Cervical cancer is one of the most preventable types of cancer, largely due to effective screening programs that allow for the early detection and treatment of pre-cancerous cervical lesions (NHS, 2022). In England, a national cervical screening programme has been in place since 1988, which invites women between the ages of 25 and 64 for regular smear tests to check for abnormal cervical cells (PHE, 2024). It is estimated that this programme prevents up to 5,000 cervical cancer cases each year (CRUK, 2023). However, participation rates have declined, with coverage rates dropping from 72.7% to 69% over the past decade (Douglas et al., 2016).
Our general practice clinic carries out approximately 350 cervical screenings each year as part of this national screening programme. Of these tests, around 10% detect abnormal cells that require additional follow-up testing or referral to specialists (PHE, 2024). The current system relies heavily on paper letters, phone calls, and faxes to coordinate follow-up care when abnormal results are found. This leads to dangerous delays and gaps in care continuity – putting patients at risk. Recent research has shown that failures in the follow-up system account for 30% of malpractice claims related to cervical screening (Castanon et al., 2013). To address these problems, we have secured funding through a national digital health initiative to overhaul and automate parts of our current cervical screening pathway. This report provides background on our clinic, analyses key needs identified amongst stakeholders, proposes a system design to transform screening coordination, and provides guidance for implementation and evaluation.
Cervical cancer remains an ongoing public health concern in the UK, with over 27,500 new cases of cervical carcinoma in situ recorded annually. Incidence rates peak among 25-29-year-old women but have declined 10% in the past decade (CRUK, 2023). However, significant inequities exist, with 18% higher incidences in England’s most deprived areas accounting for 2,000 extra cases a year (CRUK, 2023). Mortality sits around 850 deaths annually, predominantly occurring in women over 75 years old. Nevertheless, optimism exists given the 75% reduction in death rates since the 1970s, thanks to screening advancements, alongside a further 18% drop in the last ten years. Survival metrics also highlight progress – with 86% of women diagnosed before age 45 now surviving 10+ years and 63% across all age groups, up from just 46% in previous eras (CRUK, 2023).
However, England continues to lag behind European averages for 5-year survival. The vast majority of cervical cancer burden is preventable through HPV vaccination, targeting infections behind practically all cases. Further mitigating smoking can curb another 21% of the incidence (CRUK, 2023). Ongoing screening to detect pre-cancerous lesions, paired with improved access to timely, affordable treatment, has the potential to make cervical cancer progressively rare. Realising health equity across socioeconomic gradients remains vital to ensure equal prevention and survival opportunities regardless of deprivation. Continued vigilance and evidence-based intervention are needed to relegate cervical cancer to the historical archives eventually.
Our clinic serves a patient population of approximately 15,000, primarily covering the Little Whinging area. We have four general practitioners, two practice nurses, and five administrative staff members who assist with health records, referrals, and appointment bookings. Like most NHS general practices, our clinic utilises EMIS Web – an electronic health record system (EHR) that has been deployed nationally across primary and community care settings (EMIS Health, 2023). Most elements of our cervical screening care pathway have been digitised in EMIS, including tracking screening appointments, recording cervical samples, returning test results, and notifying patients. However, the processes surrounding abnormal results and specialist referrals remain highly manual, relying on paper letters from cytology laboratories to communicate positive results. Our practice nurses then phone the patients, consult paper records to assess screening history, and coordinate next steps for additional testing or onward referral depending on the grade of abnormality.
These referrals are completed by hand faxed to local colposcopy clinics, after which there are more phone calls to book appointments. Patients are added to paper registers to log referral status and follow-ups, which nurses must check regularly and manually update. The problem this system intends to solve is the need for more connectivity between stakeholders and data sources involved in follow-up care for abnormal cervical screening results. Relevant info
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