National Cervical Screening Programme – sector update August 2020
As we return to some form of normality following the COVID-19 lockdown and work through the next phase of the national response, the Ministry of Health would like to thank you for all you have done over this time to manage our screening service.
With a significant number of our staff redeployed to the COVID-19 response, our business-as-usual tasks are being undertaken by fewer people and our communication hasn’t been as frequent. We hope the following communication will go some way to bringing you up to speed with other aspects of the programme.
The COVID-19 lockdown period temporarily disrupted the provision of cervical screening services but, thankfully, for a relatively short period compared with other countries.
We have set up an NCSP COVID-19 impact and recovery advisory group to assess the impact of the pandemic and enable the Ministry to work with you to support and facilitate recovery.
We would like to acknowledge the hard work screening providers undertook during this initial recovery phase to encourage and support women to screen. We have seen a significant increase in screening across all population groups during June and July.
A key priority for the programme is improving access to screening for wāhine Māori and Pacific women. Initial data shows the proportion of Māori women screened in June was lower than for other women. Initiatives to encourage screening uptake need to address the inequity for Māori and Pacific women.
As part of efforts to support equitable recovery, the Ministry is considering what can be done to remove some of the barriers that prevent Māori and Pacific women from engaging with screening services. One option being considered is to offer additional free screening directed towards these groups.
HPV primary screening
Given the significant pressure on health funding in the wake of COVID-19 funding for the introduction of HPV primary screening has not been secured.
The Government understands the importance of this programme change, and funding for it will be considered as part of Budget 21.
A significant challenge remains with the limited adaptability of the current National Cervical Screening Programme (NCSP) Register and the need for a custom-built IT platform that incorporates the new clinical pathways, necessary safety-nets and programme monitoring capability.
The current NCSP Register that supports the programme was specifically designed for a cytology-based screening pathway and the current technology is not able to be adapted for an HPV primary screening programme.
To ensure we don’t lose ground while waiting for funding to be secured, the Ministry is exploring how it can progress initial work to develop an NCSP component of the National Screening Solution.
We acknowledge the motivation by sector groups to consider implementation of temporary solutions for HPV primary screening and set up a stand-alone register via practice management systems or other means.
The Ministry has significant concerns about the clinical safety of such arrangements, particularly their ability to ensure obligations under Part 4A of the Health Act 1956 are met.
The foundations of an HPV primary screening-based programme must be underpinned by robust collective processes and appropriate, dedicated technology to keep women safe through the screening pathway.
The Ministry remains committed to introducing HPV primary screening and self-testing. International evidence convincingly shows it is the most effective test. However, in the meantime the current cytology-based programme, remains a proven, clinically safe and effective service to reduce death and disease from cervical cancer. We will continue to work to enhance the programme’s effectiveness and ensure equal access for all.
Change to the screening start age
In late 2019, the NCSP worked with providers to extend the recommended start age for cervical screening from 20 to 25 years. This change was made in response to evidence that screening women between 20 and 24 years of age provides little benefit and may cause harm as a result of over-treatment for women in this age group.
In February 2020, the NCSP launched the ‘give your cervix some screen time’ campaign, aimed to encourage women who are least likely to be screening and are those most at risk (wāhine Māori and Pacific women 25 to 29 years) to participate in cervical screening.
After running for only five weeks the campaign was suspended as the country responded to the COVID-19 pandemic, however early indications are that it was reaching the target audience and gaining considerable traction. As part of our recovery plan, we are preparing to re-launch the campaign as soon as possible.