By Lynne Caffrey, NSS Communications
In December 2022 the National Cervical Screening Laboratory at The Coombe Hospital processed its first samples for the CervicalCheck programme. This significant step marked the end of the journey to build and equip the laboratory, and the beginning of the journey to establish it as not only the primary processor of the programme’s samples but also as a global centre of excellence.
The Coombe Hospital was identified as having the expertise and governance in place to run the service for CervicalCheck. The decision was therefore taken - in conjunction with the Board of The Coombe Hospital, the National Screening Service (which operates CervicalCheck) and the HSE - to redevelop the existing Coombe laboratory into a new purpose-built facility on the grounds of the Coombe Hospital site. The redevelopment was funded by the Department of Health.
Dr Cillian De Gascun, Interim Director of the NCSL believes the laboratory is unique as it is dedicated to cervical screening, housing all the elements of the screening test process under one roof.
“It’s a very exciting time and a very exciting opportunity,” Cillian said. “This laboratory is certainly the first of its kind in Ireland, and probably in Europe, to be dedicated to cervical screening.”
Samples coming into the lab are tested initially for the presence of high-risk HPV, if no HPV is found the result is returned to CervicalCheck which sends the result letter to the woman. If HPV is found the same sample is used to make a slide which is then looked at for abnormal cell changes by two medical scientists, specialising in cytology, under a microscope. If there are any potential differences in the opinions of the medical scientists, the sample is passed to a consultant cytopathologist who will examine the sample. The outcome of this determines whether CervicalCheck recalls the woman for further investigation in colposcopy or for another screening test in 12 months’ time.
Each stage of the testing process – from the sample arriving at the specimen reception to being examined by cytology and the result reported - will happen in NCSL. While the plan is that the laboratory will become the main processor of CervicalCheck samples, reaching that point will take time. The ongoing recruitment of dedicated NCSL staff including medical scientists, consultant pathologist and key support staff such as IT and admin, is a high priority.
Dr Aoife Doyle, Lead Pathologist, says: “This is an exciting work opportunity for any specialist who wants to come to Ireland, this is a unique opportunity in a purpose-built lab encompassing the screening arm with HPV testing and cytology, as well as the smaller diagnostic arm with histopathology. It’s a lab that’s very much wanted by the Irish public and by scientists in Ireland, but it’s not about doing it quickly, it’s about doing it correctly.”
Dr De Gascun, who will work in the laboratory part-time, combining the Director role with his current position as Director of the National Virus Reference Laboratory, adds: “I’m very committed to ensuring that HSE labs are in a position to provide a quality service and also, on a personal level, I’m very committed to screening. We want to ensure that the screening programme is successful and continues to be successful.
“Equally, I’m excited from the point of view of developing this specific skill set in Irish trainees and Irish consultants and to provide opportunity for employment here in Ireland. That I can help with that is a privilege.”
“It’s key that we don’t get caught up in the misnomer that this laboratory will be better than the US-based laboratories that currently process the bulk of our cervical screening tests. We all work to the same set of CervicalCheck quality assurance standards, so from a quality perspective, women in Ireland can be assured that the quality of service they are receiving from laboratory in the US is equivalent to the service they receive here. That being said, I am very strongly of the opinion that we should be self-sufficient at NCSL, that eventually we should have capacity to deliver the service. We will always need a contingency, because obviously we saw what happened with the two cyberattacks that affected The Coombe Hospital last year.
“Seeing the first samples being processed in December since the cyberattacks was a real milestone - it’s great to see the staff here getting back to doing what they enjoy doing.”
Read more about the development of the National Cervical Screening Laboratory here