**Please note, the following information is directed at Health Professionals. If you are a patient and require information about the Northern Ireland Cancer Screening programme, please click here**
December 2023
The Northern Ireland Cervical Screening Programme introduced the Primary HPV testing pathway from Monday 11th December 2023.
Specimens provided from this date are tested for the presence of High risk HPV (HrHPV). Samples which test negative for HrHPV will not have cytology and these patients will be returned to routine recall.
If a sample tests positive for HrHPV then cytological examination is the next step to determine which samples contain abnormal cells. Individuals who test positive for HrHPV and for whom abnormal cells are detected will be directly referred to the Colposcopy Services to enable clinical assessment.
Primary HPV screening is a more sensitive first step test for use in cervical screening than traditional screening by primary cytology.
9th October 2023
Cervical Screening in the Southern Trust Laboratory
The Southern Health and Social Care Trust provides a Cervical Cytology Service as part of the Northern Ireland Cervical Screening Programme. In July 2022, senior laboratory staff notified the trust’s management team that they had concerns about performance in some steps of their laboratory’s screening system. To fully investigate these concerns, the trust commissioned the Royal College of Pathologists (RCPath Consulting) to undertake an independent assessment of its cervical screening services between 1 January 2008 and October 2021. As a precautionary measure, the trust is undertaking a precautionary review of the results of some patients who had cervical smears analysed by the trust during this time period. To find out more information on this issue, visit www.southerntrust.hscni.net.
Covid-19
Resumption of the Cervical Screening Programme following a temporary pause.
All invitations for the cervical cancer screening programme were paused from the week beginning 16 March 2020 as part of the HSC response to the COVID-19 pandemic.
The programme resumed in June 2020. Initially women who were at a higher risk of cervical changes were prioritised. This included women who required further investigation or who had a previously inadequate screening test.
Routine invitations resumed in August 2020, beginning with those women who were due their screening test in April 2020. Routine invites continue to be delayed until there is an opportunity to catch up.
For more information on Cervical Screening and Coronavirus, please click here.
Cervical Screening Programme
The aim of the Northern Ireland Cervical Screening Programme is to help prevent cervical cancer. The screening test or smear test detects early pre-cancerous changes in cells that line the cervix. Most changes are caused by persistent infection with high risk types of the human papillomavirus (HPV).
If high risk HPV is detected during screening, the sample will also be checked for abnormal cell changes under a microscope.
If abnormal cells are found, they can be treated so they do not get a chance to develop into cervical cancer.
Who is eligible for screening?
Screening is offered to all eligible women aged 25-49 every three years, and to women aged 50-64 every five years. Screening is intended for women who do not have symptoms. Women of any age who present to their GP with symptoms suggestive of a cervical abnormality (such as bleeding or pain) should be examined and referred for onward investigation as clinically appropriate.
How are Patients called for screening?
BSO provides the regional call and recall functions for the screening programme. This involves identifying those women who are eligible for cervical screening and issuing invitation letters, requesting women to make an appointment with their GP Practice to have their screening test. This information is generated from the Prior Notification List and so it is important that GP practices ensure patient information is correct and up to date.
How to manage patients who are symptomatic of cervical cancer?
Women of any age who present to their GP with symptoms suggestive of a cervical abnormality (such as bleeding or pain) should be examined and referred for onward investigation as clinically appropriate.
What if a person eligible for screening is undergoing gender re-assignment?
Those who were assigned female at birth, aged 25-64 and registered as female with their GP practice, will be routinely invited for cervical screening.
Those who are assigned female at birth, are aged 25 to 64 and registered as male with their GP Practice, will not be invited for cervical screening, however they may be screened as a self-referral at the request of his/her GP.
We recommend that anyone within screening age that has not had a total hysterectomy, and still has a cervix, should attend cervical screening. This is especially important if cell changes have been detected in the past.
Screening results
Screening results will be sent to the GP when the lab report is authorised.
All samples will have an HPV result, and samples that are found HPV positive will also have a cytology result. This may take on average up to 12 weeks, although we expect that HPV negative results will be issued much more rapidly.
In approximately 87% of cases the results will be negative for HPV. These women will be invited for screening again in 3 or 5 years’ time.
If high risk HPV is found, the sample will be checked for abnormal cells under a microscope. If no abnormal cell changes are found the patient will be invited for another test in 12 months’ time. If they continue to test positive for HPV for the duration of 3 annual cervical screening tests, they will be referred for colposcopy examination.
If the patient has high risk HPV and abnormal cell changes they will be referred to colposcopy directly.
In the instance there are not enough cells in the sample to get a reliable HPV result the patient will be asked to return for a repeat test in 3 months’ time.
Colposcopy
A colposcopy is a simple examination of the cervix using a colposcope (a type of magnifying glass), to visualise changes to the cervix and determine if treatment is required. A biopsy may also be taken from the surface of the affected area. The colposcopy and any biopsy results will show the type and extent of the cell changes on the cervix, determining if treatment is required. If the Colposcopy shows that treatment is required, this can usually be done by local anaesthetic. The patient will be offered another screening test 6 months after treatment has been provided, to ensure the procedure has been successful.
Audit of invasive cancer
Cervical screening reduces the risk of developing cervical cancer. Regular screening is the best way to find changes to the cervix early on. But, like other screening tests, it is not perfect. Screening cannot identify every single case of cancer or pre-cancer.
If a women develops invasive cervical cancer an audit is undertaken to review their screening pathway. The purpose of the audit is to monitor the overall effectiveness of the screening programme, to identify areas of learning and highlight areas where further improvements can be made.
It is the responsibility of the relevant Health and Social Care Trust to inform a woman diagnosed with an invasive cervical cancer that her screening history will be reviewed, and to offer appropriate feedback on the outcome of that review. For more information on the Cervical Cancer audit please refer to ‘Resources for health professionals’ section.
When should a woman be ceased from cervical screening?
Women aged over 64 are automatically ceased from recall, if the previous test was normal. A woman can be ceased from the programme prior to this for the following reasons:
- Absence of the cervix (following total hysterectomy)
- Informed choice
- Radiotherapy/stenosis of the cervix
In Northern Ireland, a woman will only be ceased from the cervical screening programme following notification from her GP. For more information on Ceasing please click here (insert hyperlink to Guidance for Primary Care document- in process of being updated)
If you require more information about the Northern Ireland Cervical Screening programme, please get in touch using the contact information below:
Public Health Agency
Young Person and Adult Screening Team
9th Floor, Linum Chambers
2 Bedford Square
Bedford Street
Belfast
Tel: 0300 555 0114
Email: screening.cervical@hscni.net