Published: 25/06/2021
Background
It was announced by the Scottish Government this week that an error has led to some women being wrongly removed from the Scottish Cervical Screening Programme. Around 430 women incorrectly excluded from the Scottish cervical screening programme over the last 24 years are being offered fast-tracked appointments with GP practices or gynaecology services following an urgent review of cases.
The issue came to light during a routine audit of cervical cancer data in one NHS Health Board. The 2020 audit identified a very small number of individuals (fewer than five) who developed cervical cancer and were found to have been excluded from the cervical screening programme due to the ‘no cervix/no further recall’ exclusion being opened on their Scottish Cervical Call Recall Screening (SCCRS) record after a hysterectomy.
An investigation found the cervix had not been fully removed and the ‘no cervix/no further recall’ exclusion was incorrectly applied. The individuals affected have already been contacted and informed about the error.
To make sure this issue had not affected anyone else, a review of records held on SCCRS was carried out. This further investigation involved identifying everyone who had been excluded from screening who had a record of having had a subtotal hysterectomy. Their hospital records, laboratory records, GP records and screening records were checked to make sure each individual had been correctly excluded from the programme.
What did the investigation find?
- Some records showed a total hysterectomy had taken place, i.e. the cervix had been removed during the operation. This means these individuals had been correctly excluded from the screening programme. No further action was needed for this group.
- Some records showed a subtotal hysterectomy had been carried out, i.e. the cervix had not been removed during the operation. This means these individuals had been incorrectly excluded from the cervical screening programme. They will receive a letter of apology and an invitation to contact their GP practice to make an appointment for cervical screening if they are within the eligible age range for screening. For those over the eligible age range for screening, these individuals will be invited to attend a clinic appointment with a gynaecologist to find out whether they need to have cervical screening.
- Some records showed it was unclear what type of hysterectomy had been carried out, i.e. it was not possible to tell if the cervix had been completely removed during the operation. This means these individuals will be invited to attend a clinic appointment with a gynaecologist to find out whether they still have a cervix and whether they need to have cervical screening.
Advice for patients in Scotland
The following guidance has been given to GP practices and health professionals to communicate with their patients.
If someone has had a hysterectomy, do they still need to attend for cervical screening?
This depends on the type of hysterectomy they have had.
- If they have had a total hysterectomy, the uterus and cervix will have been completely removed. The individual’s consultant gynaecologist will ensure the necessary follow up. The individual should be removed from the cervical screening programme, so they no longer receive invitations.
- If they have had a subtotal hysterectomy, only the uterus will have been removed. This means the individual should continue to be invited for cervical screening as part of the Scottish cervical screening programme.
Advice for people who have not received a letter, but have had a hysterectomy, and would like to know if they have been wrongly excluded from screening?
Provide reassurance that the overall risk of developing cervical cancer is low and that, in the UK, fewer than 1 in 100 (under 1%) women and people with a cervix will develop cervical cancer in their lifetime.
Advise the first piece of work carried out has only looked at people recorded as having had a subtotal hysterectomy as those individuals should not be excluded for screening and are therefore at most risk. The programme is still working to investigate the records of people recorded as having other types of hysterectomies and find the best way to manage these findings.
It should be noted that most hysterectomies carried out are total hysterectomies, meaning those individuals do not require screening.
Advice for RCOG and British Society for Colposcopy and Cervical Pathology (BSCCP) members across the UK and Ireland
Gynaecologists are reminded of their responsibility to ensure accurate information regarding type of hysterectomy when discharging women to the GP and with advice as to whether the woman needs further screening or can be ceased from the cervical screening programme.
For those working in England, Wales and Northern Ireland, the links to the guidance on ceasing from the programme are available from:
Ceasing and deferring women from the NHS Cervical Screening Programme
Colposcopic diagnosis, treatment and follow up (chapter 4.5)
For the Republic of Ireland:
Opting out of cervical screening
We will provide an update as more information becomes available.
For women and their families who may have further queries about the incident in Scotland, Jo’s Trust have written a helpful blog on their website.