Big delay in life-saving improvements to cervical cancer screening

A major improvement to screening for cervical cancer has been delayed. Photo/Andrew Labett Hawkes Bay Today

A change that would mean women would need to take a smear test every five years has been delayed until 2021.

Cervical cancer tests were due to this year change to screening for human papillomavirus (HPV), which would mean screening would be required once every five years, instead of the current three.

However, the Ministry of Health has today announced a "phased approach", meaning the change won't likely happen for a number of years.

Dr Jane O'Hallahan, clinical director of the Ministry's National Screening Unit, said a date for transitioning testing to HPV primary screening was still to be decided, "however we're working towards commencing from 2021".

"For human papillomavirus primary screening to be safely introduced the clinical pathways must be supported by a fit-for-purpose IT solution. Simply adapting the current IT system is not a viable option."

A more imminent change will be to raise to change the starting age for cervical screening from 20 to 25 years in 2019. This was decided because there is strong evidence that screening between the ages of 20 and 24 provides little benefit and can cause harm.

This is because human papillomavirus that causes more than 90 per cent of cervical cancers is common in younger age groups and often clears up on its own.

Around 160 women develop cervical cancer each year.

New Zealand currently has liquid-based cytology screening. Former Health Minister Jonathan Coleman announced the change to HPV screening in 2016, saying testing for the virus was internationally recognised as a better primary test for cervical screening, and the change was expected to further reduce cervical cancer deaths by 16 per cent in unvaccinated women.

The Herald has recently reported on tensions between some DHBs and the Ministry over low cervical cancer screening coverage rates, particularly for Māori.

DHBs have a responsibility to reach target coverage of 80 per cent of eligible women screened for cervical cancer. Only three of 20 DHBs are meeting the target. Coverage has worsened in 15 DHBs.

Auckland DHB screening coverage for both cancers is the worst in the country and has been dropping since 2016. Just 66 per cent of women aged 25-69 had a cervical smear in the three years to March 31 – meaning 51,365 women were missed.

Nationally, cervical coverage is 74 per cent. Three of 20 DHBs - Nelson Marlborough, Taranaki and Bay of Plenty – are over the 80 per cent target.

Cervical coverage is just 55 per cent for Māori women in Auckland. Screening for Māori has worsened in 17 of 20 health boards.

The national cervical screening programme is largely provided through GP and family planning and sexual health services. It's not fully funded and women make a co-payment, the cost varying by practice and whether a GP or nurse performs the test.