Screening coverage increased from 66.9% to 74.7%, with significant boosts for Māori and Pacific women. Photo / 123RF
By Ruth Hill of RNZ
Gynaecology services have been overwhelmed by thousands of referrals via the cervical screening programme since self-testing was introduced two years ago, pushing out wait times for all patients.
Northland gynaecologist David Bailey said many women skipped cervical screening when it involved the discomfort of a smear test using a speculum.
“But when they are offered the chance just to have a swab test, which they can do themselves, then suddenly a lot of people are getting screening who haven’t been screened for years, and many of them may have had untreated abnormalities for a long period of time,” he said.
“So we’ve been flooded with referrals for colposcopy, which has completely overwhelmed the service, and I’m sure the same thing has happened elsewhere.”
The new cervical screening programme has been incredibly successful in boosting coverage, particularly for Māori, for whom it’s up 19%, and for Pacific women, whose participation is up 34%.
Overall, screening coverage has increased in the past two years from 66.9% to 74.7%. The target is 80%.
Women who test positive for the Human Papillomavirus (HPV) need a colposcopy: a physical examination of the cervix to check for abnormal cells or cancer.
In Northland, the gynaecology service has been forced to shift clinics for people with general gynaecology problems to doing colposcopies instead.
“Because these people are all being referred as possible cancers, they all have to be prioritised.
“So you get a flood of a large number of people who become ‘urgent’ and overwhelm the system.
“And this was entirely predictable because we knew what happened overseas, we knew what happened when there were pilot studies here – but they went ahead and launched the programme with no additional colposcopy resource.”
This was contrary to good screening practice, and the complete opposite to what happened with the bowel screening programme, he said.
“In that case, they did not roll it out in Northland until they had the capacity in place to provide the colonoscopies they knew they would need.”
Bailey said he and his colleagues had been pushing for managers to take staffing and service size seriously for years.
“This is what frustrates us so much – we’re in this situation where things have been building up for years.
“Now that the problem has hit, and this was entirely predictable... we’ve got this unmanageable backlog, and suddenly people are saying ‘We’ve set a national standard and we want this fixed by Christmas, or by June 30’. It’s not real world.”
Specialists in Northland had been doing extra sessions in the evenings and weekends, and drafted in GPs to help.
They also plan to train specialist nurses to do routine colposcopies.
However, Bailey said even if they got more staff, they would not arrive before next year.
Meanwhile, the pressure was unrelenting.
“When we receive a referral for somebody who should be having a colposcopy for a high-risk HPV screening, they should be seen within 30 days.
“Currently our wait time for seeing these people is seven months.”
Health NZ data shows that in the three months to the end of June, only 55.3% of women who tested positive for the two highest risk strains of HPV were being seen within 30 days of referral.
The clinical director for screening programmes, Dr Jane O’Hallahan, said modelling suggested there would be some increased demand.
“But nevertheless we did not imagine it would be to this level.”
When monitoring showed wait times increasing, Health NZ took action, she said.
The Government recently announced $900,000 was earmarked for an extra 1650 colposcopies during the next year.
“We have been addressing this, it’s absolutely important that women who test positive for HPV have access to specialist colposcopy services. So this has been a high priority for us to look at these waiting lists and address this issue,” O’Hallahan said.
Overall, about a third of women who were referred for all types of colposcopy were waiting longer than clinical guidelines, she said.
However, it varied between regions: with 38% overdue in Northland, 15% overdue in Midland/Te Manawa Taki, 21% overdue in Central/Te Ikaroa, and 26% overdue in South Island/Te Waipounamu.
When asked whether it was acceptable that colposcopy referrals had pushed out wait times for other gynaecology patients, O’Hallahan admitted it was “a constant juggle” for specialists and services with competing demands.
“But nevertheless the colposcopy service is an important one and the districts are very skilled at working to ensure that women get the right service.”
Health NZ was looking at ways to “increase capacity to see more patients and faster”, O’Hallahan said.
“We acknowledge it can be distressing for patients when they have to wait to be seen for colposcopy appointments.
“We are working to address this and expect to share more details on that in due course.”
The director of Te Tātai Hauora o Hine/ the National Centre for Women’s Health Research, Professor Bev Lawton, who is based at Victoria University, said multiple experts in the field – including her own institution – had warned Health NZ of the looming capacity problem.
“I think we failed in a sense – we did not put in the capacity: the extra appointments that we knew we would need. It’s not as if we didn’t know.
“And it hasn’t happened. So we have to ask, what is the solution? And it’s investment.”
But Lawton said the peak will pass from the end of next year, because women only need a test every five years.
“But for those women out there who haven’t been seen in a timely way, please ring up, check on your test and see what’s happening. We need to bring more diagnostic capacity into our hospitals to be able to deal with the volume.”
Lawton said long-term, it was hoped the programme “will do itself out of a job”, as vaccination wipes out HPV and early detection and timely treatment eradicate cervical cancer.
“It’s the three-pillar approach. Currently we are doing really well on screening, but we’ve got work to do on vaccination and treatment.”
About 80% of people are exposed to HPV over their lifetime.
Currently only 58% of 15-year-olds are fully vaccinated against HPV, which not only causes cervical cancer, but a range of other malignancies in both genders, including penile cancer, anal cancer and throat cancer.