There has been a lot of media interest in the last few days on the changes happening in the cervical screening programme (CSP) in England, and the impact on women who attend for screening. The CSP in England, like that across the whole of the UK and many other countries worldwide, is in transition as to the test used within the programme. Historically the CSP relied solely on the examination of cells on a glass slide under a microscope, with certain types of abnormality having a second test for the virus (HPV) that causes the vast majority, if not all, of cervical cancers.
By the end of this year, this will change to a system whereby the virus infection is looked for first, and cells will only be examined down the microscope if the test for HPV is positive. This change of delivery, which all professional bodies fully support, means that the number of laboratories reporting samples from over 3,000,000 women annually in England will fall from 49 to 9. This change is currently undergoing a tendering and evaluation process, led by NHS England (NHSE) and advised by Public Health England (PHSE). This process is obviously causing many issues for laboratories in retaining and recruiting staff, with many looking at other posts or possible careers. This is causing major problems for laboratories in delivering the expected results to women within the NHSE target of 14 days.
Many laboratories have significant backlogs of samples. and this is putting significant pressure on laboratory staff who are trying hard to meet the 14 day target and maintain quality standards when faced with backlogs of thousands of slides and falling staffing levels in the lab. Cytology staff have a long history of delivering a high-quality service and reporting samples as soon as possible and the failure of the lab service to meet the target is putting additional stress on an already beleaguered laboratory service.
It is on the background of these changes that recent campaigns to increase the number of women attending for a cervical test have been launched. The professional bodies fully support the efforts to increase the number of women attending but are acutely aware that this is at a time that laboratories are under severe pressures as outlined above. The laboratories will always offer a professional and quality service, but staff issues and increased workloads, often of the order of 30% or more with these campaigns, does mean that many will be unable to report the samples within the 14 days that women are typically advised it should take.
The laboratories will always strive to process and report samples as quickly as they can, maintaining the required quality, but in many places the time taken will be many weeks if not potentially a month or longer. It is essential that women are informed of these possible delays at the time that the sample is taken, to try and avert women’s fears and anxieties that may be caused by the delay.
Professor Jo Martin President, The Royal College of Pathologists
Dr Paul Cross President, British Association of Cytopathology
Allan Wilson, President Elect, Institute of Biomedical Science