The National Screening Service’s Programme Evaluation Unit has changed its predictions for the number of cervical screening tests CervicalCheck will carry out in 2022.
Last year we predicted that 295,000 unique women* would have one or more satisfactory cervical screening test in a primary care setting in 2022. These figures were published in the HSE’s National Service Plan 2022 here.
We have now revised that figure to 261,000 women, following a predictive modelling exercise we did in May of this year. The modelling is based on the previous year’s patterns for women attending for screening.
Factors affecting our original predictions for 2022
We made our original predictions in a modelling exercise in August 2021. Predicting attendance numbers was made more difficult by:
- the COVID-19 pandemic and associated pauses in service
- the availability of appointments in GP practices for cervical screening tests
- the legacy of the extra 100,000 women who had out-of-cycle screening tests in 2018
- the introduction of a new screening model, HPV cervical screening, in 2020
- our aging cervical screening register which has limited ability to support accurate forecasting.
Why we decided to reassess our predictions in May 2022
- We have been operating HPV cervical screening for two years now, so we are in a better position to assess our actual recall rates and dates for those being invited for HPV cervical screening.
- The effect of COVID-19 on our services in 2020 and 2021, and last year’s cyber-attack on the HSE, has meant the number of women screened in those years varied considerably from month to month. We now have the total 2021 figures to help us predict more accurately the invite rate in 2022.
- In February 2022 we made our end-of-year calculation for the number of women screened in 2021. We found we had screened around 318,000, which is much higher than the 280,000 we had predicted for that year. The effect of this increase on screening attendances in 2022 was now more evident; fewer women are now due their repeat screen than we envisaged when setting 2022 targets back in August 2021.
How and when we invite women for cervical screening
CervicalCheck is a national cervical screening programme with an eligible population of 1.3 million. Each year women and people with a cervix in the eligible population are invited for screening as their screening test falls due. This is a complex call/recall system with many screening invitation options depending on the person’s age, clinical history, and treatment. Call/recall times range from three months to five years.
This means that CervicalCheck cannot invite people who are not due for an initial or repeat screening, in order to meet forecasted numbers. In addition, while we are responsible for inviting women for screening, we cannot control if or when someone makes an appointment for a test.
Why HPV cervical screening can affect our invite predictions
With HPV cervical screening, those who have HPV found but have no cell changes found on routine screening are invited to return for HPV screening in a year’s time. Under the previous screening test, if you had no cell changes found you were not invited for a 12-month HPV test. You were invited to return for routine screening in three or five years, depending on your age.
We began HPV cervical screening in Ireland in March 2020. In 2021 we made literaturebased predictions on the number of women who would require a 12-month repeat screen for the presence of HPV. We had yet to gather significant Irish population data. By early 2022 we were aware that in the first two years of HPV cervical screening, the rate of HPV found was lower than the literature had predicted. This is meant that the number of women requiring a repeat screen in 2022 would be lower than predicted.
As we move from literature-based predictions to real-data forecasting for HPV cervical screening, the significance of this data will not be confirmed before the end of the first fiveyear HPV cervical screening round.
It is important to us that we reflect the reality of our programme targets as we embed the new HPV cervical screening test in Ireland. We aim to ensure there is accurate reporting of the number of people we are inviting to attend their cervical screening appointment, so that we can more accurately measure the number of people who are eligible yet do not attend.
This level of accuracy will help us work out what we need to do to ensure we maintain an equitable screening service. Working to reduce inequity in screening 2021
If you would like to comment on this article, please contact us at communications@screeningservice.ie
*When we say ‘women’ we include women and people with a cervix