Cytopathology is the study of cells in body fluids, smears and tissue samples, for example the study of cervical smears for the detection of changes in the cervix that could lead to cancer.
Cervical Screening Programme
There have been significant problems with communication and delivery of the cervical screening during the pandemic. Specific points are:
Women were receiving invitations for screening at the same time as general practices were being told they should only see patients if urgent. This was interpreted differently in different areas and different practices. This meant that women’s experience was inequitable. Some women may well have had a test taken by staff wearing full PPE.
The NHS in Scotland, Wales and Northern Ireland took a public decision to defer screening appointments but no such decision was reached nationally by NHS England. This resulted in further confusion and uneven implementation.
The cervical screening call and recall IT system was unable to be easily modified and a “hold” on cervical screening appointment letters was only implemented in mid-April.
There has been no agreed information resource available for women to support them in their decision whether to seek screening or not.
Guidance, where it existed, was poorly communicated, and some was not shared at all even though it was produced. NHSEI laboratory testing cell produced guidance which was sensible and was jointly published with the Royal College of Pathologists and Institute of Biomedical Science, however the screening part of NHSEI knew nothing about this.
Throughout, laboratories and other providers of cervical screening have had to take decisions in a timely way regarding the risk of continuing to screen or not, because NHS guidance was lacking. In some areas, HPV testing was completely stopped and converted to COVID-19 with no planning for continuity of HPV testing.
So in summary, cervical screening has been inevitably impacted by the COVID-19 pandemic and trusts have done their best to respond to the pathology requirements, but leadership from NHS England has been slow, unclear and unhelpful. This has led to confusion and anxiety for women, and inequity in delivery of the screening programme. There is an urgent need for the screening programme to agree and publish expectations of providers in delivery of cervical screening in a timely way. This includes clarifying the current position and then in moving to a much more ordered return to normal function. As, and when, the cervical screening programme recommences, there must be sufficient capacity to restart the programme, as well as undertake whatever level of COVID-19 testing is required. This may require more testing platforms or a different approach using new or existing platforms.
Post COVID-19 cytology
Changes identified during COVID-19 that should be considered as part of the “new normal” post pandemic are:
Cytopathology SC Chair