Dr. Helen Lambkin:

In terms of increasing capacity, medical scientists who work in cytology generally undertake a four-year honours degree programme, either in GMIT, DIT or CIT and UCC. They will also complete a clinical laboratory placement training, which would not be in cytology but in all disciplines of the laboratory. Post graduation, they would have to train, usually for a year or a year and a half, in cervical cytology. It has that extra training because one must learn to recognise all of the normal cells, abnormal cells, infectious agents and patterns that are seen in smears. Those elements can be varied depending on the day of a woman's cycle, whether she has a previous smear history of abnormalities, etc. It takes a long period of learning before a medical scientist can sign out smears. In generating that capacity, we cannot just say that we will take all of the tests back in a month's time because we do not have the trained personnel in situ. We would probably have to bring in people from abroad to perform the smears.

However, the Irish Cervical Screening Programme, ICSP, has been looking at the introduction of the human papilloma virus, HPV, test as the primary test on the cervical smear sample. The reason is Australia, New Zealand, Sweden, Italy, the United Kingdom and other European countries are all moving towards the idea that when a woman has a cervical smear taken in this liquid preparation, the primary test will be for high risk HPV. About 40 HPVs can be found in the anogenital region, but the ones that are high risk are oncogenic which can lead to cervical abnormalities. The recommendation in many countries is that the first test be for HPV.

HIQA brought out a report last year on the HPV test. It looks as if it will be tendered for. That is the future for the next developments in the service. In itself, it will take some time to implement. When it is implemented, if it is the primary test, for any positives for the high risk HPVs, smears will be prepared and examined as usual. The Irish laboratories have capacity to deal with the number when there is a reduction, but that will take several years. The academy's recommendation is that in the short term the plan be to implement the HPV test and then ensure all other testing, including smears, be performed in Ireland.