**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**
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 prevent cervical cancer from developing. This is achieved by detecting early changes in cervical cells that have the potential to develop into cancer if left untreated. While the programme succeeds in detecting a small number of cancers each year its main role is in detecting precancerous changes.
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
When cell changes that require further investigation have been detected, an abnormal result is issued. These may be severe/moderate changes or mild/borderline changes. All women with high grade changes are referred for colposcopy. Those with low grade changes are triaged, with a test for high risk human papilloma virus (hr-HPV) carried out on the sample. Depending on the outcome of the hr-HPV test, the woman may be referred to colposcopy or returned to routine recall.
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