UK medical team to lead study into access to cervical screening after birth

A team of UK gynaecological oncology doctors have been awarded £300,000 to run a research study aimed at improving the uptake of cervical cancer screening among women who have recently given birth.

The team, based at the Somerset NHS Foundation Trust, will get people’s views on how to improve the take up on cervical screening and access to services.

While cervical screening is safe during pregnancy and may be needed, it is often delayed until afterwards, particularly if a woman’s screening was up-to-date and normal prior to pregnancy.

Current guidance from the national screening programme suggests women should wait for 12 weeks after they have given birth to be screened.

But women and GP practices told Dr Jo Morrison, consultant gynaecological oncologist at the NHS trust, and Dr Holly Baker-Rand and Dr Becky Newhouse, both specialty registrars and clinical fellows, that it may be easier to get this done at their regular six-week post-birth appointment. This would avoid coming back for a second appointment when women are busy and have other priorities.

It is not the first time the Somerset NHS Foundation Trust has been involved in cervical screening research with Morrison and former Musgrove postgraduate doctor, Dr Sarah Coleridge, winning a national Jo’s Cervical Cancer Trust Innovation Award for a project to improve the take up on cervical screening in young women who’d just had a baby.

One of the ideas that was generated on the back of Dr Coleridge’s project, largely from the women she spoke to, was that they would prefer to have had a postnatal follow-up smear at their six-week GP check-up.

“Current guidance says that a cervical smear test can only be done 12 weeks after a woman has given birth,” Dr Morrison explained.

“But we’ve listened to the feedback from women and investigated why the recommendation is to delay to 12 weeks.

“We found that it was based on just one very old study, involving only a few people, at a time when smear testing wasn’t as advanced as it is today, and before we tested for HPV.

“So we wanted to carry out research based on the idea that new mums might find it easier to get their screening done at that one appointment, rather than having to make another appointment six weeks later – much easier for our GP practices and the patients themselves, who would be less likely to miss it.

“Before we begin the ‘Postnatal Instead of Normally-timed Cervical Screening’ study  – or PINCS for short – we are running a study to check women’s view to make sure that this is absolutely something that women would want us to look into.

“If our study shows no difference in the quality of testing at six rather than 12 weeks, this could be offered to women earlier. Obviously, those who aren’t ready by six weeks would be free to delay the test.”

Morrison said her team would check the acceptability of testing with a urine test, rather than a normal smear test, and whether this is something that women might find easier.

“We’re calling this first part of the study, ‘Pre-PINCS’, where we’re testing what women think about the idea, and whether they would be willing to have a smear done six weeks after giving birth. If the reaction is positive, then we hope to get a full clinical study up and running,” she added.

“Pre-PINCS has involved a questionnaire given to women who’ve given birth within the past five years. We will also offer conversations with a few women who have given birth recently or are currently pregnant, to find out in more depth about their views on cervical screening in general, and any ideas they might have for the study.

“The only way we can change the national screening programme would be to prove that this is acceptable and as accurate as delaying screening to 12 weeks.”

Dr Becky Newhouse, who has been working as a clinical fellow in gynae-oncology in Somerset for the last couple of years, said she was pleased to be involved in this piece of research.

“We’ve already done some preliminary work with women to find out about the challenges they’ve faced in getting a smear test, which is a good first step,” she said.

“We know that pregnancy and caring for a newborn is a very busy time, so it’s natural that a smear test may not be at the top of a to-do list. But this means a lot of women are out-of-date with their smear tests in pregnancy and we want to do everything we can to make it easy for them to get their test – the six-week GP appointment is ideal in so many ways.”

She added: “Sadly, cervical cancer is most prevalent in the age range around the usual childbearing age so we want to make sure smear testing is as accessible as possible for that group of women so they can get pre-cancerous changes detected as early as possible so they can be easily treated and stop them developing a cancer.”