COVID-19: Information for screening providers

National screening programmes are gradually returning to normal, with appropriate safeguards in place to comply with COVID-19 Alert Level 2 protocols and to keep participants and staff safe.

Routine breast and cervical screening appointments are going ahead but bowel screening is restarting in a more phased way.

Key information

Further information has been provided for screening providers below:

Antenatal and newborn screening programmes

BreastScreen Aoteroa

National Bowel Screening Programme

National Cervical Screening Programme

 

Ante-natal and newborn screening programmes

All antenatal and newborn screening programmes continue to operate with some important service changes being made to ensure that risks to staff and the public are minimised.

Antenatal screening for Down syndrome and other conditions

Antenatal care for pregnant women continues to be provided across all Government alert levels, including antenatal screening for Down syndrome and other conditions.

All women, including those who identify as a probable / possible COVID-19 case should continue to receive maternity care. However, there are some changes to the services provided to women for antenatal screening to help limit the spread of COVID-19 in community settings and protect pregnant women and health staff. The key changes include:

  • Women who identify as a probable / possible COVID-19 case. Access to first trimester anatomy scans for women who identify as a probable / possible COVID-19 case may be limited as some practices are not equipped to manage these cases. Some radiology facilities do have correct PPE measures in place for staff and are able to provide essential maternity ultrasound services. We encourage women or their LMC to contact practices to check whether anatomy scanning services are available and any precautions required.

  • No support person except in high risk situations. All women are to arrive and be scanned alone, except if they need a translator or their appointment is deemed to be high risk, for example where there is suspected loss of pregnancy. Then a support person is allowed. However, all other family or support persons should not enter the practice.

  • Shorter scan times. Shorter scan times may be offered to allow more spacing between appointments. While essential scanning procedures will continue, social scanning, such as 3D imaging, will not be available in these shorter appointments.

  • Scans can be stopped. Providers have the right to stop a scan if they are uncomfortable with a patient’s behaviour or undeclared symptoms, such as coughing.

  • Some radiology practices are closed. Due to the restrictions on non-essential healthcare, many radiology practices have closed some offices or limited their opening hours. Please check their website or phone messages to confirm opening before referring women for scans.

  • Second trimester screening. Remember MSS2 is available to complete screening from 14 weeks if the nuchal scan is unavailable locally or the scan is unable to be completed.

  • All reporting remains unchanged.

Health providers should review the full guidance for ultrasound service providers available on the Ministry of Health COVID-19 webpage here. This document should be read in conjunction with information available at www.health.govt.nz/covid-19

 

Newborn metabolic screening

As an essential service, newborn metabolic screening will continue to be provided for babies under all alert levels. This includes babies where they or a family member identify as a probable/possible COVID-19 case.

  • Collection of samples. Providers are to follow service guidelines for collection and use standard precautions during collection, and when handling the cards (PPE such as gloves, gown). Cards can be sent in the usual manner. If collecting from a baby or environment in which COVID-19 is suspected or confirmed, providers are to follow Ministry of Health guidelines for patient management.

  • Timing of sample collection. While the optimal time for collection of a blood sample for newborn metabolic screening is 48 to 72 hours, due to the national COVID-19 response, the laboratory will be accepting blood samples collected from babies as early as 24 hours post-birth. This change is designed to assist providers and midwives with patient accessibility issues during the COVID-19 response period.

  • Courier/mail deliveries as normal. Mail is an essential service and should not be disrupted during the COVID-19 response. Courier services are operating as normal, however please advise LabPlus if you are aware of any issues regarding collection or delivery of samples. Note that if a Post Shop is closed, providers can call the courier company for a pickup or to drop off samples at their local maternity facility.

  • All reporting remains unchanged.

 

Newborn hearing screening

As an essential service, newborn metabolic screening will continue to be provided for babies under all alert levels. This includes babies where they or a family member identify as a probable/possible COVID-19 case.

  • Collection of samples. Providers are to follow service guidelines for collection and use standard precautions during collection, and when handling the cards (PPE such as gloves, gown). Cards can be sent in the usual manner. If collecting from a baby or environment in which COVID-19 is suspected or confirmed, providers are to follow Ministry of Health guidelines for patient management.

  • Timing of sample collection. While the optimal time for collection of a blood sample for newborn metabolic screening is 48 to 72 hours, due to the national COVID-19 response, the laboratory will be accepting blood samples collected from babies as early as 24 hours post-birth. This change is designed to assist providers and midwives with patient accessibility issues during the COVID-19 response period.

  • Courier/mail deliveries as normal. Mail is an essential service and should not be disrupted during the COVID-19 response. Courier services are operating as normal, however please advise LabPlus if you are aware of any issues regarding collection or delivery of samples. Note that if a Post Shop is closed, providers can call the courier company for a pickup or to drop off samples at their local maternity facility.

  • All reporting remains unchanged.

 

Breast Screen Aotearoa

Breast screening appointments are gradually resuming during Alert Level 2, with the exception of participants with existing medical conditions.

  • Breast screening has resumed, but at reduced capacity. Priority is being given to Māori and Pacific and participants who were deferred, except those with existing medical conditions.

  • Mobile screening restarts, ensuring that physical distancing can be maintained.

  • Additional support is available to ensure that women who missed an opportunity to be screened on the mobile can access a fixed site

  • Assessments to resume.  All participants who need assessment are being offered one.

  • Support people. Support people accompanying women to appointments should be someone from their ‘bubble’ and are not permitted to be in the room for screening or assessment.

  • Option to defer appointment. Women should be assured of their safety in attending their appointment but be given the option to defer until the COVID-19 threat has lessened.

  • Women concerned about symptoms. Women who have symptoms suggestive of breast cancer are encouraged to contact their GP.

 

National Bowel Screening Programme

The National Bowel Screening Programme is restarting in a phased way to allow hospitals to re-instate staff and resources diverted in anticipation of an influx of COVID-19 patients. This decision is being regularly reviewed so the NBSP can return to full operation as soon as it is safe to do so.

  • No Invitations are to be mailed out. There will be no new or 2 yearly recall invitations to screen mailed out during Alert Level 2. This is to allow the NBSP to catch up with participants already in the pathway

  • kits received can now be returned. People who received a FIT 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, that was in place to mitigate against the health system not having capacity to contact participants directly has now been withdrawn.

  • People with a positive result, who are asymptomatic are being contacted by their DHB Colonoscopy Screening team to arrange a colonoscopy appointment as soon as feasible.

  • A colonoscopy after a positive FIT 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 patients that 92 out of a hundred 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 are being contacted to say they will get an opportunity to participate in screening, even though they are now over the cut off age. This is approach is considered to be fair and ethical as the circumstances that lead to this situation were beyond their control.

This information will be reviewed regularly to enable bowel screening to resume as soon as possible.

 

National Cervical Screening Programme

Cervical screening in primary care during Alert Level 2

  • Routine cervical screening has now resumed for eligible participants. For those who are 70 + or with existing medical conditions, the decision to be screened will be made on a case-by-case basis.

  • In the first instance, health providers should prioritise annual surveillance rescreens, overdue screens, and priority populations. As capacity allows, providers can invite other participants for screening

  • Screening support services can assist with engaging priority populations

  • Providers will continue to triage/ assess patients with symptoms of abnormal bleeding

 

Change to the follow-up pathway after treatment at colposcopy

Currently women are seen at 6 months for a colposcopy and cytology test and have a ‘test of cure’ (cytology and HPV test) in primary care at 12 and 24 months post-treatment.  From April 2020 the following changes are being made:

  • Many patients treated for high-grade squamous disease will be able to be discharged to primary care for a ‘test of cure’ at 6 and 18 months after treatment (rather than at 12 and 24 months).
  • Women can still be followed up at colposcopy post-treatment if there are any clinical concerns.

This change to the follow-up after treatment of high-grade lesions is effective immediately. Providers will be advised by the colposcopy unit if this change affects any of their patients.

The change was planned to be introduced with HPV primary screening but has been fast-tracked due to the evolving COVID-19 situation. This will help limit non-essential attendance at outpatient appointments.  Other countries, including the UK and Ireland have introduced this change to their patient care pathways.

Most importantly, 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.

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 alert system, which is different to Government COVID-19 alert level.

  • Women who need to be seen urgently are prioritised.
  • A delay in women with a low-grade result being seen may be expected.

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 screening@health.govt.nz

 

Page last updated: 14 May 2020