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Guest Blog: Helping to save lives by increasing the uptake of cervical cancer screening

Written by: Louise Flanagan - 2nd June 2021

Our Health Innovation Exchange events bring industry innovators and NHS stakeholders together to explore and discuss healthcare challenges. In this blog, Louise Flanagan from Yorkshire Cancer Research discusses the joint showcase event we hosted together, exploring innovative work taking place to increase the attendance at cervical cancer screening.

Sadly, people in Yorkshire are more likely to have their lives cut short by cancer than almost anywhere else in England. The county has significantly higher cancer incidences and mortality rates compared to the England average and has done for  the past 15 years. That is why at Yorkshire Cancer Research, we are committed to funding research that will help the people in our region live longer, healthier lives. Our goal is that by 2025, at least 2,000 more people in our region survive cancer every year.

Two key areas of the work we fund to achieve this goal are the prevention and early diagnosis of cancers; part of which is funding programmes that help improve knowledge of signs and symptoms and increase participation in vital screening that identifies cancer at the earliest stage when it is easier to treat.

Across England, there are three national cancer screening programmes. These are for breast, bowel and cervical cancers. These programmes improve survival rates by finding cancer early. Bowel and cervical screening also detects pre-cancerous cells, which can then be treated to prevent cancer from developing in the first place. There is significant local variation in screening attendance; in some areas of Yorkshire, cervical screening is as low as 20%. There are many reasons for non-attendance at screening appointments, including embarrassment, cultural barriers, deprivation and, more recently, worries about COVID-19.

With all of this in mind, we brought together stakeholders from across the country to hear about innovations in cervical screening and open up discussions about future collaborations to try and tackle the issues surrounding the high levels of non-attendance in cervical screening that we see in some areas of Yorkshire.

Together with the Yorkshire & Humber AHSN, we set up a virtual cervical screening showcase event. There was a great lineup of speakers on the day and we heard about lots of innovative pieces of work that are being conducted around the country.

Currently, in England, cervical screening is offered to all women aged 25 to 49 every three years and every five years up to the age of 64. In 2019, the programme changed from checking all samples for cell changes to primarily testing for the presence of Human Papilloma Virus (HPV), which causes almost all cervical cancers. If samples test positive for HPV, the sample is then checked for changes to the cells of the cervix.

Dr Anita Lim of King’s College London spoke about a clinical trial she is leading called YouScreen, which will test whether offering HPV home-testing kits can increase participation in screening. The kits will be provided through the NHS cervical screening programme across London-based GP practices where screening attendance is particularly low. It aims to recruit over 31,000 women who are at least six months overdue on their cervical screening and will invite them to take the test in the privacy and convenience of their own home. The test kits are posted or given out by the GP and are returned by post once completed.

Clare Gilham from the London School of Hygiene and Tropical Medicine presented the work she has been conducting, which looked at the large number of women, aged 65 and over, who are no longer included in the cervical screening programme and have never had their samples tested for the presence of HPV due to the recent introduction of HPV primary testing. Women currently being discharged from the screening programme with a negative HPV test are at extremely low risk of ever developing cervical cancer. However, almost half of women dying from cervical cancer in England are aged 65 or over and are no longer being screened, so most of their cervical cancers are diagnosed at a late stage. It is now known that those women who were discharged from the screening programme without having been tested for the presence of HPV would be at much lower risk if their final screen had been an HPV test rather than the previously offered smear test, which tested only for cell changes. Clare and her team are now looking to conduct a feasibility study into the impact of offering ‘catch up’ HPV screening to this group of women.

We also heard from Alex Cocker and Lisa Hammond who are Screening and Awareness Coordinators for the Cancer Wise Leeds programme, which is funded by Yorkshire Cancer Research and aims to improve screening rates in areas of the city with low participation. They talked about the establishment of a weekend screening hub within the Bramley Wortley and Middleton Primary Care Network which has allowed women with work and childcare commitments to attend their screening appointment at a more convenient time. They showed us videos they have produced to reassure women about the safety precautions put in place during the pandemic. The videos have been translated into a number of different languages and have subtitles in order to increase the accessibility of these materials.

The event was well attended by a mix of primary care, public health and academic representatives. There were interesting discussions about how existing innovations could be rolled out more widely across Yorkshire and around new innovations that could tackle some of the specific problems seen in our region. The introduction of HPV primary testing is a positive change to the national screening programme. However, more resource and funding is needed in this area. Following on from this showcase event we will be building partnerships and proposals to test new ways to increase cervical screening across the region.

If you missed the event, you can watch the recording here.