By Susan Donlon, Communications Team, National Screening Service
We were delighted to welcome our partners in cervical screening to our 2024 CervicalCheck conference in Limerick city recently.
Opening the conference, our CervicalCheck Programme Manager Gráinne Gleeson said this is the first time all partners across our cervical screening services have come together for a day of learning, discussion, collaboration and reflection - based on our theme ‘Fostering partnerships in cervical screening’ - and welcomed our partners from primary care services, colposcopy, histology laboratories, our two screening laboratories and our international guest speakers.
A standout moment, as the conference started, was the introduction of a new video featuring women sharing their experiences with CervicalCheck and what it means to them. Our screening participants are at the heart of our cervical screening programme, and highlighting their stories reassures us of the caring, compassionate services being provided by our partners.
CervicalCheck Clinical Director Professor Nóirín Russell demonstrated the impact of the CervicalCheck programme, presenting data from the first 3 years of primary HPV cervical screening in Ireland, and showing how cervical screening and treatment has reduced the incidence of cervical cancer. “Combined with HPV vaccination we will reduce it further”, Prof Russell said. “Ireland is on track to eliminate cervical cancer.”
Quality Assurance focus
We delved into the topic of quality assurance (QA) across the cervical screening pathway with our next panel of speakers presenting on their commitment to providing a high-quality service.
Advanced Nurse Practitioner Orla Loftus, a registered sample taker with CervicalCheck, discussed the key considerations for sample takers in delivering a high-quality service that prioritises patient care and safety. She highlighted CervicalCheck’s “user-friendly” cervical screening protocol and audit tool.
Randy Henderson, National Laboratory Operations Director - Cytology, Quest Diagnostics followed with insights on how lab operations are measured and monitored. He outlined the quality assurance processes that all cervical screening samples must go through and the quality systems framework for measuring and monitoring for continuous improvement. These processes, Randy said, are in line with regulatory requirements and National Screening Service quality requirements.
Colposcopist Dr Myra Fitzpatrick from the National Maternity Hospital in Dublin emphasised the importance of good governance, IT and data management, clinical standards and effective communication to maintain quality assurance in colposcopy. While adhering to QA standards, Dr Fitzpatrick said, we must also be realistic about the evolution of change in cervical screening. “Quality assurance,” she said, “is our best defence against disinformation and misinformation.”
Consultant Histopathologist and CervicalCheck Laboratory Clinical Advisor Dr Síne Phelan told us about the very human and manual process of the histology pathway, which is reliant on highly trained scientists. Robust QA measures are vital to monitor for continuous improvement and to maintain quality, she said, reminding us that “what we measure, we improve”.
It’s all about keeping standards high, and it’s all about making sure that the standards are consistent across the board, as Deputy Programme Manager Laura Tobin explained the fundamental role of the CervicalCheck programme in ensuring that every woman receives the same high-quality service, no matter where she is in Ireland.
Looking to the future
As the day progressed, newly appointed Clinical Director of the National Cervical Screening Laboratory, Dr Corinna Wright, presented on the future role of cytology in an HPV screening programme. With a drop in the percentage of cervical screening tests showing high-grade cell changes in young women, due to the effect of the HPV vaccination, Dr Wright discussed the potential for assessing risk in women with HPV infection by using genotyping – identifying the specific type of HPV to determine risk of disease progression.
Consultant Gynaecologist Professor Maggie Cruickshank, presenting on managing women with HPV in colposcopy, said that we need to develop more evidence on the complex balance needed between over-referral and over-treatment of women in colposcopy, versus the reassurance of ongoing colposcopy surveillance in women with persistent HPV.
Our Director of Public Health Dr Caroline Mason Mohan shared her thoughts on the future of HPV cervical screening, covering the impact of HPV vaccination and the potential role of HPV self-sampling.
Equity in Screening
Focusing on equity in cervical screening for our final session, Medical Oncologist Dr Carl Niamatali presented on HPV screening among indigenous women in the Amazon rainforest of Guyana in South America. Dr Niamatali explained the challenges of the lack of timely screening and inadequate treatment, leading to poor outcomes.
Gráinne Gleeson returned to the stage presenting on our work to improve equity in cervical screening – research, education, accessibility and communication. Gráinne encouraged our partners to work with us to improve equity in screening and to gain insight into why some people may not take part in cervical screening. With 40% of cervical cancers occurring in women who have never been screened, we must continue to tailor our resources to reach these women, she explained.
Equity in action at a rural general practice in Co. Mayo was the focus of Dr Carol Duffy’s presentation, highlighting the work being done to promote uptake of cervical screening among vulnerable and minority populations. The case studies presented demonstrated the powerful relationship between the patient and the practice nurse or GP.
Poster Presentations
There was a superb display of over 30 poster presentations at this year’s conference showcasing the work being carried out by our partners on quality improvement, partnerships and improving equity in screening.
Closing the conference, our Chief Executive Fiona Murphy thanked all our partners showing the ambition to always improve. “The next steps for cervical screening could go in many directions as evidence evolves. There’s lots to learn for the future. We are assured by the inputs provided by so many experts today to help guide us. Our cervical screening programme is in good hands.”
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Poster Winners
Congratulations to our poster presentation winners:
- Improving equity – Cervical screening onsite in Limerick prison
- Quality improvement – Methods to improve cervical screening uptake in a rural setting
- Partnership – Smoking, HPV and cervical cancer: a colposcopy clinic partnership project
Changes to screening programmes
Changes to population screening programmes in Ireland, must first be evaluated by the National Screening Advisory Committee. This independent committee makes recommendations to the Minister for Health and the Department of Health. When recommendations are accepted, we begin planning for implementation.