Over a period of 13 years, the screening performance at the Southern Trust has fallen below operating standards, with actionable measures falling short up until a recent independent review by RCPath (Royal College of Pathologist) Consulting. The report published by the College has highlighted the effects of a lack of specialized staff and improperly monitored performance on the reliability of some 4.1% of the samples evaluated during the review period. (HSC, 2023) This has generated a massive backlog that has almost doubled the expected wait time (~12 weeks) for cytological screening results. According to BBC News NI, ~40% of women in the Southern Trust specifically have been waiting more than 3 months for their test results.
Prior to March 2023, the predominant system for cervical screening in Northern Ireland (NI) was based on cytology screening. Women ages 25 and 64 are typically invited for testing every 3-5 years. The test assesses the health of the cervix by collecting cervical cells and looking for any abnormalities in the samples. Northern Ireland as a whole is in a transitional period of implementing an HPV primary screening system, which is generally accepted as the ideal standard of care for preventative cervical cancer screening programmes in England, Scotland and Wales. Because 99.8% of cervical cancers are associated with high-risk HPV infection, performing HPV testing in the primary instance aids in sample prioritization and eliminates social challenges associated with attending a smear test.
It is expected that primary HPV testing will be implemented in full in NI by December, but the Department of Health is adamant that the cervical screening programme ‘remains highly effective overall’ (Department of Health, 2023). In contrast, it is important to note that the call for investigation was prompted by concerns raised by internal staff at the Trust, with the final RCPath report highlighting severe cases of underperformance and poor quality control mechanisms of action by management for more than a decade. The general sentiment from the Southern Trust has been that the RCPath review is a precautionary measure to address a low risk of false negatives during the 2008 – 2021 period. However, the published review does note that “a significant number” of negative results would have been incorrect, a potentially devastating scenario for those women affected. It was only in 2019 that a 45-year-old woman under the care of NI’s Southern and Western health trusts had to undergo a radical hysterectomy- surgical removal of most of the cervix including the uterus and parts of the vagina- after three of her abnormal smear tests were missed over 10 years (Connolly and Smyth, 2023).
Despite having undertaken the recommendations set forth by the RCPath report and issuing an apology to anxiously waiting patients, the reality of the situation reflects a poorly regulated and governed system that demonstrates poor investment in women's healthcare. There have been recent calls from charities and grassroots organizations within Northern Ireland advocating for the implementation of an official Women's Health Strategy, focused on research, development and funding related to a range of girls' and women's health issues. Scotland was the first in the UK to establish such a strategy in 2021, followed by England and Wales attempting to follow suit. Institute of Biomedical Science (IBMS) Vice President, Allan Wilson, has commented on the vitality of implementing regular competency assessment and quality control measures to optimize patient safety. (IMBS, 2023) It remains that 99.8% of cervical cancers are preventable, and greater strides should be made to ensure that patient safety is not impeded by poor standards of practice.
10zyme is leading The Prevention Revolution and working to make cervical screening and results reliable, easy and timely. We intend to democratise women’s healthcare on a global scale-giving control back to anyone with a cervix. Follow us for news and updates on our social channels, LinkedIn, Facebook, Instagram, Twitter and TikTok.
Connolly, M.-L. and Smyth, C. 2023. Cervical cancer: Health trusts miss abnormal cells in smear tests. BBC News. [Online]. [Accessed 19 October 2023]. Available from: https://www.bbc.co.uk/news/uk-northern-ireland-64373964.
Department of Health 2023. Northern Ireland cervical screening programme. Department of Health. [Online]. [Accessed 19 October 2023]. Available from: https://www.health-ni.gov.uk/news/northern-ireland-cervical-screening-programme#:~:text=We%20would%20assure%20women%20that.
HSC 2023. Cervical Screening Review. Southern Health and Social Care Trust. [Online]. [Accessed 19 October 2023]. Available from: https://southerntrust.hscni.net/news/cervical-screening-review/.
IMBS 2023. IBMS Response: NI Smear Test Review. Institute of Biomedical Science. [Online]. [Accessed 19 October 2023]. Available from: https://www.ibms.org/resources/news/ibms-response-ni-smear-test-review/?mc_cid=4258f2de81&mc_eid=f2a175083c.