Spotlight on Cervical Screening

Our Cytology department processes around 400,000 cervical screening samples every year. Yet despite the high throughput, the department has demonstrated exceptional progress in the last financial year.

The service has grown rapidly since 2019/20 when our hospital won the bid to provide the East of England cervical screening services taking samples from Norfolk, Cambridgeshire, Suffolk, Essex, Hertfordshire, Bedfordshire and Milton Keynes in Buckinghamshire.

Prior to this, the department was responsible for processing around 60,000 samples from across Norfolk each year. During the pandemic the team also processed Covid testing for key workers and care homes across Norfolk until the large national super labs were established. It’s fair to say the department, based at the Cotman Centre, has had to be adaptable to meet the exceptional demand for their services.

The NHS Cervical Screening Programme (NHSCSP) sets a target of 98% for the 14-day turnaround time (TAT) standard, the time from when a sample is taken to when the patient should receive their result letter. Our performance showed a dramatic improvement over the course of the last financial year, from just over 60% in April 2023 to consistently exceeding the target in the latter half of the year. By July we had surpassed the NHSCSP target, achieving 99.5% TAT for all patients across the East of England cervical screening service.

Cervical Screening Provider Lead Viki Frew said: “In every sample, we test for 14 different genotypes of human papillomavirus (HPV), the virus strains which are associated with cervical cancer. By identifying the virus in the screening sample we can then analyse those samples under the microscope for any abnormal cell changes. Historically, we have had a long legacy of providing an efficient service meeting the 14-day TAT and this put us in good stead for taking on the new expanded service. Since we’ve become the East of England provider, we’ve redesigned and refurbished the laboratory and brought in new machines which are capable of processing a higher throughput, specifically looking for high risk HPV DNA in the sample.

“Since 2019 we have more than doubled our total staff, several of whom have embarked on a two-year training programme to undertake microscope screening of slides. Last year five new members of our team of biomedical scientists and cytology screeners passed the national exam, which has certainly helped us fully meet the needs of the service. Later this year two more will sit the exam and join the screening team. This puts us in good stead for the future and continued high performance and efficiency.”

NNUH also has the largest colposcopy unit in the East of England. The cervical screening cytology laboratory refers patients to colposcopy if abnormal cells are found in their sample. At the colposcopy clinic a closer examination of the cervix is completed where the clinician looks for any areas of abnormality. NNUH provides a ‘gold standard’ service by taking a diagnostic biopsy if any degree of abnormality is seen.

The tissue biopsies taken from the cervix are sent to the histology department and reported by a specialist team of gynaecological histopathologists. This is to determine if there are any precancerous changes present on the cervix. The aim is to treat women at risk of developing cervical cancer at the precancerous stage.

“I’m very proud of our colposcopy and histology departments who work very well together to provide the best care and outcomes for patients,” added Viki. Each year Viki audits all cervical cancer diagnoses, and these show that fewer and fewer younger women are developing cervical cancer and last year the peak incidence was in the 61-70 age group. Viki said: “It shows the HPV vaccine and the screening programme are helping and that our colposcopy and histology departments are diagnosing and treating patients earlier, which is fantastic.”

Looking to the future, there is the potential for AI to be used to scan slides of cells and staff are already reviewing cases online to build up our experience of using digital technology to report slides.

By consistently meeting and exceeding the NHSCSP target, the department is playing a crucial role in the early detection and prevention of cervical cancer, helping the global strategy to eradicate the disease altogether.

Viki has one last plea: “Every year we see a surge in samples in the new year after people book appointments after Christmas. Similarly, we see a spike after awareness months. It’s great that awareness campaigns have the desired effect, but I’d encourage women to attend their appointments as soon as they receive a letter. And if you realise you’ve missed your last one or you’re not sure, you don’t have to wait another three years until you get your reminder. Just call your GP surgery to check and book yourself in with the practice nurse.”

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