Southern HSC Trust cervical smear test main review now almost completed, director reveals
Senior Southern HSC Trust representatives have renewed their apology to the 17,543 ‘ladies with letters’ whose smear test results had to be reviewed due to inadequate screening, and they have revealed that 99.5% of the review process has now been completed.
They also had a message for women within the Trust – cervical screening saves lives, and it is vital that women do come forward for smear tests, when given that opportunity.
Speaking at the latest board meeting of the Southern HSC Trust, Cathrine Reid, Trust director of Surgery and Cancer Services, stated: “First of all, I’d just like to say that I’m very mindful of the distress this review has caused over the past year to many people and their families. And I’d like to apologise to all of those 17,543 women and their families who’ve been affected by this.
“Secondly, I really appreciate the hard work, commitment and support of our staff, and staff of other Trusts and the PHA (Public Health Agency), who have worked so hard to complete this extremely large and complex review, one of the largest reviews in the UK.
“Finally, I offer my deepest sympathies to the families of all those who’ve sadly died from cervical cancer.
“I urge women of all ages to continue to come forward for their smear tests as part of the Northern Ireland screening programme, when invited. Screening does save lives.”
Executive medical director, Stephen Austin gave a detailed account of the screening review to date, outlining the scale of it, and providing some reassuring data: “During the period from 2008 to 2021, some of our screeners’ performance fell below the required standard.
“It is recognised [the performance] of screeners can fluctuate for a range of reasons, and there are a number of measures usually put in place to pick that up, and to give refresher training for staff. Now, [sub-optimal] performance was identified by the Trust at the time, and action taken to deliver an improvement.
“But in some years, the performance of the screeners did not reach the required standard, despite having the required update, training and support. This was not recognised, and we do apologise for this.
“In 2021 we took action to address screen underperformance, and some of the screening staff were removed from those duties.
“Senior staff notified the management team in the Trust in 2021/22, [sharing] their concerns about the performance of some steps in the laboratory screening system. To fully investigate these concerns, last year, we brought in the Royal College of Pathologists/RCPath Consulting to undertake an independent assessment of those concerns in cervical screening services.
“We published that report on our website last year. The report found that for some screeners, [the level of] performance dropped during the period of 2008 to 2021, and the Royal College of Pathologists/RCPath Consulting were not satisfied the actions taken by the Trust were sufficiently robust.
“A number of recommendations were supplied to the Trust, and we worked with the Public Health Agency to implement those in full.
“Almost one year ago, in October 2023, the Southern Trust launched a precautionary review of cervical cytology for 17,543 women.
“The review was carried out in partnership with the Public Health Agency, and that was to check that the original screening result was correct.
“To avoid any conflict of interest, the Southern Trust laboratory did not undertake and participate in the review of cytology slides themselves. This was undertaken in partner Trusts in Northern Ireland – the Belfast, Western and Northern Trusts.
“Letters were sent out to women, notifying them that their cases would be reviewed. And since this time, their overall reviews progressed through pathways, the Cervical Cytology Review and the Call Forward Smear Pathway.
“Slides are retained for 10 years, and therefore most women’s historical slides were available to be reviewed. With a smaller number of women whose slides weren’t available to be reviewed, they were offered a new cervical smear as part of this Call Forward Pathway.
“Today, the main review is over 99.5% complete. There are approximately 79 women currently completing the Call Forward part of the pathway, due to complete in the next number of weeks.
“Those who required a repeat smear test based on slide review outcome had one issued to them, and we expect this work will complete in and around the end of October.
“The initial findings of the review confirm that the vast majority of previous smear results are unchanged and were reconfirmed as normal. Some low-grade abnormalities, around 300, and a very small number of higher-grade abnormalities, fewer than five, have been found.
“Identifying [these] abnormalities does not mean cancer has been found, but rather, these are pre-cancerous cell changes that might progress to cancer if left unchecked and untreated.
“Those women have been followed by clinical staff for further investigation and management as required, using normal pathways.
“There have been no cervical cancers identified, arising out of the cervical cytology review to date.
“This review has been a significant undertaking, but the vast majority of results did not change. We are very mindful of the stress this has caused in recent months, and again, we apologise to women for the distress that they have suffered.
“The review was carried out in a very comprehensive manner, and I must thank our laboratory colleagues across Northern Ireland for [undertaking] this review over this last year.
“Cervical screening does save lives. And just to repeat again, it’s really essential that women come forward for the cervical screening testing in the future, when invited to do so.
“Moving on to the separate issue of women who have had a diagnosis of cervical cancer, we know that in Northern Ireland approximately 80 women are diagnosed with cervical cancer, [with] around 21 deaths annually.
“Between 2019 and 2024, there have been 60 confirmed cases of cervical cancer in the Southern Trust area that have been reviewed through an audit process.
“The audit is for learning and improvement purposes. This is normal practice and happens on an ongoing basis throughout Northern Ireland, in fact, throughout the UK.
“Cervical screening has been very effective in reducing cancer in Northern Ireland. In fact, the numbers of cancers in Northern Ireland are particularly low compared to the rest of the UK. I also urge women at this stage, therefore, to continue to come forward for their smear tests as part of the Northern Ireland screening programme, when invited.
“The next step is to complete work on a detailed outcomes report, and we expect that this report will be completed in detail and published in the autumn.”