News

 


Breast Screening
Cervical Screening
Bowel Screening
Diabetic Retina Screening

National Screening Service update

– November/ December 2021 

We wish to thank all our screening partners and our stakeholders for their support of the four National Screening Service programmes, BreastCheck, CervicalCheck, BowelScreen and Diabetic RetinaScreen, in 2021.

BreastCheck
Despite the many restrictions COVID-19 has placed on our operations, we are successfully achieving the maximum invitation rate for screening 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 continuing to respond to the capacity pressures across the health services.

We continue to inform women that due to COVID-19, their invitation for breast screening has been delayed by up to a year.

  • If you were due to be screened in 2020, we aimed to invite you in 2021
  • If you were due to be screened in 2021, we will now aim to invite you in 2022 

Women aged 50-52 who are due their first screening appointment may be aged 53 when they are first invited.

We aim to return to screening women every 2 years as soon as possible. This is dependent on the situation with COVID-19 restrictions.

Prevention and awareness
It is estimated that approximately one quarter of breast cancers may be preventable through modifiable risk factors and environmental factors. The first line of defence against most disease, including cancer, is prevention through a healthy lifestyle – don’t smoke, maintain a healthy weight, limit alcohol consumption and be active. Breast cancer awareness is also an important tool in the early detection of cancer. Our media campaign during Breast Cancer Awareness Month focused on messages of prevention and awareness, and we will continue this focus into 2022.

Investment and recruitment
A new mobile unit has been added to BreastCheck to facilitate screening appointments around the country and a further two units have been commissioned. BreastCheck has four screening units in hospitals and 22 mobile screening units across the country that stay at different locations for three to 24 months, depending on the need for screening. We are engaged in ongoing recruitment for radiographers to join the BreastCheck programme in 2022.

CervicalCheck 
We are pleased to report that by the end of 2021 we will have screened the same number of people as in any other two-year period. We have increased our testing capacity and are monitoring this carefully. 

  • CervicalCheck is up to date with invites for screening.
  • Screening samples continue to be processed as normal.
  • The turnaround time for test results is now 4 weeks, reduced from 6 to 8 weeks earlier this year.

Sample taking and seasonal post
We asked sample takers to post December cervical screening samples by Friday December 17 and resume normal screening from 27 December 2021. This is to ensure sample delivery is not affected by the increased seasonal pressures on An Post, and will enable us to continue to process all samples in a timely manner.

The Coombe Women and Infants University Hospital cyber attack
The Coombe is one of the laboratories that processes CervicalCheck samples. The recent cyber attack at the hospital on 16 December 2021 has affected its IT systems. We are working closely with the Coombe and our US laboratory to limit the impact of the attack on the processing of screening samples. However, some people may have a short delay in receiving their cervical screening results. The Coombe will return to processing samples as soon as possible.

Sample taking and COVID-19
We are mindful of the pressures our GP colleagues are under during the fourth wave of COVID-19, and of their commitment to the roll-out of the COVID-19 vaccination programme in late December / early January.

  • We are aware that GP practices and community clinics may have reduced capacity for cervical screening in the short-term.
  • We are advising people who are due a screening test that their sample taker may not be able to offer an appointment for a number of weeks.
  • We are advising our participants that cervical screening is for well people who do not have symptoms. Anyone who is worried about symptoms at any time is advised to contact their surgery immediately, and request an appointment with their doctor. The doctor will advise on next steps.

The majority of cases of cervical cancer develop slowly, over a 10-15 year period. This means that for the majority of people who come for screening regularly, any short delay in screening is not likely to negatively impact their outcome.

We continue to ask that people do not attend their screening test appointment if they are unwell or self-isolating because they have symptoms of COVID-19. People should not attend either if they are a confirmed close contact of someone who has tested positive for coronavirus.

The safety of our participants and all those involved in their care continues to be our highest priority at this time.  

BowelScreen
BowelScreen, the HSE National Bowel Screening Programme, offers population-based bowel screening to eligible people countrywide every two years. 

Since 2020 BowelScreen has matched its capacity to screen with the follow-up treatment capacity of its host hospitals. As we end 2021, all BowelScreen units are scheduling screening colonoscopies. BowelScreen continues to monitor colonoscopy capacity closely and invitations to participate are being issued relative to each unit’s capacity.

The impact of COVID-19 means invitations in our current screening round (where we normally invite people for screening once every two years) are delayed by up to a year.
This means:

  • if a person was due to be issued with a screening test kit in 2020, we aimed to issue their kit in 2021
  • if they were due to be invited to be screened in 2021, we aim to invite them in 2022
  • We are prioritising inviting people who have been waiting for screening longest, and new entrants to the screening programme
  • BowelScreen continues to emphasise the importance of being symptom aware, and for anyone with symptoms to contact their GP who will give them appropriate advice on follow-up care. 

New communication materials
Our capacity to screen continues to depend on the effect of COVID-19 on our capacity to perform follow-up testing in a safe environment. To help reduce the number of repeat colonoscopies due to poor bowel preparation we have created a video on preparing for a colonoscopy which is available to view here

Cancer detection
Most of the time bowel screening looks to detect and remove benign growths (known as polyps). Polyps are small growths that are not cancer but, if not removed, might turn into cancer over time (approximately 10 years). If polyps are found, they can be removed easily. 

In BowelScreen, the number of cancers detected is small (11% of all colon cancers per year) and they are at very early stages. Studies during Covid-19 have so-far shown that a 6 month delay in screening does not adversely affect outcomes.

Diabetic RetinaScreen
Diabetic RetinaScreen continues to report a high attendance rate for screening. We have now invited everyone for screening whose invitations were delayed during COVID-19. We are pleased to note also that all our IT systems have been reinstated after the cyber-attack on the HSE.
This means that:

  • All clinics are continuing to screen
  • All urgent referrals are being prioritised.

However, COVID-19 is continuing to impact the waiting time for follow-up appointments. We are working with hospital clinics to ensure all those who have an urgent referral are seen without undue delay. Those on routine referral may have to wait longer for their hospital appointment, or may have an appointment rescheduled.

We are continuing care pathways for our participants who have retinopathy detected but have not yet been offered a follow-up hospital appointment.

The programme has recently introduced two new screening pathways, digital surveillance screening in the community and two yearly screening.

Digital Surveillance screening will offer monitoring to people who have had retinopathy detected at screening, as follows:

  • People will be invited for monitoring two times a year.
  • Monitoring will take place in an existing screening location.
  • The clinic will take a specialised scan of the eye called optical coherence tomography (OCT). This scan helps find out if [more urgent?] further investigation or treatment is needed.

Two yearly screening will be available for participants whose two consecutive screens had no retinopathy detected. 

New communications materials
A new animated video explaining the diabetic retina screening process is available here

National Screening Service News

Equality report published

In 2021 the NSS set out to share the many ways the organisation is working to reduce inequity to participating in screening. We published our findings in December in the report Working to Reduce Inequity in Screening 2021. The report details the variety of projects we have undertaken to improve access to our services and improve the outcomes for people, who use our service.

National Screening Service Interval Cancer Project
The Interval Cancer Reports, issued in October 2020 by the Expert Reference Groups, outline a new and comprehensive approach to interval cancer evaluations in people who have been screened by Ireland's breast, bowel, and cervical cancer screening programmes. The assessments stated that Ireland's cancer screening programmes meet the highest international standards and help to minimise cancer-related fatalities in the country. They state that world-class screening programmes must create a balance between patient trust, staff recruiting, and cost, and that interval cancers are an unavoidable part of every screening program, despite best efforts. They stress the importance of maintaining our essential public health screening programmes.

The first year of the Interval Cancer project brought together experts from screening services, symptomatic services, healthcare policy, ethics, communications, the legal profession and patient/public advocates to begin planning, design and implementation. This report outlines the significant work accomplished by all implementation groups to establish and initiate implementation. The report says that Year 2 will see the development of an interval cancer rate for both the cervical and bowel screening programmes.

The National Screening Service (NSS) is committed to implementing the recommendations arising from the reports, in partnership with the people we care for, and our professional screening teams around the country.

National Screening Advisory Committee
The National Screening Advisory Committee is seeking a new member in the role of Public Voice representative. A competition has launched on StateBoards.ie to fill this vacancy. 

Information on the role and application process can be accessed via this link. The closing date for applications is Friday 14 January 2022. 

NCRI Report 2021 
National Cancer Registry of Ireland released updated statistics on cancer incidence, mortality and survival for patients diagnosed with cancer in Ireland.

In response, Chief Executive Officer of NSS Fiona Murphy said, "We are delighted to see the ongoing improved survival rates for cancer in Ireland and the contribution screening programmes make through early detection of cancer in breast screening, and cancer prevention in cervical and bowel screening.

"In Ireland, about 5pc of cancers are diagnosed through organised screening, so it is a small but significant contribution to cancer detection. While it will take some years to fully assess the impact of COVID-19, all screening services have restarted and continue to provide an opportunity to detect signs of cancer early." 

The NCRI Annual Report 2021 is available here.

Information Resources
The communications team updated printed materials and videos throughout the year of 2021 to strengthen its information resources across the four screening  programmes.

A series of BowelScreen and colonoscopy leaflets have been produced in ‘easy-to-read’ format to make it easier for people who have additional needs to access bowel screening material. The documents include consent information that is concise and clear; and photo stories that give a clear visual impression of what a programme participant can expect from the BowelScreen service.

BowelScreen’s guidance on supporting people with additional needs can be viewed here

The BreastCheck consent forms have been translated into the following: Arabic, Bulgarian, Chinese, Croatian, Dutch, English, Filipino, French, German, Hindi, Hungarian, Italian, Irish, Latvian, Lithuanian, Polish, Portuguese, Romanian, Russian, Slovak and Spanish.

CervicalCheck have updated their list of information sheets which are now available in over 16 languages. Bengali will be available on the website in 2022. You can view the current list of translated materials here.

We plan to develop multilingual videos similar to our CervicalCheck series for both BreastCheck and Diabetic RetinaScreen in 2022.

Cervical Cancer Prevention Week 2022
As part of our activity for Cervical Cancer Prevention Week 2022, from 17-23 January, the Communications Team is preparing a toolkit for media. We hope this will be a useful resource for writers and fact checkers, clarifying some commonly misused terms; explaining what screening is (and what it is not); and outlining the benefits and limitations of screening.

We will be back in touch in the New Year with details of how you can support our CCPW activity.

If you would like to make a suggestion or comment on any of the above, please contact the NSS communications team at communications@screeningservice.ie

 

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