be enough capacity to provide appointments in secondary care in colposcopy clinics.

“This may include returning nursing and administrative staff from other clinical areas where they were deployed to during the last few crazy months of the Covid-19 pandemic.

“To ensure that the biopsies taken at these clinics can be processed and read involves further laboratory expertise from histopathologists,” said Dr Russell.

“It is important to also mention the programme staff behind the scenes who coordinate the invitation letters and the overall safe running of the programme.

“In summary, this is complex — everyone involved wishes for it to restart but only when it is safe to do so,” she added.

Dr Russell stressed that, in the meantime, any woman experiencing symptoms such as vaginal bleeding after sex or in between periods or postmenopausal bleeding should be referred to gynaecology services.

“These women need urgent specialist review and this should not be delayed,” she explained.

“It is not appropriate for any woman with these so-called ‘red-flag’ symptoms to be delayed until the screening programme restarts as screening is aimed at asymptomatic women.

“Screening is not for people with symptoms,” she added.

Stephen Teap from Carrigaline, a leading campaigner on behalf of all those impacted by the CervicalCheck screening failures in Ireland, has called for plans to restart the screening services
Stephen Teap from Carrigaline, a leading campaigner on behalf of all those impacted by the CervicalCheck screening failures in Ireland, has called for plans to restart the screening services

In recent days, Sharon Butler Hughes, who helped expose test result delays in the CervicalCheck programme due to an IT glitch, criticised delays in resuming smear testing calling for the return of the service to be made a priority.

“It’s such a vital service for all women in Ireland and it was stopped back in March,” she said.

“The country is opening back up with McDonald’s, Woodies and more reopening but this vital service hasn’t.

“Of course, it should be done safely and within the Covid-19 guidelines, which I believe it could be, along with BreastCheck and other crucial services,” she added.

Ms Butler Hughes’ personal story is included in the rapid review report, which was published last August, and from which she has since withdrawn.

The incident occurred when Ms Butler Hughes, who was diagnosed with precancerous cells more than a decade ago, went for screening towards the end of 2018.

When she did not receive her test result, the Dublin woman made a series of phone calls to CervicalCheck and the Department of Health between March and June last year.

Eventually, it was discovered that an IT glitch at the Quest Chantilly lab in the US was the reason for the delay.

The discovery led to a rapid review into the matter which found that 4,088 women were impacted by the glitch.

Ms Butler Hughes’ persistence in the matter led to the review and the discovery that thousands of women had been affected.

In response to the calls to recommence cancer screening, a spokesperson for the HSE said the health service is treating it as a priority and that restart dates for screening are to be announced by the end of this month.

The spokesperson explained there is to be “extensive modifications” made to screening units and once approved, screening invitations will be issued on a phased basis according to priority.

“Any recommencement is underpinned by the assumption that there will be no worsening of the Covid-19 situation and restrictions will continue to ease.” Looking to the future viability of CervicalCheck, Dr Russell stressed the importance of recognising that no cancer screening programme is one hundred percent effective.

“Everyone involved in cervical cancer screening wants the same thing, a world-class screening programme that reduces the risk of women developing cervical cancer,” she said.

“We have learnt a lot from the last two years of discussions about screening — it is a test performed for healthy women without symptoms that reduces their risk of developing cancer.

“However, no screening test detects 100% of cancers,” she added.

“The recent change in the programme that uses a HPV test as the primary screening test is very promising as the data shows that this reduces the risk of developing cancer by 90%.

“However, it is important to be open and transparent about the limitations of this test as there will still be false negatives, ie, women where the screening test fails to detect their cancer at an early stage.

“These false negatives will be less frequent but they will still occur,” explained Dr Russell.

“This is the reality of screening.”

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