The report, The opportunities and challenges to eliminating cervical cancer in the UK, includes testimonies from professionals working in cervical cancer prevention, HPV primary screening and cytopathology services in the UK.

Nine women a day are diagnosed with cervical cancer in the UK, with 2 women a day dying from the disease. Data from England also shows around 4.6m women are still unscreened or behind with tests. In 2020, The World Health Organization launched a global call for action to eliminate cervical cancer. Professionals working in cervical cancer services outlined workforce pressures and inequalities in the uptake of HPV vaccination and cervical screening as the main challenges to elimination. HPV self-sampling, which allows women to test for HPV in their own home, was considered the top opportunity.

Pathology workforce pressures

The report explains that the consolidation of laboratories following the transition to HPV primary screening caused many to leave the pathology workforce, in anticipation of the change leading to both a reduced workforce. There were also challenges in recruiting new staff leading to workforce pressures.

Dr Paul Cross, Chair of The Royal College of Pathologists’ Cytopathology Committee, and a contributor to the report said:

‘Cytology, histopathology and other laboratory services are central to the prevention and diagnosis of cervical cancer. This report from Jo’s Trust highlights workforce pressures and staff shortages as significant challenges in the delivery of these services to eliminate cervical cancer. ‘We need a vision for the pathology workforce which looks to the needs of the cervical screening programmes of the future and includes the training and retention of staff.’

IT and digital pathology

Digital cytology and the potential for AI technology were identified in the report as opportunities to ease workload pressures and provide more accurate results. While not routinely in use, some hospitals are moving towards digital pathology, with AI technology recently piloted in Scotland. Other suggestions for digital innovation included the ability to add test results directly to patient GP records to speed up reporting, and risk-based screening intervals to alleviate pressure on services.

RCPath Fellow, Dr Raji Ganesan, a gynaecological pathologist, said:

`’We know that inefficient IT systems which are no longer fit for purpose are a major cause of frustration for the pathology workforce. ‘We need to embark on an ambitious programme to upgrade, standardise and modernise IT systems and expand the adoption of digital pathology. This will help to ease workload pressures, tackle backlogs and provide more timely and accurate results.’

What is cytopathology?

HPV primary screening tests samples for the presence of high-risk HPV. Cytopathology services screen samples of cervical cells for abnormalities. Cytology is undertaken when a sample has tested positive for high-risk HPV. Although, in Northern Ireland, the service still uses cytology as the first test on screening samples. When cytology suggests an abnormality, the person is seen at colposcopy. Biopsies can be taken and the tissue is analysed by histopathologists in a histology laboratory.