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CervicalCheck Audit 2018

Report on the Data Validation Project for the 221 Women Impacted by the Cervical Screening Crisis 

The HSE has published the report on the Data Validation Project for the 221 Women Impacted by the Cervical Screening Crisis.

The purpose of the project was to produce a summary report on the 221 women and their families impacted by the cervical screening crisis.

The intention of this report was to answer two questions that were frequently asked about the 221 women:

  1. what their current state of health is
  2. what resources might be needed to address their ongoing problems

This report does not provide an individual report on each of the 221 women. It is not an audit or a clinical review.

A clinical review is currently being undertaken by the Royal College of Obstetricians and Gynaecologists (known as the RCOG review).

This report does not provide any opinion on the CervicalCheck audit as this was reported upon in the ‘Scoping Inquiry into the CervicalCheck Screening Programme’ by Dr. Gabriel Scally (September 2018).

Whilst the report aims to provide an overall picture of the group of women, it has some data limitations where it was not possible to gather all data. For example, the HSE is not authorized to access data on women who had private healthcare.

Read the report on the Data Validation Project for the 221 Women Impacted by the Cervical Screening Crisis 

Implementation plan for Scally recommendations

The HSE has welcomed the publication of the Implementation Plan for the Scoping Inquiry by Dr Gabriel Scally.

The plan sets out how all 56 of Dr Scally's recommendations will be put in place.

It was published on 11 December 2018.

You can read the Implementation Plan for the Scoping Inquiry on the Department of Health’s website.

You can read more about the HSE Implementation Oversight Group and our progress to date here.

Free repeat smear tests ended on 31 December 2018

Free GP consultations and repeat smear tests for women concerned about their previous test results ended on the 31st December 2018.

These additional services had been available since April 2018.

The Minister for Health had previously announced that any woman with concerns about her cervical screening could have a free consultation, and if necessary, a free repeat smear test with any GP registered with CervicalCheck.

This has now ended as scheduled on the 31st December 2018.

We sent information to GPs to remind them of the end date.

Cervical screening will not prevent all cases of cervical cancer. But it is still one of the most effective ways of preventing cervical cancer. This is why having regular screening tests is important.

If you are aged between 25 and 60, you should still attend your free routine smear test when it is due.

Check when your next smear test is due.

If you have concerns or symptoms at any time, you should contact your GP.

Find out more about the symptoms of cervical cancer.

Scoping Inquiry Report

The HSE welcomed the publication of the final report of the Scoping Inquiry by Dr Gabriel Scally and his team. We would like to acknowledge the focus and commitment of Dr Scally and his team and the patient-centred approach that they have taken in this regard.

We are re-iterating our deepest apology to all those women and those families affected.   At the centre of this issue was our failure to communicate with the women who were the subject of the audit.  As Dr Scally noted, and with which we agree, these women should have been informed.   The impact of this failure has been profound both for every single woman and all family members affected.   We further accept that the manner in which women were told was inconsistent and in many instances ill-judged and poorly handled.

The priority for the HSE over the past number of months has been to support the women and families involved and continue to stabilise the cervical screening programme.  Designated liaison officers throughout the country are in ongoing contact with the women and families directly affected.

We welcome confirmation by Dr Scally that the current laboratories have and continue to provide services in a quality assured manner.

We are now working to implement all 50 recommendations and are continuing to thoroughly examine the findings.

Independent Expert Panel Review

An independent Expert Panel Review has been set up by the Minister for Health. The Royal College of Obstetricians and Gynaecologists (RCOG) is leading this Expert Panel Review. The British Society for Colposcopy and Cervical Pathology are also providing input. The review will take at least 6 months to complete. You can read more about the purpose of the review and the consent process here.

A CervicalCheck Steering Committee is in place to provide oversight and assurance on the implementation of key decisions taken by Government in relation to CervicalCheck. Weekly reports from the CervicalCheck Steering Committee are available here.

We continue to update this website with key information regarding the CervicalCheck audit for women and healthcare professionals. If your question is not answered by the information below, you can email us at info@cervicalcheck.ie or make a request for a call back here. You can also call us on Freephone 1800 45 45 55 (+353 21 4217612 from outside Ireland).

Here we have information which may answer some of your questions:

What has happened to date

We carried out an audit of women who had been diagnosed with cervical cancer over the last 10 years. The audit happened after their cancer was diagnosed and the purpose was to evaluate the quality of the screening programme.

Not all of these women were told about the audit. The audit found that 221 women could have got a different result from their screening test (smear test).

It also found that each woman could have been advised to have an earlier follow-up. They could have had a repeat screening test or a colpsocopy.

We did not withhold information that delayed a diagnosis of cancer for any woman.

It is clear that there has been a very serious breakdown in communicating to the women concerned. They should have been told that this audit was happening and of the outcomes of the audit, but in many cases they were not. 

You can find out more information about the audit in this statement.

Smear test result delays

Due to increased demand for repeat cervical screening tests (smear tests), there is a delay in providing results. This is for both repeat and routine smear tests.

In the past, you would get your smear test result within 4-6 weeks of your test.

Currently, results are taking an average of 93 days from the time you had your test. In some cases, results are taking up to 27 weeks. 

We are sorry for this delay. We are working to reduce these waiting times.

We will write you a letter to let you know when your results are available.

If you are waiting for your smear test result, you may get a reminder letter for your next routine smear test before your results letter arrives. You should wait for your results letter to find out what to do next.

We also recommend you check our online register to make sure your contact details are up-to-date when results do become available.

Expired samples — April to June 2018

When processing smear tests, laboratories must transfer smear test samples to slides within 6 weeks.

If they do not transfer the test to a slide, the sample can become expired. This does not mean that the test is processed within 6 weeks. It can be processed any time after that, once it is on a slide.

During the period April to June 2018, due to increased demand for repeat smear tests, this timeline was not met in a small number of cases. These samples expired.

We wrote to women affected by this and their GPs. We recommended they attend another smear test in 3 months. You need to wait 3 months so that the cells in the cervix have time to grow back and we can get the best samples.

As of 30 July 2018, all smear test samples are transferred to slides within the 6-week timeframe and we are closely monitoring this.

Remember that smear tests are not diagnostic and no screening test is perfect.

If you have any concerns or symptoms, you should visit your GP without delay. 

Symptoms may include unexplained vaginal bleeding, bleeding after sex, unusual discharge or pelvic pain.

If you have had a smear test within the last 3 months

If you have had a recent cervical screening you must wait at least 3 months before being tested again. This is to allow cells to grow back and to get the best samples. If you want to know your most recent smear test results, your GP will be able to give you this information.

If you have normal smear test results

Women who have had normal screening results do not need a repeat smear test.

If you are concerned or are experiencing any symptoms you should talk to your GP. 

When to see your GP

If you have symptoms

Smear tests are for women who do not have symptoms. Visit your GP if you are experiencing any of the following symptoms:

  • a pain in your pelvis (anywhere between your
    bellybutton and the tops of your thighs)
  • irregular vaginal bleeding
  • bleeding between periods
  • vaginal spotting or discharge
  • pain during sex
  • bleeding after sex.

If you have cervical cancer

You may have been included in this audit if you have been diagnosed with cervical cancer since 2008.

If you have queries about your case, you can talk to your oncology clinic or team.

You can also call the CervicalCheck Freephone line 1800 45 45 55. We will arrange for a callback to let you know if you are affected.

Colposcopy patients

If you are currently in the care of colposcopy, discuss your screening needs with your colposcopist or hospital doctor.

Hysterectomy patients

If you have had a radical hysterectomy, you do not need to get a smear test.

If you have had a partial hysterectomy, you should get a smear test.

Register for a smear test here.

Your GP can tell you what type of hysterectomy you have had and whether you need a smear test.

Visit your GP if you are concerned or experiencing any of the following symptoms:

  • a pain in your pelvis (anywhere between your
    bellybutton and the tops of your thighs)
  • irregular vaginal bleeding
  • bleeding between periods
  • vaginal spotting or discharge
  • pain during sex
  • bleeding after sex.

Pregnancy and smear tests

If you are pregnant and are due a smear test, you should delay having it until 3 months after you give birth. You can call the CervicalCheck freephone number to defer your routine smear test.

If your last result was not normal and you are pregnant, the result will not affect your pregnancy. If you are due to have a repeat smear test you should discuss this with your GP or nurse.

If you are due to attend colposcopy, you should attend your appointment. You can discuss this with your GP or nurse.

A not normal smear test result has no effect on your pregnancy. You may have slight bleeding after having a smear test in pregnancy. A smear test will not increase the risk of miscarriage.

Scheduled smear tests

If you already are due a smear test, you should still attend it as planned.

Regular cervical screening is one of the best ways to reduce your risk of cervical cancer. It is very important to attend and keep up to date with your tests. You can check exactly when your next free cervical screening is due here.

Reliability of screening

All women should avail of routine smear checks to protect their health.

We know that cervical screening in Ireland is safe and effective. Over 3 million smear tests have been carried out in Ireland since 2008. Over 50,000 cases of pre-cancer and cancer have been detected and treated.

But screening has its limitations. Read about the benefits and limitations of cervical screening.

This is why you should always attend your cervical screening test when it's due.

The labs we use

Tests are sent to one of three laboratories. Two of them are in Ireland - MedLab Pathology Ltd, Dublin and the Coombe Women and Infant’s Hospital, Dublin. One of them is in the US - Quest Diagnostics Inc, Teterboro, New Jersey, USA.

We are assured that all the labs we use are operating to the required standard. They are certified by the relevant national authorities. All three labs meet our quality assurance standards.

Two experts examine every test.

We have published data from the 3 labs we currently use on the HSE website. This shows that these labs are performing as they should compared to international norms, and to each other.

Why we use a lab in the US

There are not enough quality-assured labs available in Ireland to meet the need of the screening programme.

New HPV test

Our current smear tests examine a sample of the cells on the cervix under a microscope. Two different people check for any abnormalities that can be seen.

In 2019 we are moving to a new type of smear test, where we will also test for the presence of HPV virus. This will be more accurate than the current smear test. HPV is a sexually transmitted infection that is extremely common.

Getting the HPV vaccine and attending for smear tests when called are the best ways to protect women and girls against cervical cancer.

This new screening process will be the same for you. You will visit your smear-taker, and the sample will be collected in the same way. The testing for HPV will offer an additional level of accuracy and reassurance.

Open disclosure (sharing information)

We will communicate with you in an open, honest, timely and transparent manner if:

  • something goes wrong with your care
  • you experience harm as a result of your care
  • we think that harm may have occurred

This means that we will keep you fully informed of the facts and details related to your participation in the cervical screening programme.

You can also access your screening records. Read how to access your cervical screening records.

How to contact us to arrange a telephone consultation

Around 5,000 telephone consultations with a health professional have now taken place

To arrange a callback, you can either:

or

  • call us on Freephone 1800 45 45 55 (+353 21 4217612 if calling from outside Ireland) and an advisor will take your details. This helpline is open from Monday to Sunday, 9 am to 6 pm.

If you have already spoken to an operator or emailed us your details have been recorded and we will call you back as soon as possible.

Other information

CervicalCheck daily reports can be found here

Information for healthcare professionals from CervicalCheck can be found here

Check when your next smear test is due