Goal to make cervical cancer ‘a rare illness’

AROUND 255,000 women attended for cervical screening in 2022, while the CervicalCheck service has caught up on its backlog from Covid-19 and is returning test results within four weeks in 95% of cases.

Speaking to The Echo, CervicalCheck director Dr Nóirín Russell said she is proud of the work CervicalCheck did in 2022 in terms of screening take-up, making it more accessible and test result turnaround times.

She also discussed plans to introduce a patient-requested review programme this year, and to continue to work towards the elimination of cervical cancer in Ireland.

The latest CervicalCheck figures show that 255,000 women attended for screening in 2022 - 80% of those invited for screening appointments.

Some 13% of those screened tested positive for HPV and around half of these women (15,000) had abnormal cells in addition to a HPV infection, and were referred for colposcopy.

An additional 6,000 women were referred to colposcopy as they had two positive HPV tests even though their cells did not show any abnormality.

Every year, 12,500 women have a treatment performed for abnormal cells. Most of them never go on to develop cervical cancer because of this early intervention.

Meanwhile, 80% of women who had cervical cancer detected at screening had their cancer detected at the earliest possible stage, allowing for timely treatment.

“While we are happy with the attendance levels, we will be working this year on that other 20% and to better understand and address the barriers that might be there for those who don’t attend,” said Dr Russell.

The introduction of HPV testing in 2020 has widened the cohort eligible to attend to include those aged up to 65, and Dr Russell highlighted the importance of women over 50 to continue to attend for screening, even if they are postmenopausal.

To reach women who may not be aware of the screening service, CervicalCheck worked with Translate Ireland in 2022 to develop multilingual, informational videos featuring healthcare workers discussing what cervical screening is and why people should attend.

CervicalCheck also worked with LINC, a community resource centre for lesbians and bisexual women and their families in Cork and beyond, on a survey to identify and address barriers to screening for this cohort.

“While many reported positive experiences of cervical screening, only 66.5% said they attended cervical screening regularly, which compares to 80% up-take by the general population,” revealed Dr Russell.

“It’s important for people to know that anyone who has had sexual contact of any type, it doesn’t have to be penetrative, should attend for screening,” explained Dr Russell.

Dr Russell also encouraged those eligible for cervical screening to make sure that their address on the CervicalCheck register is correct, to ensure that screening invitations are reaching them.

“We know that if you attend for screening, you’re 19 times less likely to get cervical cancer than women who don’t attend,” she said, highlighting the benefits of screening.

“You’re also 36 times less likely to die from cervical cancer if you attend for screening.

“It doesn’t mean that it might never happen to you but it does make it a lot less likely if you attend for screening.”

The Covid-19 pandemic and cyber attack on the HSE in May 2021 left many health services facing a backlog of appointments.

While CervicalCheck was among those facing a backlog of appointments and delays in issuing test results, Dr Russell revealed the service has now caught up completely, and is offering timely appointments and results.

Women are being offered a screening appointment when they are due, and 95% of women attending for screening are getting their result within four weeks.

Meanwhile, those referred to colposcopy services are being seen within four weeks if their scans are deemed high grade, and within eight weeks if their scans are deemed low grade.

“It’s really, really reassuring to see the high numbers of attendance and to be able to get the results back quickly for people because we know it was stressful for those who had to endure delays,” said Dr Russell.

“It was also great to see the positive commentary from Dr Scally’s final report in which he said women can have confidence in the cervical screening programme.”

The National Cervical Screening Laboratory (NCSL) officially opened in Dublin in December 2022.

“The building is phenomenal and now it’s just about building up the numbers of staff in it,” Dr Russell explained.

“I think there are shortages of staff in every area. We’re building up a cervical screening expertise in a country that country that hasn’t been training specialists in this area.

“It takes a while to grow that expertise and training that takes a bit of time.”

Looking to the future, Dr Russell explained that CervicalCheck is working to eliminate cervical cancer in Ireland.

“Ireland is committing to the World Health Organisation’s target of eliminating cervical cancer - what that means is making cervical cancer a rare illness,” she said.

“It’s about eliminating it as a public health issue and that means making it so rare that less than four women in every 100,000 actually get cervical cancer.

“At the moment in Ireland, around 11 in every 100,000 get the disease and we want to get that down to less than four,” Dr Russell added.

“We know that elimination is possible if we get 90% of girls vaccinated for HPV, 70% of women get two screening tests by age 45, and if 90% of women who have precancerous cells or early cancer receive timely treatment.

“Cervical cancer is such a devastating disease and we’ve seen, particularly over the last couple of years, the pain and heartache it can cause,” Dr Russell stated further.

“The idea of making that so rare that it impacts less than four women in 100,000 is incredible.”

Dr Russell praised the late Laura Brennan and her family for the impact they have had on HPV vaccine uptake in Ireland.

“The extension of the programme, making it available to those who previously missed out, and the impact Laura and her family have had in raising awareness of the vaccine, which is really going to be the game changer in allowing us to eliminate cervical cancer, has been amazing.

“We in healthcare are indebted to the Brennan family - their advocacy has changed the whole country’s attitude towards the HPV vaccine and I think they’re an incredible group of people.”

CervicalCheck will launch a patient-requested review programme in 2023, providing those who do get cervical cancer and have attended for screening with the opportunity to have their history reviewed.

“It’s completely understandable that, following a cancer diagnosis, people might have questions and seek answers,” said Dr Russell, who added that CervicalCheck is working to reduce the harms associated with screening.

“It’s not without harms and that is something we’re aware of - false positives and false negatives can impact people.

“To reassure people, we’re working really hard to minimise those harms.

“We’re examining the population and examining whether or not we’re detecting as many high grade scans as we should be, based on those population figures,” she explained.

“We’re also constantly working on our turnaround times and ensuring that the labs we are working with are working to the highest possible standards.

“We’re determined to be open and honest with people in that screening is a risk reduction tool - it might detect your cancer and, in some cases, it might not,” she added.

“It’s so important that people attend to ensure that risk is reduced, along with taking other measures such as maintaining a healthy lifestyle, exercising, not smoking.

“It’s also so important that, if women have any worrying symptoms, they talk to their doctor even if they were recently screened.”