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Goal to make cervical cancer ‘a rare illness’

EchoLive.ie, 28 Jan

Director of CervicalCheck, Dr Nóirín Russell, speaks to Darragh

Bermingham about the programme’s aim to eliminate cervical cancer as a

public health issue in Ireland

Speaking to The Echo, CervicalCheck director Dr Nóirín Russell said she

is proud of the work CervicalCheck did in 2022 in terms of screening

take-up, making it more accessible and test result turnaround times.

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Darragh Bermingham

AROUND 255,000 women attended for cervical screening in 2022, while the

CervicalCheck service has caught up on its backlog from Covid-19 and is

returning test results within four weeks in 95% of cases.

Speaking to The Echo, CervicalCheck director Dr Nóirín Russell said she

is proud of the work CervicalCheck did in 2022 in terms of screening

take-up, making it more accessible and test result turnaround times.

She also discussed plans to introduce a patient-requested review

programme this year, and to continue to work towards the elimination of

cervical cancer in Ireland.

The latest CervicalCheck figures show that 255,000 women attended for

screening in 2022 - 80% of those invited for screening appointments.

Some 13% of those screened tested positive for HPV and around half of

these women (15,000) had abnormal cells in addition to a HPV infection,

and were referred for colposcopy.

An additional 6,000 women were referred to colposcopy as they had two

positive HPV tests even though their cells did not show any

abnormality.

Every year, 12,500 women have a treatment performed for abnormal cells.

Most of them never go on to develop cervical cancer because of this

early intervention.

Meanwhile, 80% of women who had cervical cancer detected at screening

had their cancer detected at the earliest possible stage, allowing for

timely treatment.

“While we are happy with the attendance levels, we will be working this

year on that other 20% and to better understand and address the

barriers that might be there for those who don’t attend,” said Dr

Russell.

The introduction of HPV testing in 2020 has widened the cohort eligible

to attend to include those aged up to 65, and Dr Russell highlighted

the importance of women over 50 to continue to attend for screening,

even if they are postmenopausal.

To reach women who may not be aware of the screening service,

CervicalCheck worked with Translate Ireland in 2022 to develop

multilingual, informational videos featuring healthcare workers

discussing what cervical screening is and why people should attend.

CervicalCheck also worked with LINC, a community resource centre for

lesbians and bisexual women and their families in Cork and beyond, on a

survey to identify and address barriers to screening for this cohort.

“While many reported positive experiences of cervical screening, only

66.5% said they attended cervical screening regularly, which compares

to 80% up-take by the general population,” revealed Dr Russell.

“It’s important for people to know that anyone who has had sexual

contact of any type, it doesn’t have to be penetrative, should attend

for screening,” explained Dr Russell.

Dr Russell also encouraged those eligible for cervical screening to

make sure that their address on the CervicalCheck register is correct,

to ensure that screening invitations are reaching them.

“We know that if you attend for screening, you’re 19 times less likely

to get cervical cancer than women who don’t attend,” she said,

highlighting the benefits of screening.

“You’re also 36 times less likely to die from cervical cancer if you

attend for screening.

“It doesn’t mean that it might never happen to you but it does make it

a lot less likely if you attend for screening.”

The Covid-19 pandemic and cyber attack on the HSE in May 2021 left many

health services facing a backlog of appointments.

While CervicalCheck was among those facing a backlog of appointments

and delays in issuing test results, Dr Russell revealed the service has

now caught up completely, and is offering timely appointments and

results.

Women are being offered a screening appointment when they are due, and

95% of women attending for screening are getting their result within

four weeks.

Meanwhile, those referred to colposcopy services are being seen within

four weeks if their scans are deemed high grade, and within eight weeks

if their scans are deemed low grade.

“It’s really, really reassuring to see the high numbers of attendance

and to be able to get the results back quickly for people because we

know it was stressful for those who had to endure delays,” said Dr

Russell.

“It was also great to see the positive commentary from Dr Scally’s

final report in which he said women can have confidence in the cervical

screening programme.”

The National Cervical Screening Laboratory (NCSL) officially opened in

Dublin in December 2022.

“The building is phenomenal and now it’s just about building up the

numbers of staff in it,” Dr Russell explained.

“I think there are shortages of staff in every area. We’re building up

a cervical screening expertise in a country that country that hasn’t

been training specialists in this area.

“It takes a while to grow that expertise and training that takes a bit

of time.”

Looking to the future, Dr Russell explained that CervicalCheck is

working to eliminate cervical cancer in Ireland.

“Ireland is committing to the World Health Organisation’s target of

eliminating cervical cancer - what that means is making cervical cancer

a rare illness,” she said.

“It’s about eliminating it as a public health issue and that means

making it so rare that less than four women in every 100,000 actually

get cervical cancer.

“At the moment in Ireland, around 11 in every 100,000 get the disease

and we want to get that down to less than four,” Dr Russell added.

“We know that elimination is possible if we get 90% of girls vaccinated

for HPV, 70% of women get two screening tests by age 45, and if 90% of

women who have precancerous cells or early cancer receive timely

treatment.

“Cervical cancer is such a devastating disease and we’ve seen,

particularly over the last couple of years, the pain and heartache it

can cause,” Dr Russell stated further.

“The idea of making that so rare that it impacts less than four women

in 100,000 is incredible.”

Dr Russell praised the late Laura Brennan and her family for the impact

they have had on HPV vaccine uptake in Ireland.

“The extension of the programme, making it available to those who

previously missed out, and the impact Laura and her family have had in

raising awareness of the vaccine, which is really going to be the game

changer in allowing us to eliminate cervical cancer, has been amazing.

“We in healthcare are indebted to the Brennan family - their advocacy

has changed the whole country’s attitude towards the HPV vaccine and I

think they’re an incredible group of people.”

CervicalCheck will launch a patient-requested review programme in 2023,

providing those who do get cervical cancer and have attended for

screening with the opportunity to have their history reviewed.

“It’s completely understandable that, following a cancer diagnosis,

people might have questions and seek answers,” said Dr Russell, who

added that CervicalCheck is working to reduce the harms associated with

screening.

“It’s not without harms and that is something we’re aware of - false

positives and false negatives can impact people.

“To reassure people, we’re working really hard to minimise those harms.

“We’re examining the population and examining whether or not we’re

detecting as many high grade scans as we should be, based on those

population figures,” she explained.

“We’re also constantly working on our turnaround times and ensuring

that the labs we are working with are working to the highest possible

standards.

“We’re determined to be open and honest with people in that screening

is a risk reduction tool - it might detect your cancer and, in some

cases, it might not,” she added.

“It’s so important that people attend to ensure that risk is reduced,

along with taking other measures such as maintaining a healthy

lifestyle, exercising, not smoking.

“It’s also so important that, if women have any worrying symptoms, they

talk to their doctor even if they were recently screened.”

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