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National Screening Service update

– 22 October 2021

The road to recovery: the impact of the COVID-19 Pandemic on Cancer Screening

In March 2020 the National Screening Service (NSS) supported Ireland’s emergency response to the COVID-19 pandemic by pausing services and redeploying staff and resources. Our BreastCheck staff, for example, continued to work to diagnose and treat high-risk women with known symptoms of breast  cancer through the height of the pandemic.

The cyber-attack on the HSE caused some temporary disruption at our interfaces with the wider HSE system. However, we can confirm that all NSS programmes are today operational and, we are pleased to say, working steadily towards reaching full capacity by the end of 2021. We are also happy to report that all our screening programmes are ahead of their screening targets for the year to date and continue to maintain screening services across all four programmes in line with current safety measures. The programmes are continuously reviewing screening pathways. Ongoing mitigation of any potential risk along the screening pathway is taking place.

Priorities for the rest of 2021

Population screening programmes are a key part of any country’s strategy for improving the health of its population. Uniquely in healthcare, screening programmes invite healthy people, without symptoms of the condition, to have a test that might lead to them having other more invasive tests and treatments with the overall aim of improving the health of the population overall.

This brings a responsibility to ensure that there are demonstrable benefits from the programme and that achieving those benefits is the right way to use the public money invested in it.

Key to all screening programmes is the need to balance the benefits that the programme delivers to individuals and the health of the population, against the potential harms that those people taking up the offer of screening might experience. This can be a careful balancing act and therefore we use internationally agreed evidence based criteria when making decisions about screening.

Unfortunately, the pandemic added an important potential harm – that of bringing people who are presumed healthy into an environment where they could be at high risk of contracting or spreading another dangerous disease, and many of our participants are in the high risk category.

We in the NSS have been cognisant of our duty not to increase the potential harms to the people we care for in screening. Our priority during COVID-19 has been and must remain the safety of patients and staff. We also have a duty to ensure our treatment pathways are operating and safe, to ensure further harm is not done through screening people for whom there is no timely follow-up treatment available.

Despite the many restrictions COVID-19 has placed on our operations, today, our programmes are successfully achieving the maximum invitation rate that is compatible with a safe and controlled follow-up assessment, and our treatment capacity within the health service.

In line with screening programmes internationally, we are focused on 'restarting' our participants' screening journeys, while remaining cognisant of the capacity pressures across the whole of the health services. Our funding request for 2021 was generously supported by Department of Health and the HSE and we are seeking to use that to increase sustainable capacity:

We are:

  • Actively recruiting staff across the programmes, while noting that staff recruitment remains a global challenge in certain specialities. 
  • Utilising the new funding available to us to add three new BreastCheck mobile units and to build a new National Cervical Screening Laboratory.
  • Finding innovative ways to improve capacity. For example, we have followed international best practice in creating a new two-yearly screening pathway for people who fulfil certain criteria in diabetic retina screening.

We have been asked to define the effect of the pandemic on cancer diagnosis and prognosis in the future.

Scientists are beginning to model the impact of the pandemic on diagnosis and treatment for those who develop cancer. Screening accounts for just under 7% of all cancers detected in Ireland every year and so delays in screening will have a small but defined impact on detection rates. The effect of the pause in screening on the well population during this period has yet to be determined and we are monitoring the research closely.

Screening is a preventative health measure where the intervals between screens are set on an assessment of evidence of what produces the best outcomes for the population, rather than the individual. For the individual who comes for screening, they can be assured that once they are screened, they personally are 'caught up' and back on a screening journey that reduces their personal risk.

There is good news to tell about each of our programmes;

  1. Our BreastCheck staff vaccination programme is complete and a new text message appointment system is maximising uptake. Three new mobile units have been commissioned, and we expect our work treating high-risk women with symptoms during the pandemic will rebalance the reduction in the number of well women being screened during that period.
  2. In CervicalCheck, we are up to date with invites for screening. We have increased our testing capacity and are monitoring our capacity to screen carefully.
  3. The CervicalCheck programme has experienced a 25% increase in estimated volumes in the first six months of the year. Women and GP practices continue to use the service despite the impact and restrictions from the COVID-19 pandemic.
  4. BowelScreen's 14 units are in operation. We are continuing to work towards reaching pre-COVID activity by year-end.
  5. Diabetic RetinaScreen has invited 80 per cent of those who were overdue screening due to COVID-19, and is also inviting those currently due to be screened. We have opened two new pathways for people requiring diabetic retina screening.

We are working with hospital clinics to ensure all urgent referrals are prioritised. Our stakeholder and status updates continue to inform people as to the status of routine screening and encourage awareness of symptoms.

Our communication campaigns for CervicalCheck and BowelScreen earlier this year have successfully increased awareness and uptake. Our largescale awareness campaign for cervical screening in March 2021 saw a high number of women returning to screening over a short period. We expected to process almost 300,000 cervical screening tests in 2021; however, by the end of the first six months of the year an unprecedented 200,000 tests had been processed.

In July we reported that of these 200,000 people, 135 people required a retest as their sample could not be tested within the timeframe. We are happy to report that we have contacted all of the people concerned and the majority have now had their repeat test. We continue to investigate ways to increase capacity to address the longer screening times that are a factor of care in a COVID-19 environment. 

Our current campaign for BreastCheck during Breast Cancer Awareness Month continues to inform women when they can expect their next screening invitation, and gives information on what they can do to reduce their personal risk of breast cancer and aid early detection. We are telling women that if you were due your test in 2020, you will be invited in 2021. And if you were due your test in 2021, you will be invited in 2022. Ireland has a two-year screening round but for a while, Ireland will be more like England, where women are invited every three years. We are working hard to return to two-yearly screening as soon as possible, whilst noting the worldwide pressure on recruitment in radiography and radiology which makes it difficult to recruit additional staff for screening. 

We are indebted to all of our screening partners who provide follow-up care to our participants. They have shown a huge commitment to upholding the quality of the service, during the on-going pandemic. We thank our participants for patience as we work to restart their journeys in screening. 

Our aim of 'building a better screening service for all' is informing all the work we do, from working with patients to inform our planning and delivery of services, strengthening our governance, improving our information resources, and enhancing our quality assurance processes.

 

 

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