National Cervical Screening Programme (NCSP) screening updates

Cervical screen takers may have received an incorrect follow-up recommendation for patients with a history of invasive vaginal or cervical cancer, screened between September 2023 to June 2024. The total number of patients affected across the country, is less than 1,000. 

The recommendation they should have received is:

This person has been unenrolled from the NCSP Register due to previous cancer. Please consult your local gynaecology service for advice on follow-up or further HPV/cytology testing. 

The National Cervical Screening Programme will notify the screen taker, by email to the practice, but for privacy reasons could only include the patient NHI. Technical limitations mean they were unable to send this as an amended lab result. A copy of the letter is below: 

Kia ora [Screen taker’s Name],

Re: [Patient [NHI] 

We are writing to let you know you received an incorrect follow-up recommendation for the above patient, who has a history of invasive cervical or vaginal cancer. 

Testing after invasive cervical cancer is not screening, therefore the National Cervical Screening Programme (NCSP) no longer provides testing recommendations. Follow-up should be guided by the treating specialist. 

The correct recommendation for this patient is:
This person has been unenrolled from the NCSP Register due to previous cancer. Please consult your local gynaecology service for advice on follow-up or further HPV/cytology testing.

Please update your recall records accordingly and share this information with your patient. 

Please check specialist letters or reach out to your local gynaecology service if guidance is needed regarding further HPV and/or cytology tests. 

For technical reasons we were unable to send this as an amended lab result. This amendment is due to a change in policy in June 2024, not an error by the lab. 

We apologise for any inconvenience.

ENDS

Policy update (June 2024):

• The National Cervical Screening Programme (NCSP) no longer provides follow-up recommendations after invasive cervical or vaginal cancer (except early-stage superficially invasive cases).
• Testing decisions are now made by the treating oncologist, not NCSP.
• Individuals with a history of invasive cancer are unenrolled from NCSP. Their records remain and continue to be recorded on the NCSP Register, but no reminders or case tracking will occur.
• Laboratory reports will no longer include follow-up recommendations.

Please note the upcoming cervical screening updates to the BPAC Patient Prompt and BPI report (both linked below) due for release on, or soon after, 26 March. Please see these reference documents for the relevant updated changes. For any queries or issues please contact itservicedesk@bestpractice.org.nz.

This guidance came into effect on 1 July 2024. Zero-fees routine cervical screening, irrespective of whether an HPV self-test or cervical sample is used, is available for the following groups for screening.

• All women and people with a cervix aged 30 years and over who are un-screened (i.e. they have never been screened for cervical cancer).
  • This includes women and people with a cervix aged 70 to 74 years who have never been screened.
• All women and people with a cervix who are under-screened (please refer to page 3 for the definition of under-screened, including for people that are immune deficient).
  • This also includes women and people with a cervix aged 70 to 74 years who have not had:
    • two consecutive normal cervical cytology results between 62 to 69 years, OR
    • an ‘HPV not detected’ result in the five years prior to age 70.
• All wāhine Māori and whānau with a cervix aged 25 to 69 years.
• All Pacific women and people with a cervix aged 25 to 69 years.
• All women and people with a cervix aged 25 to 69 years who hold a Community Services Card.
• All women and people with a cervix under 25 years who are already part of the National Cervical Screening Programme (e.g. they commenced screening before the screening age was lifted from 20 years to 25 years), AND who are Māori, Pacific, or hold a community services card.

HPV and cytology testing following treatment for cervical and vaginal cancer is not screening. Because of this, anyone with cervical or vaginal cancer was unenrolled from the previous NCSP Register and communications were turned off.   

People who have had early-stage cervical cancers which have been treated by: 

• local excision (i.e. LLETZ) – these participants will return to regular cervical screening after successful treatment and completion of a Test of Cure
• a total hysterectomy – these participants can cease cervical screening after completing a Test of Cure. 

With the exception of the above groups, the NCSP will automatically unenroll anyone with a history of cervical or vaginal cancer and will not be making recommendations on tests received for this group.   

For those who are unenrolled because of previous cancer, there are no restrictions on continuing to have HPV or cervical cytology tests. This should be determined by the clinician and the participant. Labs will no longer give recommendations for further screening when reporting these tests.   

Women with gynaecological cancers who have had a sub-total hysterectomy need to continue screening and will continue to receive notifications from the NCSP Register.  

Some participants who had previously ceased screening after an early-stage cancer in the previous programme may now be recommended to return to screening or to complete a Test of Cure. These participants will receive reminders from the NCSP and will be included in the PHO Cervical Screening Status Report. 

Who may need further testing?

• For many people diagnosed with gynaecological cancer, their specialist will recommend no further HPV or cytology testing . In particular, testing is not recommended after pelvic radiation. This is because of the difficulty in assessment due to radiation changes, and the risk of complications such as fistulas. 
• Some participants who had previously stopped screening after an early-stage cancer may be recommended to return to screening or to complete a Test of Cure. These people will receive reminders from the NCSP and will be included in the PHO Cervical Screening Status Report. You will receive communications regarding these people from your regional coordinator or PHO.  
• Some people with a history of more advanced gynaecological cancer may be advised by their specialist to continue having tests, however the labs will not be giving recommendations based on the test result. Determining the need for follow up and further testing should be made by the ordering clinician.   

If you need advice on a specific individual, refer to the discharge letters from specialist gynaecologists or contact the treating oncologist. If this is not possible, contact your local gynaecology services for advice on individual cases.   

If you have a participant with previous cancer who you think has been allocated to the wrong pathway, please contact info@ncspregister.health.nz.  

Te Whatu Ora's cervical screening reports now include people aged 70-74 eligible for screening.

Previously only 70–74-year-olds enrolled in primary care who had at least one cervical screen but had not met the exit criteria were included.

This will now also include ALL UNSCREENED 70–74-year-olds as well.

Unscreened people aged 70-74 will appear on the PHO cervical screening status report with:

• screening status = unscreened, over 25 years old
• programme status = registered
• pathway status = registered
• next expected event = HPV screening test
• next expected event due date= 01/01/2000 (not actual date, included as a flag).

Unlike participants aged 25-69 years old, unscreened people aged 70-74 years will not receive letters from NCSP inviting them to screen. 

Offer an HPV test if their programme status is ‘Registered’ or ‘Enrolled’ on the NCSP Register and the PHO cervical screening status report. Those aged 70-74 years who are unscreened or who have not met the criteria to exit the cervical screening programme can access free screening. 

Those with an ‘Unenrolled’ programme status on the NCSP register and the PHO cervical screening status report.  

Screening for asymptomatic people aged 75 years and over is not recommended and anyone who is symptomatic should see their GP. 

We have excluded participants who are on the NCSP Register for cervical screening purposes but are deceased as per the NHI. If a participant in your region/practice is now showing as unscreened with a programme & pathway status on the NCSP Register and you know them to be deceased, please contact your NCSP Regional Register Coordination team.

The new NCSP Register is population based and automatically includes anyone in the programme, who is aged 25-69 and whose NHI gender is recorded as female. 

The NCSP Register receives gender information from NHI data and uses ‘gender’ for baseline eligibility for cervical screening. 

Where someone’s needs are different to what their gender data suggests, ‘Sex assigned at birth’ can be manually entered in the NCSP Register. 

Transgender men (identify as male, assigned female at birth) or non-binary people who have had a cervical screen or colposcopy in the past, will automatically be included in the programme and will follow the cervical screening pathway. 

Transgender men and non-binary people who have a cervix but have never had a cervical screen, while visible in the NCSP Register, will not automatically be included in the Programme unless the ‘Sex assigned at birth’ is updated to ‘Female’. This means they may be unaware they are eligible for cervical screening and the importance of getting screened. They will not receive NCSP notification letters and will not appear in PHO status reports unless their sex assigned at birth is in the NCSP Register. 

Transgender women (identify as women, assigned male at birth) whose sex assigned at birth has not been entered in the NCSP Register, will receive notification letters even though they don’t require screening, unless ‘Sex assigned at birth’ is updated to ‘Male’.

he National Cervical Screening Programme recognise that transgender women may find reminders and other communications around cervical screening confronting and ask health care providers to minimize discomfort around this by ensuring their patient’s sex assigned at birth is correct in the NCSP Register. 

If you have transgender or non-binary patients, please check their sex assigned at birth is recorded in the NCSP Register. Clinicians or individuals can update their sex assigned at birth via email: info@ncspregister.health.nz or phone 0800 729 729. 

To support you in your kōrero with people round cervical screening, Rainbow resources have been developed which can be downloaded or ordered from HealthEd. 

Thank you for your mahi in ensuring the NCSP serves the needs of the transgender and non-binary community. If you have any questions, please contact HPVScreen@health.govt.nz.

An ‘overdue’ reminder and an apology letter has been sent to 2,913 participants who had a previous abnormal result and should have received a 3-month reminder between 25 September and 3 November. This delay was due to changes in the NCSP-Register when the new HPV Primary Screening test was introduced. A copy of the letter of apology can be found in the files section at the bottom of this page.

Note: Participants will likely have received a reminder communication from their primary care provider in the meantime.

Please advise anyone with concerns, that for most people this delay will not be significant and encourage them to book their follow-up appointment as soon as possible. If they have further questions, direct them to the helpline 0800 729 729.

Notifications messages

As part of the continuous improvement of HPV Primary Screening, the National Cervical Screening Programme (NCSP) has commenced sending the below notifications from the NCSP-Register to participants via mail. 

Eligibility notifications

Eligibility notifications are being sent to anyone eligible for cervical screening who: 

• reaches 25 years of age (due for their first screen)
• is new to the NHI system. 

There has also been a one-off eligibility mail out to participants who are Māori or Pacific, over 30 years and, not enrolled in primary care and have never been screened or haven’t been screened in the last 5 years.  

The NCSP-Register is now a population-based register that enables notifications to be sent to people eligible for cervical screening but not yet enrolled in the NCSP.  Notifications are integral to welcoming participants to the NCSP, clarifying options available to them and how to opt-out if chosen.    

This eligibility letter is a new letter that has not previously been sent for Cervical Screening. Regional Coordinators and Screening Support Services can expect to receive an increase in queries from participants. A copy of the letter can be found in the files section at the bottom of this page.

Reminder letters

Because it’s taken longer than anticipated to enable letters in the Register, a catch-up for delayed 6-month reminder notifications for routine screening was sent to 9,659 participants this week. A further 17,511 ‘catch-up’ reminders for routinely screened participants who are 3-6 months overdue for screening will be sent to participants on January 18, 2024.

For those of you who were unable to attend the session, view a recording here. The presentation is liked tho the files section at the bottom of this page.

Key messages to share with practices from the PHO hui

• Please continue to focus on the unscreened and under-screened people in your practice, and those requiring follow-up tests. These groups can be easily identified via your PHO Cervical Screening Status report, sent monthly to your PHO.
• It is important that screen takers provide participants a choice between having a cervical sample vs a self-test for their cervical screen
• Send one test per person - either an LBC or swab test (not both). The swab can only be tested for HPV.
• RNs working in professional partnership must order HPV tests under the responsible clinician’s HPI number
• The NCSP Register team is working closely with the labs to issue amended reports where incorrect recommendations were given.
• Remember to prescribe oestrogen cream before colposcopy appointments for post-menopausal participants
• Rainbow resources are now available electronically. Paper resources are expected early in 2024
• Translations into Pacific languages are underway, further languages expected in the first few months of 2024
• Clinical advice is available from the Clinical Nurse Lead-HPV, an experienced screening nurse who has access to the NCSP Register; you can access this advice on 0800 729 729. 

Workforce expansion key messages

Taking on the HPV Screen taker role is optional for enrolled nurses, registered nurses, and nurse practitioners (who are not accredited cervical sample takers and who meet certain criteria) and requires they:

• hold a current NZ Annual Practising Certificate
• have a documented professional partnership with an accredited cervical sample taker who will be the responsible clinician.
• have completed the required training.

The NCSP encourages practices and PHO's to support teams by allowing time to complete the training requirements.

The training is designed to ensure that HPV Screen takers comply with The Health Act 1956 Section 112L that requires that every person that obtains a cervical screening specimen provides certain information, understands the responsibilities, and can demonstrate competence in doing this. 

Answer to question asked at hui re data access and sharing

Currently formal approval is required for sharing NCSP PHO cervical screening status reports with third parties ie Karo. We acknowledge this is important and are working on a process to make this easier, which we will share in the New Year. 

NCSP want to extend our thanks for all those who participated in our recent hui to hear about progress and to provide the project with feedback and suggestions. NCSP have scheduled a meeting in February to provide another PHO update. 

NCSP appreciate your ongoing input and support to ensure a successful embedding of the new HPV primary screening testing within the National Cervical Screening Programme. The NCSP will continue working collaboratively with the sector and are planning regional hui in the first quarter of 2024 to discuss the key phase two initiatives of the project, including sustainable funding, PMS integration, notifications and self-test at home. 

If you have any questions or feedback, please contact HPVScreen@health.govt.nz 

In Aotearoa New Zealand, persons taking cervical screening specimens have legislated responsibilities in accordance with Part 4A of the Health Act 1956. Given the weight of these responsibilities cervical screening tests must be requested by a ‘responsible clinician’ who is an accredited cervical sample taker.  

Ensuring HPV screen takers are supported, trained, and resourced appropriately, and have ongoing clinical support from a cervical sample taker (responsible clinician) is required.   

HPV Screen taker learning pathway 

HPV Screen takers must complete the following learning pathway prior to facilitating HPV self-testing with participants. 

1. Establish a professional partnership with a responsible clinician who will be available to provide clinical support, take responsibility for results requiring follow-up or referral, and undertake follow up liquid-based cytology (LBC) sample taking.
2. Complete the four NCSP Cervical Screening with Human Papillomavirus (HPV) testing training modules: module 1, module 2, module 3, module 4 
3. Be familiar with the updated National Cervical Screening Programme Policies and Standards Section Three: Cervical Screening Services and the Clinical Practice Guidelines for Cervical Screening in Aotearoa New Zealand.  .  
4. Complete a professional partnership assessment and agreement with the nominated responsible clinician. 

Resources will be available on the Understanding HPV Primary Screening webpage from 16 November 2023 and will include: 

• HPV Screen taker Learning Pathway 
• updated NCSP Section Three Policies and Standards for Cervical Screening Services 
• professional partnership assessment and agreement form 
• HPV Screen taker Resources 
• webinar “Working in professional partnership for HPV screen takers and Responsible Clinicians”. This webinar is aimed at both responsible clinicians and HPV screen takers and will be available to watch after the event.  

• Accredited cervical sample takers (responsible clinician) who are comfortable to work in a professional partnership with colleagues who meet the HPV screen taker criteria can support wider and more equitable access to HPV screening. Taking on these expanded roles and responsibilities is optional; and the professional partnership must be mutually agreed. Enrolled and Registered Nurses and Nurse Practitioners who do not have a professional partnership agreement cannot facilitate HPV self-testing.  
• Allow time for training and upskilling of team members. 
• Ensure the team has an operational process in place to support this role and to provide participants with a quality cervical screening experience.  

A second phase approach is underway to support HPV Screening Kaimahi working in Screening Support Services to facilitate HPV self-testing.

For further information, please see the Understanding HPV Primary Screening webpage or email hpvscreen@health.govt.nz. 

From 28 May, the new cervical screening data match report will be sent to each practice with their enrolled patient data, the report will be named as follows: {practice id}_cervical_screening_data_match_{date}.csv.

To make things a little easier, we have added three new tabs so you can prioritise and reset your recalls. The new tabs are:

• patients screened elsewhere
• overdue for screening by 5+ years (ability to filter date last screened, age, ethnicity)
• anyone who requires follow-up.

Clinical guidelines have been developed and updated for practitioners providing the cervical screening pathway. They provide a standardised national approach to assist providers to achieve best-practice outcomes. 

• Effective for use from 12 September 2023.
• The guidelines define screening pathways and clinical management guidelines for use when the NCSP changes to human papillomavirus (HPV) primary screening.
• This is a major and exciting change to the cervical screening programme in Aotearoa New Zealand for wāhine/whānau and providers in the detection of HPV early
• Cytology will continue to play an important role in the management of those who have HPV detected, under surveillance, require a Test of Cure or symptomatic.  
• The clinical guidelines will be reviewed on a regular annual basis to ensure changes that arise are reflected. 

Free screening will be available from 12 September for:

• women and people with a cervix 30 years and over who are unscreened (have never had a screening test) or under-screened (haven’t had a cytology test in the past 5 years)
• anyone requiring follow up
• Māori and Pacific
• anyone who is a community service card holder.  

From September 2023, the primary test for cervical screening will be a test for human papillomavirus (HPV), the cause of over 95 per cent of cervical cancers. 

Self-testing will be an option for everyone. A vaginal swab sample is required for a self-test – the cervix does not need to be reached with the sampling device, making it a simple test for participants. It can be done in the clinic, at home, or other community settings but clinical oversight is required in order to explain the test, manage results and arrange follow up. 

Participants can choose how to have their screening test: either take it themselves or have a clinician take it for them. The clinician can take a vaginal swab sample which will be managed by the lab as a self-test; or the clinician can take an LBC using a speculum. For primary screening, an LBC sample will be tested for HPV initially and reflex tested for cytology if the HPV test result is positive.

The simplicity and privacy of self-testing means it will reduce barriers for all participants and will increase access to the clinical pathway for all participants, and in particular for Māori and Pasifika. 

Participants need to be reassured that a self-test is just as effective as a clinician-taken sample at detecting the presence of HPV. Clinical oversight for self-testing means that for every self-test sample, there is a health professional who signs the laboratory request form and who is responsible for:

• providing advice and obtaining informed consent
• providing the test kit to the participant/coordinating getting it back (tests won’t be sent out centrally)
• ensuring the correct lab request information is provided on the request form and that the request form is signed by them
• ensuring the participant is told of the test result and the result is followed up and the next steps/referrals are completed as needed.

Protocols to manage results will be formalised before the programme starts, based on the following guidance.

• HPV not detected -> 5-year screening interval.
• HPV 16/18 detected -> option of returning to primary care for a cytology sample or direct referral to colposcopy, where cytology will be taken.
• HPV other (non 16/18) detected -> Cytology sample required: Normal.
  • Low-grade cytology -> repeat HPV test in 12 months.
  • High-grade cytology –> referral to colposcopy.

The NCSP register will be population-based, sourced from NHI data and include both those already enrolled in the NCSP and those who are unenrolled (with an opt-off option). The register will provide direct look-up access for primary healthcare and provide centralised notification to let participants know it is time to get screened. This notification is not an invitation, this will still come from primary care. 

Clinicians will continue to provide communication with patients about screening, take responsibility for test delivery and results, and ensure appropriate clinical follow up of abnormal results. 

Further information is available in the Goodfellow webinar recording and on the National Screening Unit website.

The overview of HPV primary screening video provides a basic introduction to HPV screening, which will become the primary cervical screening method for cervical cancer prevention in Aotearoa New Zealand from 12 September 2023. This is the first in a series of planned educational and learning tools to be made available in the run up to the transition to HPV testing in September 2023. Keep an eye out for more information as more resources become available here and via the Sector Update newsletters. 

These modules will be a key part of training and education for the sector alongside other educational resources.

• Clinical Module One (Approx 60 minutes to complete)
  An overview of cervical screening in Aotearoa New Zealand, introduces the new Clinical Practice Guidelines for cervical screening, and will help you understand HPV and its role in the development of cervical cancer; HPV vaccination; and HPV testing and pathways.
• Clinical Module Two (Approx 30 minutes to complete)
  Presents a series of examples of how to interpret the cervical screening pathways in the Clinical Practice Guidelines for Cervical Screening in Aotearoa New Zealand. It then presents a further 13 scenarios, to give you a chance to check your understanding and apply the guidelines to each situation.
• Clinical Module Three (Approx 30 minutes to complete)
  Provides an overview of the National Cervical Screening Programme (NCSP) Register and the history of the NCSP. It also covers the persisting inequities in cervical screening and how aligning with the new health reforms and reflecting on practice can improve health equity.
• Clinical Module Four (Approx 60 minutes to complete)

All four modules must be completed to receive a Certificate of Completion.

If you don’t have an account with LearnOnline, you can create one here and you’ll then be able to access the course.

Dr Margaret Sage (NCSP clinical lead, Pathology and NCPTS cytopathologist) has provided information videos for HPV primary screening, written to train lab staff. These are free to access (linked below) and available on the National Cervical Pathology Training Service site. No login needed.

Note: these are information talks only, these are not the education modules.

To mitigate clinical risk and to ensure overall data consistency we ask you to please manually update your Medtech PMS to reflect the nationally recommended HPV outcome codes. You'll find the codes and instructions (Medtech Evolution and Medtech 32) on our website.