Cervical programme finally gets push

Ayesha Verrall. Photo: supplied
Ayesha Verrall. Photo: Supplied
Those who have been pressing for improvements to the national cervical screening programme will be pleased at the recent announcement from Associate Health Minister Ayesha Verrall.

In a bid to reduce the inequities in the programme, boost participation (particularly among Maori women) and ultimately prevent more cancers and save more lives, the Government plans to change the initial screening test from July 2023.

Instead of the smear test which gathers cells from the cervix for analysis, the new initial test will involve a much simpler (and less confronting) vaginal swab for the human papillomavirus (HPV) which causes almost all cervical cancers. Women will be able to choose to administer the test themselves rather than have a health professional complete the task.

Making the announcement, Dr Verrall said clinical modelling predicted the change to HPV screening would prevent about 400 additional cervical cancers over 17 years and save about 138 lives.

Cervical cancer is not among the top 10 cancer killers in the country but each year about 50 women a year die from it and 160 develop the disease. It is worth noting, however, that in 1988, before the screening programme’s 1990 introduction, it was the eighth highest cause of cancer deaths for women in New Zealand, dropping to 17th by 2015.

Despite its obvious value, cervical screening seems to have been the poor screening relation in recent years, particularly with the push for the bowel programme.

Those who recognise cervical cancer (unlike breast cancer) can be almost entirely preventable through a combination of HPV vaccination, screening and effective follow-up treatment of abnormalities, are understandably frustrated about the time it has taken to get this far.

While there may have been some advantage to delays to the introduction of the HPV test because it allowed time for planners to fully consider this was the best option, this has gone on for too long.

Two years will seem a long way away, but it seems there are still many aspects of this to be settled, including how to incorporate any changes into the new IT system, consultation about clinical guidelines, how to transition women to the new system, ensuring the workforce capability, and education.

Successful screening is about much more than the initial test.

As the 2019 report of the parliamentary review committee regarding the National Screening Programme said: ‘‘Population-based screening is an organised, integrated process where all activities along the screening pathway are planned, co-ordinated, monitored and evaluated through a quality improvement framework. All of these activities must be resourced adequately to ensure benefits are maximised.’’

Increasing participation will be futile if those needing further follow-up cannot be dealt with properly.

University of Otago emeritus professor Charlotte Paul, who has a long involvement with cervical cancer/screening research, has already made the point that monitoring of the new programme should be a priority, noting the existing programme’s website shows there has been no monitoring report since June 2018, published in 2020.

Already there is confusion about what will happen in 2023, with some reports suggesting women will have home-test kits (like the situation with bowel screening) which they will complete and post for analysis. However, that is not what is envisaged initially. Women will go to their health provider where they will have the option of self-sampling. It will be interesting to see whether that clinic trip will still be off-putting to some of the hard-to-reach women.

Dr Verrall says there may be a fee for the new test. We believe it should be free, in line with tests for breast or bowel screening. (Now, although there is some support for priority groups, most women pay a doctor’s visit fee when they get a smear test.)

We hope all those involved with planning for the change will make the most of the time before 2023 to ensure a smooth transition which is adequately funded.

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