10 May 2021

IT issues holding up cervical test rollout 'unacceptable' - GP

From Checkpoint, 5:42 pm on 10 May 2021

It is not acceptable that computer technical issues are holding up the rollout of the do it yourself cervical cancer screening tests, the clinical director of one of the largest GP cop-operatives says.

The government is committing $53 million to making self-testing swabs for the HPV virus available, but not for two more years.

The kits will mean women can do the test in the privacy of their own home, rather than a smear test done by a GP.

According to the government, one of the reasons for the delayed rollout is the need to build and test a new computer database for the screening programme.

ProCare Health represents more than 170 general practices around greater Auckland. Clinical director Dr Allan Moffitt told Checkpoint the self-test is a lot less invasive than a full examination.

"Basically the self-test is a swab, which is a little cotton bud at the end of a stick that you insert into the vagina, and get some cells.

"It's looking for a virus called Human Papilloma Virus, because that is a virus that leads to, or causes cervical cancer. There are very, very rare cases of cervical cancer that aren't related to that virus but pretty much it accounts for the vast majority of women that go on to get cancer.

"So no virus, no need to have a smear. However, if the test is positive for the virus, then you still need to go and have a proper smear done, so it's not a full replacement, but as a screening test, it's highly accurate, and a lot less invasive than having to have a full speculum examination.

"It's relatively new technology, but having said that, we've known now for at least two years that this is gold standard internationally, and it was looked at here several years ago.

"I think there were both financial and some logistical reasons as to why the government hasn't adopted it.

"ProCare has written to the minister and Director-General about prioritising this ahead of other things because it's a huge impact on equity to get a more accessible test to people.

"They wrote back … to say it's not yet prioritised, and my understanding is there are delays on the Cervical Screening Register which needs to be updated, and that can't be updated until the National Immunisation Register is in place, which is now the Covid-19 Immunisation Register that will become the National Immunisation Register.

"I think bowel screening is actually ahead of the cervical screening register… So that's the stated reason as to why it can't be done sooner."

Basically he said it is computer database issues that is slowing access for women to better health services.

"This is why we've written, on several occasions actually, to escalate this issue. I know most of the primary health organisations in Auckland and some of the DHBs as well, have been stating that from an equity point of view, it's really important to get access to this test.

"It does screen out the need to do a full smear test on the majority of women.

"I think it has taken too long, hence why we've been agitating to have it prioritised, but having said that the sooner the better.

"The really important thing is that this will open up to a large number of women who for whatever reason have not wanted to have a smear test done or been able to get a smear test.

"It's a lot less invasive, it's something that can be done in their own home and then just handed in to the laboratory or to the doctor's surgery.

"Yes people can come along and have it done in the surgery if they want to, but it can just be done by themselves. It's very simple, but it's important that if they test positive, or indeed if you've had an abnormal smear before, you still need to go along and have the full smear test or colposcopy done."

Dr Moffitt said technically GPs could ask for an HPV sample, but it is not part of a national screening programme.

"I think the labs would not process it currently if they had an inundation of a whole lot of tests without good clinical Indication.

"In other words, as part of a screening programme, the labs aren't funded to provide it.

"In the meantime it's really important that the woman still go and get a smear test done, and know that they're safe in the interim.

"If the smears are normal then they can leave the swabbing test for another three years.

"For anybody that's in the high-risk group, they really should go and get smeared. And very importantly, if they have had an abnormal smear before or a high-grade abnormality, those women are most at risk and they definitely need to go and see the GP or nurse, and have a smear test done."

Dr Moffitt said the delays to a cervical register because of IT issues is not acceptable.

"It's absolutely a safe test, it's the gold standard. We've known that now for a couple of years. New Zealand was part of the trials that looked at this and we can have real confidence that the test is a gold standard test to have.

"It certainly is preferable and cheaper and better than having a smear test done."