Written Statement: Cervical Screening

I am making this statement following concerns expressed by some Assembly Members in March this year about laboratory closures and delays for women receiving test results in England. I would like to take this opportunity to congratulate Public Health Wales, which delivers the Cervical Screening Wales (CSW) programme, for successfully rolling-out high-risk Human Papilloma Virus (HPV) testing as the primary screen in September 2018. This is a more sensitive test and will prevent more cancers than primary cytology testing. The programme now tests for 14 high-risk HPV types, which cause 99.8% of cervical cancers. The move to HPV testing resulted in the cytological examination workload in Wales falling significantly, with the resultant demand sufficient to sustain only one cytology laboratory at Magden Park, rather than the previous 4.

CSW prepared for the implementation of primary HPV screening for several years and worked effectively to maintain its cytological staff still needed to sustain the service and provide screening results within standard timescales whilst transitioning to the new test. As a result, the cervical screening programme in Wales has not encountered the same issues as the English programme. Turnaround times for cervical screening test results exceed our target of 95% of results to be received within 4 weeks, with more than 99% of women receiving their results within standard. The successful management of the cytology workforce by Public Health Wales has enabled Wales to be the only UK country to date to introduce HPV testing.

Members also raised the issue of self-testing. The technology now exists for women to collect a cervical screening sample themselves in their own home, and evidence around this technique is building, but is yet to be fully assured as safe and effective for screening.

The self-sampling pilot study announced in England, starting from September 2019 in parts of London which are known to have poor cervical screening uptake, is a research project. Wales will, therefore, not be duplicating the same pilot, but will await the evaluation. Self-testing will not be rolled-out across the UK until the pilot has been shown to be safe, and has been recommended by the UK National Screening Committee (UKNSC). In anticipation of any such recommendation, Public Health Wales is considering how this could be implemented in Wales.

Lastly, one Member also requested a statement to clarify the Welsh Government’s policy on screening women with symptoms of cervical cancer under the age of 25.

All women in Wales aged 25 to 64 who are registered with a GP are automatically invited for cervical screening (every 3 years if you are 25 to 49 and every 5 years if you are 50 to 64). The purpose of all screening programmes is to identify conditions at an early, more treatable stage in people who do not display symptoms but may have an increased risk of a particular condition. GPs do not refer people for screening. If they are eligible they will already be invited at the appropriate time.

Cervical screening is not appropriate for women displaying symptoms of cervical cancer as it is not a test for cancer. The test looks for HPV and abnormal cells which could potentially develop into cancer. If a woman has symptoms, screening would only delay diagnosis. If GPs have any concerns, women should be referred via the urgent suspected cancer pathway for prompt investigation.

Cervical cancer in women under the age of 25 is extremely rare with around 5 women under the age of 25 diagnosed with cervical cancer a year in Wales (around 3% of the total cervical cancers diagnosed a year in Wales). The Welsh Government, as all other UK governments, follows the expert advice of the UKNSC. In 2012 the UKNSC recommended that women should not be screened below the age of 25. This is because screening women under 25 has not shown to be effective and women in this age group are more likely to have cell abnormalities which usually resolve on their own. Previous screening found that 1 in 3 women screened under the age of 25 would have an abnormal result compared to 1 in 14 for all women screened (25-64 years old). Before the age was raised, screening of women less than 25 years of age resulted in many young women being referred for unnecessary treatment.

Rather than expanding the screening programme to include women outside the recommended age range, we should be focussing our efforts on encouraging those in the eligible age range to attend for screening.

Public Health Wales is working to improve uptake, particularly in women from 25 to 30, who are the lowest attending demographic. It has been running a comprehensive campaign to increase awareness and improve uptake of cervical screening. The #LoveYourCervix social marketing campaign launched in March, aiming to encourage uptake of cervical screening in women aged 25 to 30, and to increase understanding of HPV. Research shows embarrassment is a barrier to having cervical screening. #LoveYourCervix uses positive, empowering and honest language, with a strong focus on body positivity to encourage women to attend for screening when invited.

I would also like to take this opportunity to highlight some very encouraging research relating to HPV vaccination. Since 2008, girls aged 12 or 13 have been offered the HPV vaccine across the UK to protect against cervical cancer. Research published in the British Medical Journal on 3 April showed that in Scotland the vaccine had led to a 90% reduction in pre-cancerous cells.

We are not complacent about cervical cancer outcomes but must recognise that 1 and 5 year survival from cervical cancer has improved by more than 4 percentage points between 2005-09 and 2010-14; while the European age-adjusted mortality rate per 100,000 people has fallen by 1.5 points between 2001-03 and 2013-15. The combination of immunisation and cervical screening offers the best possible protection against cervical cancer and I am pleased that in Wales women are offered both routinely. Over the next decade we can expect to see cases of cervical cancer reduce significantly in Wales.

This statement is being issued during recess in order to keep members informed. Should members wish me to make a further statement or to answer questions on this when the Assembly returns I would be happy to do so.