Tuesday, 14 May 2019
Department of Health
Cancer Screening Programmes
I propose to take Questions Nos. 290 to 293, inclusive, together.
In April 2018, following issues which had emerged in relation to the CervicalCheck screening programme, I made the decision to offer free out of cycle smears to any woman who was concerned about her health, where her GP felt she should have a further test as part of her reassurance.
Approximately 112,000 consultations were provided by GPs, and 57,810 early repeat smear tests were provided between 1 May and 31 December – in other words, about half of the consultations resulted in a smear test.
Laboratory turnaround times have increased since that time, as a consequence both of the out of cycle smears and the increased uptake generally. The CervicalCheck programme has agreed with laboratories to prioritise those slides which originate from women who attended colposcopy, as this cohort of women are considered to have the most serious need. In addition, agreement has been reached with the laboratory with the largest backlog to process tests based on a HPV initial testing model; i.e. HPV testing will be carried out on samples prior to cytology. I am advised that this approach was chosen as the most effective way to process all outstanding tests based on prioritising women most at risk.
However, the HSE has advised that the natural history of cervical cancer would indicate that the disease would normally develop over a period of 10 to 15 years. It has said that in this context, a delay in the return of cervical screening results, whilst undesirable, is not necessarily dangerous and poses a very low risk to women.
Nevertheless, the reduction of turnaround times is a priority. With the programme now back to normal call-recall procedures, lab turnaround times are improving and the HSE reports that more than half of tests are being returned in 9 weeks. However, they can take as long as 33 weeks, and this remains a significant challenge. The HSE is continuing to work actively to reduce these turnaround times. In order to do so, it has been undertaking a global search for additional laboratory capacity to support the programme. Additional capacity has now been identified and the HSE is currently engaged in intensive negotiations to finalise commercial arrangements, in order to enable it to incorporate this capacity into the CervicalCheck programme.
Ensuring the programme is fully supported, in the interests of public health, remains my priority.
The introduction of primary HPV screening is in line with developments in cervical screening internationally. Ireland will be among the first countries in the world to make this transition. The HSE has been engaging with other countries who have already made the switch – the Netherlands, and Australia - or who are preparing to do so, to identify learnings for the project across a range of workstreams including reconfiguration of laboratories, procurement, ICT and colposcopy services.
A well organised screening programme, when combined with HPV vaccination for boys and girls, can bring us very close to eliminating cervical cancer. That is this Government’s goal and that is why we are committed to introducing the HPV vaccine for boys and to implementing the recommended improvements in our cervical screening programme.
I have asked the HSE to introduce HPV testing as the primary screening method for the prevention of cervical cancer as soon as possible. Funding to implement the switch to HPV screening, and extend HPV vaccination to boys, has been allocated in Budget 2019.