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Major Milestone For NCSP

Major Milestone For NCSP As First Quarterly Monitoring Report Released

The first quarterly monitoring report for the National Cervical Screening Programme (NCSP) was released today, showing a continued strong level of support for the programme from New Zealand women.

NSU Clinical Director Dr Julia Peters says the report, which covers the three months from October to December 2000, provides the first routine monitoring report against selected national indicators.

The report shows that there were 979,819 women aged 20-69 years enrolled on the NCSP-Register or 91.5 per cent of the eligible population excluding women who have had hysterectomies. The report also shows 73.1 per cent of eligible women, excluding those who have had hysterectomies, have had a smear recorded on the NCSP-Register in the past three years.

The report calls for the continuation of efforts to further increase both programme enrolment and coverage.

"New Zealand women continue to show a strong commitment to the Programme. It is important that they are aware of the improvements made in the past few years and that continue to be made. Routine monitoring is one of these improvements," Dr Peters says.

Dr Peters says the NSU will be working with providers to the National Cervical Screening Programme to address any issues that are identified in the reports.

"The report shows that all laboratories have met the target for the detection of high grade abnormalities - which means the programme is detecting highly abnormal lesions enabling timely and effective treatment," Dr Peters says.

"For example the report shows that some laboratories are showing slow turnaround times for providing results back to smeartakers. These issues are currently being addressed," she says.

"The establishment of the NCSP's independent monitoring arm is a key quality assurance measure and compliments the rigorous NCSP Operational Policy and Quality Standards, which were sent to programme providers in October last year. Routine monitoring is a key factor in ensuring ongoing quality and enabling the identification and resolution of problems at an early stage," Dr Peters says.

The NCSP Operational Policy and Quality Standards and the NCSP Monitoring Plan, which outlines the role of the Independent Monitoring Group, were endorsed by the Gisborne Inquiry, which called for their implementation within twelve months.

Cervical cancer usually takes ten to fifteen years to develop. Because the cells in the cervix usually change before they become cancerous, early detection of these changes through screening programmes enables early treatment.

"The message for New Zealand women is still the same. All women aged 20 to 69 years should have regular three-yearly smears," Dr Peters says.

Cervical screening has had an impact - in the ten years from 1987 - 1997 cervical cancer rates have dropped by 39 per cent. Over the same period the death rate for cervical cancer dropped by 44 per cent.


Background Information - National Cervical Screening Programme (NCSP)

Why screen? Unlike most cancers the most common type of cervical cancer - squamous cell carcinoma - is largely preventable. Cells in the cervix go through changes, which if not detected and treated may develop into cervical cancer in some women. Cervical cancer takes on average 10 - 15 years to develop. A cervical smear test can detect changes in the cells of the cervix. The success rate for adequate treatment of abnormal cervical cells, also called pre-cancerous changes, is around 98 per cent effective. As with all screening tests there is a small chance that some abnormalities may not be detected at a single screen. This is why it is important to have regular three-yearly cervical smear tests.

Who needs cervical screening? All women aged 20-69 years who have ever been sexually active. The usual screening interval is every three years for women with normal smear results. The women most likely to develop cervical cancer are those not regularly screened.

What is the National Cervical Screening Programme (NCSP)? The National Cervical Screening Programme was the first organised cancer screening programme in New Zealand. It was established in 1990, by the then Department of Health, to reduce the incidence of and mortality from cervical cancer through a nation-wide ongoing organised screening programme that would detect the majority of cases in the early precancerous curable stage. The NCSP encompasses health promotion, smeartaking, laboratory analysis of cervical smears and cervical biopsies and management of women with abnormal smear results. The NCSP is delivered to New Zealand women by a range of providers including health promoters, general practitioners, gynaecologists, nurse and lay smear-takers, family planning centres, midwives and laboratories. Regional co-ordination of the NCSP, which includes the operation of the National Cervical Screening Register (NCSR), is managed through 14 sites linked to a central database. A total of 421,427 smears were taken from 395,185 women in 1999. The recruitment focus of the NCSP is on women aged 20-69 years who have never had a smear or whose previous smear was more than five years ago. Women aged over 50 years and Maori and Pacific women of all ages are priority groups in the programme.

What is the aim of the programme? The aim of the programme is to reduce the incidence of and mortality from squamous cell cancer of the cervix. The number of women developing and dying from invasive cervical cancer has declined since the 1990s, and much of this decline can be attributed to the NCSP. In the ten years from 1987 - 1997 cervical cancer rates have dropped by 39 per cent. Over the same period the death rate for cervical cancer dropped by 44 per cent.

How does the NCSP work? Cervical smears are sent by smeartakers to laboratories for analysis. The laboratory reports the result to the smear-taker and sends it to the National Cervical Screening Register (NCSR). A 'welcome' and results letter is sent to a woman after the NCSR receives her first smear, thereafter she will be sent a result letter only if her smear result is not normal. If a woman is overdue for her smear the NCSR will send her a reminder letter. The NCSR sends a number of reports to smear takers to aid them, including a recall report, which reminds them of women due for cervical smears. Women can contact their local NCSR site to inquire if they are enrolled or for any other information about their cervical smears.

What is the National Cervical Screening Register (NCSR)? The NCSR is a key management tool of the NCSP. It is a stand-alone system that records and provides information to assist individual women and their smear-takers with appropriate follow up, as well as providing data for monitoring and evaluation. Provided they do not "opt off" it should contain a complete smear history for women enrolled in the NCSP. This information is made available to cytology laboratories, smear-takers and the women themselves.

How many women are enrolled on the NCSR? At of 31 December 2000, there were 979,819 New Zealand women aged 20 - 69 years enrolled on the NCSP. This figure represents some 80.6 per cent of eligible women or 91.5 per cent when women who have had hysterectomies are excluded.

How have cervical cancer rates changed since the NCSP began? Since the programme began there have been significant reductions in both the rates of disease and deaths from cervical cancer. In the 10 years from 1987 - 1996 cervical cancer incidence rates decreased by 22 per cent. From 1987 - 1996 the death rate for cervical cancer dropped by 43 percent. Age-standardised incidence rates for cervical cancer have declined from 13 per 100,000 in 1988 to 9.2 per 100,000 in 1998. Age-standardised mortality rates for cervical cancer have declined from 4.9 per 100,000 in 1988 to 2.9 per 100,000 in 1997.

What actions have been taken to strengthen the NCSP? The HFA's National Screening Team took over the management of the NCSP in May 1998. Following a review of the programme an additional $1.4 million was injected into the NCSP during the 1999/2000 year to strengthen elements of the programme. These areas included improved quality standards, new independent monitoring processes, improved co-ordination between providers and better information for women and training for health educators. The National Screening Team transferred to the Ministry of Health as a separate unit - the National Screening Unit (NSU) - within the Public Health Directorate in January 2001. It is currently being enhanced to have a full staff of 33 to manage the two national screening programmes.

What quality assurance mechanisms does the NCSP require from laboratories? In October 2000 the National Screening Unit introduced the NCSP Interim Operational Policy and Quality Standards. The standards were the product of eighteen months work and substantial consultation with women and service providers. Some 6000 copies were distributed to all health providers in the programme including health promoters, smear takers and providers of laboratory and colposcopy services. The document includes 22 laboratory standards which cover a wide range of areas including minimum staffing numbers, training of staff, minimum volumes for laboratories, pathologists and cytotechnologists and other quality control and quality assurance measures. Laboratories are required to process a minimum of 15,000 cytology smears a year as from 1 July 2001. This is an important factor in ensuring quality of care for women enrolled in the programme. A review of the interim standards will be commenced within a year to take into consideration any issues that may arise for providers during this time and the Gisborne Report.

What external expert advice does the NCSP draw upon? A multi-disciplinary Expert Advisory Group to the national cancer screening programmes was established in December 1998. Its purpose is to provide expert advice on strategic policy issues and programme monitoring and evaluation as well as other technical advice when required. Importantly this group provides a consumer perspective to ensure the needs of women using the programme are met.

What monitoring is in place for the NCSP? An Independent Monitoring Group was contracted in September 2000. It has commenced routine monitoring of the NCSP and will provide its first quarterly monitoring report in May 2001. Routine monitoring of the NCSP will ensure providers are meeting standards and will enable identification and resolution of problems at an early stage.

For further information contact:
Kallon Basham, National Screening Unit
DDI: 04 496 2385; Mob: 025 897 521

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