CervicalCheck – The National Cervical Screening Programme Dr Marian O’Reilly Head of cervical screening

LEARNING OBJECTIVES About CervicalCheck - history Key administration Personal Health Information & cervical screening The CervicalCheck process Call, re-call

About CervicalCheck CervicalCheck provides free smear tests through primary care settings to 1.1 million women aged 25-60 eligible for screening A successful national programme in Ireland has the potential to cut incidence rates from cervical cancer by up to 80% The overall aim of CervicalCheck is to reduce the incidence and death rate from cervical cancer in Ireland Free smear tests will be provided every three years for women aged 25-44 and every five years for women aged 45-60 years, using a call, re-call process

History of cervical screening in Ireland Prior to the establishment of CervicalCheck, it is believed that an appropriate number of smears were taken opportunistically in Ireland However, as the whole population who are at risk were not being screened, this smeartaking activity has had little or no impact on the detection and appropriate management of the disease

Key programme tasks Maintain and update the population register Identify and invite eligible women for cervical screening Send out call and recall letters Ensure that attempts are made to contact women who require follow-up failsafe process Register doctors and nurses as CervicalCheck smeartakers Process payments for smears taken Provide training and education initiatives for smeartakers Quality assure the programme Co-ordination and provision of quality assured laboratory and colposcopy services

Information System Automated Call, Recall, Failsafe Procedures Population Register CSR Automated Call, Recall, Failsafe Procedures Automated Interfaces to L.abs Clinics & D.I.M.S Systems Statistical Reports Secure Data Exchange Demographic Matching

Cervical Check Office Not normal result Invitation letter Smear test Result letter No abnormally detected result Inadequate / unsatisfactory result Not normal result 3 Consecutive Inadequate ASC-US ASC-H Low Grade LSIL High Grade HSIL AGUS/ AGC AGH Query Glandular Neoplasia Invasion cervix Repeat in 6 months Repeat in 6 months Normal recall Repeat smear 3 ASC-US 2 LSIL or 3 LSIL (10yr)‏ (Conseq)‏ Colposcopy 2 repeat smears in 1yr then annual Histology Normal recall

What does CervicalCheck provide Liquid Based Cytology (LBC) smeartaking kits – vials and brushes Transport boxes (various sizes) Cervical Cytology Forms and information sheet re consent Details for ordering supplies of smeartaking kits and forms: Screenlink Disposable speculae: order from Promed at 1800 619619 / fax 1800 684684 / comfispec@promed.ie Smeartaker training programmes – ICGP, RCSI, NUIG, clinical updates, reception staff training Health Promotion Literature CervicalCheck website – www.cervicalcheck.ie Freephone No. – 1800 45 45 55

Information leaflets & self registration forms for women Inform Display Systems Ltd. tel:061 33 85 80 fax: 061 33 85 84 email: cervicalcheck@informireland.info website:  www.informireland.info

The Call, Re-call Process in practice A woman phones you to make an appointment for a CervicalCheck smear test. Ask her, has she received a CervicalCheck Invitation or Re-call Letter? Yes Woman is eligible for a free CervicalCheck smear test

The Call, Re-call Process in practice A woman phones to make an appointment for a CervicalCheck smear test. Ask her, has she received a CervicalCheck Invitation or Re-call Letter? No Ask the woman if she has had a smear test in the last 3 years Any woman who has not had a smear test in the last three years can opt-in and request an invitation letter from CervicalCheck by registering online at www.cervicalcheck.ie, completing and returning a Freepost form, or by calling CervicalCheck on Freephone 1800 45 45 55. She may be eligible without a letter in the following circumstances: Women aged 60 and over who have never had a smear test Women of any age post colposcopy Women post hysterectomy in certain circumstances Women aged 20 and over on renal dialysis Women ages 20 and over with HIV infection Women aged 20 and over with post organ transplant

Integrating practice and clinic re-call systems with CervicalCheck Is the women due for practice or clinic re-call? Yes Advise those women to: Check they are on the CervicalCheck Register. A woman may register or update her details by: Completing the online registration form at www.cervicalcheck.ie Completing the printed Self-registration form Freepost, which practices may order from Inform Systems - Telephone: 061 33858 Telephoning CervicalCheck (Freephone 1800 45 45 55) 2. Answer ‘No’ to the registration question ‘Have you had a smear test within the last three years?’, so they will be issued with an early letter of invitation 3. Make a cervical screening appointment upon receipt of their letter of invitation

Discretionary Screening ‘for direct programme entry CervicalCheck will facilitate a smear test for a woman new to the programme without a letter of invitation (call), at the discretion of the clinically responsible doctor CervicalCheck will provide the smeartaker with the consumables required, and will process the smear test at the designated laboratory This smear test will not generate payment to the practice or clinic

Invitation letter [fullname] [address1] [address2] [address3] Cervical Screening Programme ID: [csp_id] PPS No: [PPSN] Dear Ms [Surname], CervicalCheck – The National Cervical Screening Programme invites you to make an appointment for a free smear test. Regular smear tests are important as they can find early changes in the cells of the cervix (neck of the womb). The earlier cell changes are found, the easier they are to treat. To have this free smear test, please make an appointment in the coming weeks with a doctor or practice nurse who is registered with our programme. For details of those registered Freephone 1800 45 45 55 or visit www.cervicalcheck.ie. Please ensure that you take this letter with you when going for your smear test as your doctor or nurse will ask to see it. You will find more information about having a smear test in the leaflet enclosed. I do hope you take this opportunity to look after your health. Yours sincerely, Dr Marian O’Reilly Head of Cervical Screening

Results The result of each smear test taken will be provided to the cervical smeartaker by the laboratory within 4 weeks Normal result – letter sent to woman from the programme advising her of her result and recall date Not normal result – CervicalCheck issues letter to woman advising her that follow-up is required and to contact her smeartaker for result

Result Letter – Normal [fullname] [address1] [address2] [address3] Cervical Screening Programme ID: [csp_id] PPS No: [PPSN] Dear Ms [Surname], Thank you for taking part in CervicalCheck – The National Cervical Screening Programme. Your smear test taken on the [testdate] detected no abnormalities. You will find more information about your smear test results in the leaflet enclosed. CervicalCheck will remind you to have your next routine smear test in three years time if you are aged 25 to 44; or in five years time if you are aged 45 to 60. Please let us know if you change your name or address before your next smear test is due. If at any time you have any concerns such as irregular vaginal bleeding, spotting or discharge please contact your doctor without delay. Yours sincerely, Dr Marian O’Reilly Head of Cervical Screening

Not Normal Result Letter [fullname] [address1] [address2] [address3] [address4] [address5] Cervical Screening Programme ID: [csp_id] PPS No: [PPSN] Dear Ms [Surname], Thank you for taking part in CervicalCheck – The National Cervical Screening Programme. The result of your smear test taken on the [testdate] is now available. You need to contact the doctor or practice nurse who took your test to discuss the result and provide you with more information. You may also find the leaflet enclosed helpful. It is very important that you follow the recommendations we have given you. Yours sincerely, Dr Marian O’Reilly Head of Cervical Screening [eof]

Failsafe process Failsafe is the follow-up of not normal results If a woman does not present for a recommended follow-up smear test or colposcopy, the programme will contact both the woman and her General Practitioner to encourage appropriate action

Deferral and opt out Deferral or delaying smear tests can occur due to personal or medical reasons The woman may request deferral e.g. during pregnancy A written request from the woman or from the doctor must be sent to the CervicalCheck office A woman with a not normal result should not be deferred If a woman chooses not to participate with CervicalCheck she must write to the Programme to advise them of this

Quality assured screening service - smeartakers QA Primary Care Group QA standards – publication in 2009 Self audit Objectives, measures, non conformances, continuous improvement Complaint process and corrective actions Smeartaker reports will be sent quarterly

Support People Smeartaker Training Unit stu@cervicalcheck.ie 061 46 1234/1146 Elaine Buckley, Smeartaker Coordinator Elaine.buckley1@hse.ie 061 461238 Maeve Waldron, Laboratory Coordinator Maeve.waldron@hse.ie 061 461240 Leahna Kelly, Colposcopy Coordinator Leahna.kelly@cancerscreening.ie 01 8659371

Thank you for your attention!