Cervical Screening

Problem Statement

The National Cervical Screening Programme was established in New Zealand in 1990. Since then, the number of women who develop cervical cancer and the number of women who die from it has reduced by 60 percent. Having regular cervical smear tests continues to be a woman’s best protection against developing invasive cervical cancer.

The incidence of cervical cancer among Maaori, Pacific and Asian women remains higher than that among European and Other ethnicities. One of the primary reasons for this is lower rates of screening coverage among these groups. There are many barriers for women attending their cervical smear, including embarrassment, shyness, cost, fear (for example, of cancer, pain or discomfort), lack of knowledge or understanding about the programme, and not knowing what to expect. The cervical screening programme is not free for most participants.

The Ministry of Health’s target for participation in the National Cervical Screening Programme is 80 percent. Total coverage for CM Health, as at 30 June 2019, was:

• 66.2 percent for 25 to 69 year old women as a whole
• 61.5 per cent for Maaori women
• 68.1 percent for Pacific women
• 66.2 percent for Asian women
• 67 percent Other ethnicity women.
• We need to increase cervical screening coverage across all groups, with the priority groups being Maaori, Pacific and Asian women, and women who have never been screened or are under-screened (it is 5 years or more since their last screening).

What are we trying to achieve?

Our goals are to achieve 80 percent participation of eligible women in the National Cervical Screening Programme, with equitable coverage across all ethnicities.

What have we done?

The CM Health high-needs cervical screening coordinator and the Support to Screening team are focused on improving communication, collaboration and coordination of activities across the district and region, to improve coverage rates for women in the priority groups. Many of their activities integrate with promotion activities for the BreastScreen programme, thereby providing a more holistic model of care.

Key activities include to following.

• Allocating funding for free smears to primary health organisations (PHOs), based on the numbers of priority women who reside in the PHO area and the previous year’s use. CM Health currently funds primary care to carry out an additional 1,000 screens for priority women, above those funded by the Ministry of Health.
• Promoting cervical screening to primary care, providing support and advice, holding information sharing forums and providing various newsletters to health professionals.
• Along with Auckland and Waitemataa district health boards, our cervical screening coordinator updated the cervical screening and human papillomaviruses (HPV) guidelines on Auckland regional health pathways for GPs and practice nurses to use.
• Supporting and coordinating the Metro-Auckland Cervical Screening Operations Group. All PHOs, Support to Screening service providers and Family Planning have continued to participate regularly in the group’s meetings, which also have input from nurse and GP smear takers. The group shares initiatives to increase coverage rates for priority group women; discusses and addresses barriers to increasing coverage; and maintains and promotes the Metro-Auckland Cervical Screening website, in order to share resources and information.
• Working with PHOs, practices and the National Cervical Screening Programme Regional Register Team, to ensure the National Screening Unit data-match lists are interpreted effectively. This enables unscreened and overdue women to be identified from the enrolled, eligible population.
• Supporting PHOs and practices to use the data-match lists appropriately, and to prioritise women for invitation and recall, based on clinical risk and ethnicity.
• Working with PHOs to ensure all practices get access to the data-match lists.
• The CM Health Screening Support service focuses on providing services to priority women. Its key activities include the following.

• Employing Maaori, Pacific and Asian community health workers to provide support for women to attend screening. The services also employs two cervical smear takers.
• Encouraging referrals for priority women to the service.
• Supporting practices to use opportunistic screening strategies and to refer priority women to community clinics coordinated by the Support to Screening service.
• Supporting practices with no female smear taker, by recalling and screening women.
• Providing support to primary care to increase coverage for priority group women. The focus has been on improving the systems and processes used for invitation and recall, as well as updating PMS data.
• Promoting the National Cervical Screening Programme through community health promotion events for priority women, ethnic-specific radio, billboards outside Middlemore Hospital and social media.
• Coordinating Saturday morning Mana Wahine days and Friday full-day clinics (8.30am to 6.30pm) at the Manukau SuperClinic for priority women. The focus is on women who self-refer or have been referred by their GP. Women attending breast screening at the Manukau SuperClinic are also offered cervical screening at these clinics (if eligible).

Providing free smears in community clinics in areas where priority women reside, and coordinating clinics that are co-located with the BreastScreen mobile unit.

What did we find?

Unfortunately we are seeing a decrease in coverage across all population groups.

While coverage has decreased, the PHOs have noted that there is:

• greater collaboration to increase the availability of affordable cervical screening services for priority group women
• increased capacity and capability among smear-taking nurses.

There has also been positive feedback from the practices that are referring priority women to CM Health’s Screening Support service for follow up and screening. Very positive feedback is also regularly received from Maaori women attending Mana Wahine days.

How did we make a difference?

Cervical screening coverage is continuing to decrease.

Where to from here?

In addition to the strategies already implemented, the following strategies are planned for the 2019/2020 year.

• Increase promotion of the National Cervical Screening Programme to GPs and practices, and support them to recall and encourage priority group women to have screening.
• Increase cervical screening focus by Screening Support Service to ensure clinics are attended by priority group women.
• Continue hosting the Mana Wahine days for Maaori women, and take them to different locations in the community.
• Continue to run community smear clinics in areas with high proportions of priority women.
• Liaise with Family Planning, colposcopy teams, Maaori, Pacific and Asian health and health promotion teams, the Primary Care Nurses Forum, and HPV teams to identify and develop strategies to increase coverage in priority populations.