Overview of Cervical Screening Programme

Screening for Cervical Cancer

Cervical Screening started in the United Kingdom in the early 1960s.  In Northern Ireland a small laboratory service for cervical cytology was established in the Belfast City Hospital and Royal Victoria Hospital.  As the service expanded, a specifically designed computer system was developed in the Belfast City Hospital which included the development of a recall mechanism to ensure invitations were sent to women regularly, as well as to facilitate the follow-up of abnormal smear tests.

In Northern Ireland and the United Kingdom as a whole this service grew rapidly, for example, by 1985 there were over 3 million smear tests taken in the UK.  However, even testing to this extent did not result in the expected decrease in deaths from cervical cancer and there were fears that the women at greatest risk were not being tested.  This led the Department of Health to introduce national policy guidelines in 1986/7.  In Northern Ireland, the 1988 Circular HSS (CH) 2/88 Cervical Cytology Screening was issued to all four Health and Social Services Boards.

This coincided with the introduction of lab services at three area hospitals, Altnagelvin, Antrim and Craigavon.

In January 2011 following expert advice, the Northern Ireland Cervical Screening programme adopted screening intervals in line with the national screening programme. This means that women are now being offered screening every three years from the age of 25 until 49. Women aged 50-64 continue to be offered screening every five years.

The Belfast City Hospital Laboratory computer system was developed into a regional system that linked all the laboratories and a new Regional Screening Office to one computer.

The Regional Screening Office was established in November 1989 and by 1993 all women aged 20-64 years were included in a regular call/recall system.

Follow-up of the abnormal smear test has been of major importance for the programme.  This has led to the development of a comprehensive colposcopy service (a colposcopy is a procedure where the lining of the cervix (the neck of the womb) is closely examined).  Any women with abnormal smears can be referred to a Colposcopist for diagnostic assessment and treatment.

A National Health Service Cervical Screening Programme (NHSCSP) Co-ordinating Network was also created to co-ordinate the introduction and acceptance of national standards similar to those being developed by the Breast Screening Programme.  It has produced a series of guidelines that are updated on a regular basis.  Although these documents have only been directly applicable to England, the Cervical Screening Programme in Northern Ireland has adopted them where appropriate.  The Northern Ireland Quality Assurance Reference Centre co-ordinates this work. 

Recent advances in smear taking have been adopted in Northern Ireland. The traditional “Pap” smear has been replaced with Liquid Based Cytology (LBC). Following training, all smear takers in Primary Care and laboratories have been using the LBC as the primary cervical screening test.