CERVICALCHECK IS REASSURING women that people are not automatically removed from its register, after it emerged that hundreds of women in Scotland who had undergone hysterectomies were removed from a register for cervical cancer screening.

Around 430 women who had hysterectomies were wrongly excluded from cervical cancer screening over the last 24 years. It’s claimed that a “small number” of these women later developed cervical cancer – and one of these women has since died.

While most patients undergoing a hysterectomy have their uterus and cervix removed completely, some women have what’s clinically referred to as a ‘subtotal’ hysterectomy, where part of the cervix remains, and these women usually still need to be screened for cervical cancer.

It’s important to note that Ireland does not automatically remove anyone from the CervicalCheck screening register, unlike Scotland’s system.

Despite this, CervicalCheck Clinical Director Dr Nóirín Russell told The Journal that this could be an emotional story for women in Ireland to hear about, and that the programme wants to help reassure women.

“Any screening incident could be sensitive for women,” she said, adding that women can check the CervicalCheck register if they want assurances that they are in the system for cervical cancer screening.

Ireland’s different system

Anyone who wishes to be removed from the cervical screening register in Ireland – for example, women who have undergone hysterectomies – must get in touch with the programme to request it.

“We continue to invite people for screening post-hysterectomy, unless we receive confirmation from the participant, in consultation with their GP or hospital doctor, that screening is not required,” the CervicalCheck programme said.

As a precaution, CervicalCheck said that it has paused any pending requests made by women who have undergone a hysterectomy to be removed from the register.

Scotland’s case

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Scotland’s Public and Women’s Health Minister Maree Todd said today that an audit by an NHS board in December 2020 “discovered a very small number of women had developed cervical cancer after being wrongly excluded from the screening programme following a hysterectomy”.

“These exclusions from the cervical screening programme should not have happened and I want to apologise to all those affected by this error,” she told Holyrood.

Todd said four potential points of error had been identified, including a mismatch between operations proposed and operations carried out.

The women affected are to be offered fast-tracked appointments with GP practices or gynaecology services following an urgent review of their cases.

 There are 220 women in the 25-65 age range for cervical screening who were excluded in error, and Todd said they would be written to, “to apologise, to explain the situation and to offer personalised advice”.

There area further 149 women whose health records are unclear whether they had a full hysterectomy, and they will be offered a gynaecological appointment, and screening if this is found to be appropriate.

Similar letters will be sent to 65 women who were incorrectly removed from the screening programme but who are now outside of its age range.

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HSE to review ‘as a precaution’

Despite the different systems, the HSE has said that as a precaution it is examining the Scottish review to “continue to evaluate best practice” and consider any potential improvements to the quality and safety of the process.

CervicalCheck has said that women who have undergone a hysterectomy and may be concerned when reading the Scottish screening story, can get in touch with them:

• CervicalCheck’s Freephone line: 1800 45 45 55 or contact: info@cervicalcheck.ie
• Information about hysterectomies and screening will be uploaded to CervicalCheck’s website
• An FAQ for GPs and healthcare professionals to help answer questions women may have is also being prepared.

Dr Nóirín Russell, Clinical Director of CervicalCheck, said that it was “important to recognise that even though this is in a different country, that it will be very emotional for women in Ireland.” 

The only way a woman is removed from the register here, she said, is via an opt out form via a GP or hospital doctor – but this doesn’t change the fact that cervical cancer is “a very emotional disease”. 

We realise that this story may lead to anxiety among women here, and we want to be there to allay those fears as much as we can. Women can check the register themselves to see if they’re on the register – by putting your PPSN in and seeing ‘Great, I’m on the register’ - which means you get invited for screening.

• You can check if you’re on the CervicalCheck register here.

Dr Russell said that vaginal hysterectomies and total hysterectomies usually do not require screening, so it’s only if you’ve had a subtotal hysterectomy, and your cervix remains, that you’ll need to continue screening.

“We had a face-to-face meeting with the CervicalCheck team specifically to brief them on the incident. A lot of the team found the events of 2018 very upsetting – they had a lot of questions and concerns and they were assured that the processes were different in Ireland.”

CEO of the National Screening Service Fiona Murphy, and Chief Clinical Officer Dr Colm Henry, have been in touch with the public health teams in Scotland; Russell said it is hoped that in the next couple of weeks they will be able to discuss the issue with their Scottish counterparts. 

CervicalCheck officials met earlier today with members of the 221 Plus Patient Support Group, the Irish Cancer Society, the Marie Keating Foundation and members of Patient and Public Partnership committee.

With reporting from the Press Association.