GPS and Medical Association react to cervical audit report

4.00pm

UPDATE - Reaction has been mixed to the findings of the New Zealand Cervical Cancer Screening Audit, released today.

The College of GPs expressed concern, but little surprise at the findings, while the New Zealand Medical Association has welcomed the report as one New Zealand women can be pleased with.

College of GPs president Jim Vause said the findings reflected the need for an adequately-funded public health system with proper infrastructure.

"The screening programme needs to be clear about the roles, the responsibilities and the resources required to reduce these major problems," Dr Vause said.

"We need to look very carefully at how to lift the screening rates for Maori women, those on low incomes and the elderly," he said.

The report questioned the collection of ethnicity data , the answers to which were "quite simple" but revolved around adequate funding, Dr Vause said.

At present some GPs had to fill out special forms for the screening, despite all the data being on the practice's own management system.

"It's an IT problem, matching up the various systems and getting them talking to each other."

Dr Vause said this would address some of the recall and access programmes.

He said the new PHO environment should already be making a difference in the figures.

"That women have to pay even a minor fee is also a significant barrier to screening," he said.

"That's where adequate funding would help."

Medical Association chair Tricia Briscoe said the report found the National Cervical Screening Programme (NCSP) operated to a generally high standard and in some areas a very high standard.

"The women of New Zealand can have confidence in the service provided and can have confidence in participating," Dr Briscoe said.

Health professionals could also have confidence in the programme, she said.

"The report also showed that there is no systemic issue of under-reporting of abnormal smears in our laboratories. This is all good news for New Zealand women."

One area for improvement was ensuring that women, particularly Maori, took part in the NCSP, she said.

Of great concern was the gap between Maori and non-Maori women enrolled in the programme and in the incidence of cervical cancer between the two groups.

"Scarce funding resources should be prioritised to those women in greatest need," she said.

"Overall, the women of New Zealand can be pleased with this audit report," she said.

"It clearly shows that cervical screening does work, when high levels of the population are enrolled."

The challenge now was to reach those not enrolled.

The report showed that New Zealand had made good progress in that:

-- The death rate for cervical cancer almost halved in NZ between 1988 (prior to establishment of NCSP) and 2000.

-- Between 1990 and 2000, the incidence of cancer of the cervix declined by 28 per cent.

The Ministry of Health welcomed the release of the report.

Deputy director-general public health Don Matheson said completion of the three-year, $3 million audit -- one of the most comprehensive of its kind -- provided a further level of reassurance about the NCSP.

The most important thing it reinforced was that the key way for women to protect themselves against cervical cancer was with regular screening, Dr Matheson said.

No programme provided a 100 per cent guarantee of protection against cancer, but the audit concluded that overall, women and health professionals could have confidence in the services and be encouraged to participate.

It was key that the audit did not find evidence of systemic failings in New Zealand cytology laboratories, which addressed a major recommendation of the 2001 Gisborne Cervical Screening Inquiry.

But Dr Matheson said the audit provided no room for complacency, finding inadequate screening coverage and evidence of ethnic disparities in screening and follow-up.

The audit's real value was in helping further improve the delivery of quality cervical screening services to New Zealand women, he said.

It would also serve as a baseline for future audits in New Zealand and elsewhere.

The Ministry will formally respond to the report's recommendations in the next few weeks, advising what actions will be taken, or have begun, to address the issues in the report.

The Ministry was grateful to the women in the audit, all of whom had cancer and did not personally benefit from participating, he said.

Health Minister Annette King said the audit showed that the investment and effort put into the NCSP since 2001 was paying off, she said.

The 2001 Gisborne Inquiry asked if the programme was safe, and the audit told women and health professionals they could have confidence in it, she said.

The audit confirmed the best chance of protection against cervical cancer was regular three-yearly smears, she said.

"The audit provides a useful reminder that we must strengthen our efforts to encourage all women and particularly Maori women to participate fully in the screening programme."

- NZPA

Full report [PDF 211p 735kb]

Herald Feature: Gisborne Cervical Screening Inquiry

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