A REPORT ON Ireland’s cervical cancer screening programme has indicated that the coverage of the population eligible for screening has continued to dip slightly since 2017.

The target for population coverage for the free cervical screening programme is 80%, which was reached in 2017 for the first time, and has dipped to 78.7% in 2020.

This is despite a record 318,000 women being screened last year, and an additional 100,000 smears offered to women in 2018 who had already been adequately screened – who were offered additional smear tests in an attempt to reassure them that they can have confidence in their smear test results in the wake of the 2018 controversy.

Although the overall smear figure would suggest an increase in population coverage, the decline in population coverage suggests that some adequately screened women are attending more often, and a certain amount of women who are due to be screened are no longer attending for cervical cancer screening.

The HSE said that coverage is the proportion of unique women who have had at least one satisfactory screening test taken within the defined screening interval, expressed as a percentage of the total number of eligible women in the population.

Population coverage is measured over a five-year period in order to cover the recommended intervals between screening periods. It was at 74.7% for the first five years of the programme.

The World Health Organization includes the participation rate, or the proportion of people screened of those who were invited; and examination coverage, or the proportion of individuals of the eligible population screened as two of four key ways to measure the effectiveness of a cancer screening programme.

CervicalCheck report CervicalCheck report

Almost all of public health expert Dr Gabriel Scally’s 170 recommendations to fix the CervicalCheck programme have now been implemented, with just four issues left ‘in progress’, following the revelation in 2018 that 221 women who developed cervical cancer were not informed of audits carried out on their cervical smear tests, nor the results of those audits.

There are around 336 legal cases lodged with the State Claims Agency relating to the CervicalCheck programme as part of the fallout from the controversy, with 19 cases lodged with the non-adversarial CervicalCheck Tribunal, set up by the Government.

Today’s report, published by the National Screening Service which runs Ireland’s four screening programmes, notes that since CervicalCheck began in 2008 it has reduced the incidence of cervical cancer in Ireland by 2.8% each year.

It also found that the five-year screening coverage varies greatly by county.

CervicalCheck report CervicalCheck report

Carlow, Westmeath, Louth, Waterford and Wicklow have met the 80% coverage target consistently.

In the 2019-20 period, the majority of the remaining counties have over 75% coverage.

Four counties Clare, Dublin, Monaghan, Roscommon have a coverage rate between 70-75%, whereas Kilkenny and Laois have a coverage rate under 70% in 2018-2019 and 2019-2020.

The report notes that while the coverage has been “high and either steady or increasing in the younger age groups, there is a fall-off in coverage in women over 50 years of
age”.

CervicalCheck has planned targetted messaging for women aged over 50 and members of the LGBT+ community, as well as people who don’t speak English fluently, in order to encourage them to attend screening. 

Despite CervicalCheck’s target of 90% of all results letters to be sent out to women within 4 weeks of the test sample being taken, just 27% of all results letters are sent within that timeframe from 2019-2020. In 2018-2019, just 3.6% met the target.
27.3% are sent out within 6 weeks, and 28.3% are sent within 4-5 weeks. 

For laboratory targets, 40% of all cervical smear samples are tested by laboratories within CervicalCheck’s target of 10 working days for the period of September 2019 – March 2020.

This is up from 5.6% from September 2018 – March 2020, but down from 80% and 88% in the two previous 12-month period.

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Targeted messaging planned to encourage LGBT+ community to attend cervical screening

CervicalCheck report CervicalCheck report

The referral rates for those who have a positive smear result for the periods 2017-18; 2018-19 and 2019-31 March 2020 are 4.6%, 5.7% and 5.6% respectively.

Since 2008, 64,110 cases of high-grade pre-cancerous cells (CIN2 and CIN3) and 60,650 cases of low-grade pre-cancerous cells (CIN1) have been identified through CervicalCheck.

“Many of these women could have developed cervical cancer if the abnormalities were not detected and treated via cervical screening,” the HSE said.

“In the absence of screening, cervical cancer would not have been detected in these people until they developed physical signs or symptoms of disease.”

In the same period, 1,786 cases of asymptomatic cancer have been detected by the CervicalCheck programme. 

40% of all cervical cancers are diagnosed in women who have never had a screening test.

CervicalCheck report CervicalCheck report

CervicalCheck Clinical Director Dr Nóirín Russell, who took up the role in August 2020, said the data in the report provides “a detailed picture of this period in the history of cervical screening in Ireland”.

It is my aim that the further study of this data – both within our programme and internationally – will aid learning now, and in the future.

National Screening Service Chief Executive Fiona Murphy said that the report notes “the standards met by the programme”.

“Since CervicalCheck began in 2008, more than over 120,000 women have received treatments for cell changes that might have progressed to cancer if left untreated. In addition, 1,700 women have had a cervical cancer detected and treated over the lifetime of the programme.”

You can access the report here.