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Policy Information

Screening and CervicalCheck

Published: 26 June 2019
From: Department of Health

Introduction

CervicalCheck is the Irish national cervical screening programme. It offers free cervical screening (smear) tests to women between the ages of 25 and 60.

Since CervicalCheck was set up in 2008, more than 3 million screening tests have been carried out and over 100,000 cases of abnormal cervical cells have been detected, many of which could have developed into cancer if not detected through screening and treated where necessary. Cervical cancer rates have reduced from around 14 cases per 100,000 women in the years 2009 to 2011, to 10 cases per 100,000 women in the years 2013 to 2015.

A cervical screening test (smear test) is a way of detecting abnormal cells in the cervix (neck of the womb). Abnormal cells are sometimes also known as pre-cancerous cells. If not detected, these abnormal cells could develop into cervical cancer, so removing them can prevent cancer. It is estimated that regular cervical screening can prevent 75% of cervical cancer cases.

While most smear test results are normal, some tests show changes in the cells of the cervix. Most of these changes are caused by a virus called the human papillomavirus (HPV).

Human papillomavirus (HPV)

HPV is a common virus that most people have at some point in their lives. There are over 100 different types of HPV virus. Some HPV types can cause cell changes in the cervix (neck of the womb). HPV is usually cleared by the body’s immune system. If the HPV infection does not clear up on its own, there is a greater risk of developing cervical cell changes which may need treatment.

Limitations of cervical screening

The main limitations of cervical screening are:

  • cervical screening will not prevent all cases of cervical cancer
  • some women will still develop cervical cancer despite regular screening
  • some abnormal cell changes may be missed. If 1,000 women are screened, about 20 women will have abnormal cervical cells. About 15 women will have these cells detected through screening. About five women will not have these cells detected through screening and may develop cervical cancer

False positives and false negatives

Sometimes test results are inaccurate. We call these ‘false positives’ and ‘false negatives’. False positives and false negatives are unavoidable. They happen in every screening programme.

  • a result may be reported as negative (normal cells), even though there are abnormal cells in the cervix. A ‘false negative’ may mean that a woman does not have further investigations when there may have been a risk of cancer at that time. Therefore, even if her test result is normal, she may still be at risk of developing cervical cancer in the future. Because of this, it is important that women attend for cervical screening each time you are due and always pay attention to possible symptoms
  • a result may be reported as positive (abnormal cells), even though there are no changes to cells of the cervix. A ‘false positive’ may mean a woman will have further investigations that ultimately confirm there was no risk of cancer at that time

False negative results are an inherent part of any cervical screening programme.

Attending a cervical screening

Regular cervical screening saves lives. It can detect abnormal changes in the cells of the cervix when they are easier to treat and helps to detect changes before symptoms develop.

Since CervicalCheck started in 2008:

  • more than 3 million screening tests have been carried out
  • over 100,000 cases of abnormal cervical cells have been detected, many of which could have developed into cancer if not detected through screening and treated where necessary

CervicalCheck issue in 2018

Laboratories used by CervicalCheck

Dr Scally's Scoping Inquiry

Independent Clinical Expert Review by the Royal College of Obstetrics and Gynaecology

CervicalCheck Steering Committee

CervicalCheck

The future for cervical screening and cervical cancer prevention in Ireland

The government accepted all of Dr Scally’s recommendations regarding CervicalCheck. Updates on the progress of the implementation of Dr Scally’s recommendations can be found here.

A well organised screening programme, when combined with HPV vaccination for boys and girls, can bring us to the point of eliminating cervical cancer. The HPV vaccine is already offered to girls in first year in secondary school.

In September this year, the HPV vaccine will be offered to boys in first year in secondary school. Funding has been provided for this to happen, following a recommendation by HIQA.

Funding has also been provided to switch to a new type of test for cervical screening, the HPV test. The introduction of primary HPV screening is in line with developments in cervical screening internationally. Ireland will be among the first countries in the world to introduce this change. Detailed planning work is ongoing now to switch the cervical screening programme to this new type of testing.

Ensuring open honest communications with patients

Encouraging a health service where there is honest open communication with patients is a priority. Dr Scally’s report into the CervicalCheck issues has made a number of recommendations about open disclosure and about women’s health. These recommendations are being implemented.

The National Patient Safety Office in the Department of Health was established in 2016 and its work includes a programme of patient safety initiatives including patient safety legislation. In 2017, the Civil Liability Amendment Bill 2017 was passed providing for open disclosure. These provisions are one part of the work to promote a comprehensive patient-centred approach to preventing, managing and learning from patient safety incidents.

In July 2018, Government approved the General Scheme of the Patient Safety Bill. The Bill will complement the legal protections for clinicians engaged in open disclosure which were introduced through the Civil Liability (Amendment) Act 2017.

In December last year, the Department of Health awarded the contract for a new independent Patient Safety Advocacy Service. This service will support those wishing to make a complaint about their experience of the public health service and provide support to patients who may have been affected by a patient safety incident. It is anticipated that the service will become operational in the second half of 2019.

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