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The cervical screening (smear test) programme is changing.
Starting in Wales, and followed by the rest of the UK over the coming years, cervical screening samples will first be tested for the presence of strains of high-risk HPV. HPV is the cause of almost all cervical cancers and if an infection is found, further tests will look at whether the infection has caused abnormal cells to develop. This testing method is far more effective at identifying those at greater risk of cervical cancer, meaning that not only will it save diagnoses, it will save lives.
Any change to a national programme will naturally bring challenges and some disruption. New testing methods mean new equipment, laboratory set ups and procedures. Changes to the workforce are sadly unavoidable and with HPV testing there will be less need for cytoscreeners, the experts who currently look at samples.
In England we still have 16 months until the new programme is fully rolled out across the country and the existing programme cannot function without a workforce. However members of this vital community are leaving the profession due to uncertainty over their future employment, resulting in a reduced workforce dealing with an increasing backlog of work. As a result, we are getting more and more women are coming to us worried that they still don’t have their results and feeling frustrated. In some areas the expected two week wait is greatly increased, this includes Cambridgeshire, Essex, Kent and Hull, in a few areas it is even up to 16 weeks. For women who are already feeling worried, four months is a very long time.
The clinical risk of delays is very small as cervical cancer takes a long time to develop. However the psychological impact cannot be understated. Our support services are testament to the stress that many women are feeling having to wait months for a result at an already anxious time.
I am worried that confidence in the screening programme might be affected and women could delay attending or be put off their next test in 3 or 5 years because of their experience, preferring to avoid the anxiety. With attendance in England at a 20 year low and cervical cancer incidence rising, quite simply this would be a disaster.
Increasing attendance must be our ongoing priority yet this issue could act as a disincentive for local and national activity and undo some of the successes that campaigning and policy work is achieving.
Our laboratories should not just be able to deal with current demand, they should also be equipped to deal with increased demand. There is a target of 80% coverage of cervical screening across the country but most areas are below this target, some as low as just 60%. If every area was closer to meeting their targets, our laboratories would simply not be able to cope and that should not be the case.
The process of laboratories converting to HPV primary testing will contribute to the current backlog in the short term. Time out for training and configuration of the new programme will eat into valuable testing time, this is also unavoidable but comes as no surprise. The implementation of HPV Primary testing has been anticipated for years being clearly set out in the 2015-20 Cancer Strategy for England, thus plans were afoot years before then. To me the current situation shows something has clearly gone wrong in how this has been managed.
We know not every part of the country is affected and there is activity to reduce the backlog in impacted areas with recent announcements setting out plans to tackle this. However there is a long way to go until the situation is rectified and without sustained action from NHS England and Public Health England, the situation could get worse.
For women in affected areas, it is important that clear communication is provided so that they know how long the wait might be.
If you’re currently waiting for results or due to have your test, then understandably you might be concerned. We hope the below might help:
Categories: cervical screening