COVID-19: Information for screening providers
All national screening programmes are gradually returning to normal, however there may be some delay whilst providers catch up on those appointments missed during the COVID response.
Further information has been provided for screening providers below:
All antenatal and new-born screening programmes continue to operate during Level 1 with most services returning to normal.
- Antenatal screening for Down syndrome and other conditions will continue to operate as normal.
- Newborn metabolic screening (the heel prick test) will continue to operate as normal.
- Newborn hearing screening – services will continue to operate as normal, however there may be some delays whilst the screening teams catch up on those outpatient appointments missed during the COVID-19 response.
For more information about antenatal and newborn screening programmes visit https://www.nsu.govt.nz/pregnancy-newborn-screening
Breast screening services will be operating as normal during Alert Level 1. In addition:
- Priority will be given to Māori and Pacific and women who were deferred (including anyone who turned 70 during the COVID response)
- Additional support is available to ensure that women who missed an opportunity to be screened on the mobile can access a fixed site.
- Extended clinic hours and weekend screening are being implemented to meet rescreening targets.
- Anyone concerned about symptoms suggestive of breast cancer is encouraged to contact their GP.
- Women should stay home and not attend their appointment if they are sick. They should call breast screening providers to rebook another time and contact their GP or Healthline if they have cold or flu symptoms.
The National Bowel Screening Programme is restarting.
Restarting screening invitations. In DHBs offering bowel screening, new screening invitations will begin to be sent out again from 11 June.
Kits received can now be returned. People who received a bowel screening test kit, and were advised to put it aside, are now being told it is safe to complete it and send it in. The kits are valid for 6 months from time of receipt.
Failsafe positive result letter was in place to mitigate against the health system not having capacity to contact participants directly and has now been withdrawn.
People with a positive bowel screening result, who are asymptomatic are being contacted by their DHB to arrange a colonoscopy appointment.
A colonoscopy after a positive bowel screening test is recommended within three months of having a positive result but, where a person is not experiencing symptoms, it may be extended for a few months as bowel cancer is usually slow growing. It is important to reassure participants that 92 out of 100 patients with a positive test will not have cancer
People with a positive result who are symptomatic of bowel cancer, clinicians are to assess and examine patients as clinically indicated and advise on the referral form.
People who turned 75 while the National Bowel Screening Programme was on hold will be offered an opportunity to participate in screening, even though they are now over the cut off age.
Cervical screening in primary care
Routine cervical screening has resumed.
The backlog of people who were not screened during the COVID lockdown needs to be managed by each health provider.
In the first instance, health providers should prioritise annual surveillance rescreens, overdue screens, and priority populations.
Screening support services can assist with engaging priority populations.
Providers should continue to triage/assess patients with symptoms of abnormal bleeding.
Change to the follow-up pathway after treatment at colposcopy
Prior to COVID-19, women were seen 6 months after treatment for HSIL for a colposcopy and cytology test, and then had a ‘test of cure’ (cytology and HPV test) in primary care at 12 and 24 months post-treatment. From April 2020 the following changes apply:
- Most people treated for HSIL will be discharged to primary care for a ‘test of cure’ at 6 and 18 months after treatment (rather than at 12 and 24 months).
- Some people will still be followed up at colposcopy post-treatment if there are clinical concerns about discharge to primary care.
This change has already been introduced. Health providers will be advised by colposcopy services if this change affects any of their patients.
The change has been fast-tracked because of COVID-19 and will reduce non-essential attendance at colposcopy appointments.
There is good evidence that compared to a colposcopy and cervical screening test at 6 months, cervical screening together with an HPV test is much better at identifying the effectiveness of treatment and avoids an unnecessary colposcopy. Other countries, including the UK, Ireland and Australia have already introduced this change to their patient care pathways.
The NCSP Register is fully informed of this change and will accept HPV testing carried out as part of a ‘test of cure’ from 6 months post-treatment.
Prioritisation guidance for colposcopy
DHB colposcopy clinics operate within the DHB hospital COVID alert system, which is different to Government COVID-19 Alert Levels.
- Priority is given to women who need to be seen urgently.
- Delays in seeing women with a low-grade result may be tolerated if workloads prove to be difficult to manage. The NCSP has extended the timeframe for seeing women with low-grade results at colposcopy (up to 12 months instead of the usual 6 months
All programme changes listed above will be reviewed regularly.
In the meantime, the NSU will publish advice for participants on the 'Time to Screen' website www.timetoscreen.nz
If you have any questions about the changes outlined above please email firstname.lastname@example.org