Our doctors lead study into access to cervical screening after birth

A team of Somerset gynaecological oncology doctors have been awarded nearly £300,000 by the Medical Research Council to run a national research study that aims to improve the uptake of cervical cancer screening among those who’ve recently given birth.

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

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

But feedback from those who’ve given birth, as well as colleagues at GP practices, suggests 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 new parents are busy and have other priorities.

It’s not the first time that our NHS trust has been involved in cervical screening research, with Miss Jo Morrison, our gynaecological oncology consultant, 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 women who’d just had a baby.

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

Miss Morrison, and Dr Holly Baker-Rand and Dr Becky Newhouse – both specialty registrars and clinical fellows – are leading the national research study, which is called Postnatal Instead of Normally-timed Cervical Screening’ – or PINCS for short.

“Current guidance says that a cervical screening (smear) test can only be done 12 weeks after a woman has given birth,” said Jo. “But we listened to the feedback 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 Human Papilloma Virus (HPV), which is the main cause of abnormal changes on cervical screening tests.

“Testing for HPV is much more sensitive than the original smear tests, when smears were spread straight onto slides, which were then examined in the laboratory under a microscope.

“We wanted to carry out research based on the idea that new mums and parents might find it more convenient to get their screening done at that one appointment, rather than having to make another appointment six weeks later.

“The first part of the study was called ‘Pre-PINCS’, where we are asking what women think about the idea, and whether they would be willing to have a smear done six weeks after giving birth.

“The reaction has been really positive so far, and we’re delighted to have the opportunity to get a full clinical study up and running, thanks to this funding from the Medical Research Council.

“Pre-PINCS involved a questionnaire given to women who’ve given birth within the past five years. We also offered conversations with those who’ve 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 next step will be to compare testing at six and 12 weeks to see how accurate testing is at six weeks, compared to 12 weeks - data from HPV testing in pregnancy suggests that there should be no difference.

“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 don’t feel ready by six weeks would be free to delay their test.

“We also want to check the acceptability and accuracy of testing with a urine test, rather than a normal smear test, and whether this is something that women might find easier, especially shortly after giving birth.

“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 Newhouse has been working as a clinical fellow in gynaecological oncology in Somerset for the last couple of years, where she’s been able to develop her skills, both clinically and in research.

“I’m so pleased to be involved in this piece of research as it could grow into a really important study,” she said. “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.

“We know that pregnancy and caring for a newborn is a very busy time, so it’s natural that a cervical screening 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 cervical screening 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.

“Sadly, cervical cancer is most prevalent in the those of childbearing age, so we want to make sure cervical screening 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.”

If you are pregnant or have had a baby in the last five years, we’d love to hear your views as part of the Pre-PINCS study. Please follow this link to find out more: https://forms.office.com/e/B6rwtWvAy0