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

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

3. About CervicalCheck
CervicalCheck provides free smear tests through primary care settings to 1.1 million women aged 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 and every five years for women aged years, using a call, re-call process

4. 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

5. 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

6. 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

7. 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

8. 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 / fax /
Smeartaker training programmes – ICGP, RCSI, NUIG, clinical updates, reception staff training
Health Promotion Literature
CervicalCheck website –
Freephone No. –

9. Information leaflets & self registration forms for women Inform Display Systems Ltd.
tel: fax:
website:  

10. 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

11. 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 completing and
returning a Freepost form, or by calling
CervicalCheck on Freephone
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

12. 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
Completing the printed Self-registration form Freepost, which practices
may order from Inform Systems - Telephone:
Telephoning CervicalCheck (Freephone )
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

13. 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

14. 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 or visit
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

15. 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

16. 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

17. 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]

18. 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

19. 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

20. 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

21. Support People Smeartaker Training Unit stu@cervicalcheck.ie
/1146
Elaine Buckley, Smeartaker Coordinator
Maeve Waldron, Laboratory Coordinator
Leahna Kelly, Colposcopy Coordinator

22. Thank you for your attention!