Cervical screening incident
The NHS in Scotland has identified a small group of patients that have been incorrectly removed or ‘excluded’ from the cervical screening programme. This means they’ve not been invited for cervical screening (smear test).
These patients have all had a sub-total hysterectomy. This type of hysterectomy removes the uterus (womb) but does not remove the cervix (the neck of the womb). Patients who’ve had a sub-total hysterectomy should be invited for cervical screening because they still have a cervix.
These patients were excluded from cervical screening because of errors like:
- their medical records were not correctly completed after their operation
- their medical records not showing exactly what kind of hysterectomy was carried out
- the addition of an incorrect exclusion code to their medical records
How was this identified?
Every year, the NHS in Scotland reviews the cervical screening records of people diagnosed with cervical cancer.
This review found a small number of people (fewer than 5) diagnosed with cervical cancer following a hysterectomy. These patients were excluded from cervical screening even though they still had a cervix.
What investigation was carried out?
The NHS in Scotland has carried out a review of all patients:
- who’ve been excluded from cervical screening
- whose records show they’ve had a sub-total hysterectomy
Their hospital, laboratory, GP and screening records were checked to make sure they'd been correctly excluded. This group was looked at first, because there was a higher chance of them still having a cervix.
These patients have all been contacted and have been offered an appointment to see a doctor.
What further investigation is being carried out?
As a precaution, a further investigation is underway to check the records of people who’ve had other types of hysterectomies. This will make sure no one else has been incorrectly excluded. This will not include any records already checked.
There are around 150,000 records to review (as of January 2023). It’s expected that the investigation will take at least 1 year to complete from the date that it starts. However, we expect that most people in this group will have been correctly excluded from cervical screening.
Around 95% of hysterectomies performed in Scotland are total hysterectomies. This type of hysterectomy completely removes the patient’s womb and cervix, so they no longer need cervical screening.
As the investigation goes on, the NHS will contact anyone who's been affected by the error to tell them:
- their records have been checked
- what the outcome is
How do I find out if I've been wrongly excluded?
The records of everyone who’s been excluded from cervical screening after a total hysterectomy will be reviewed. The review will start with the records of those people who’ve been excluded from cervical screening the longest.
If you've been excluded, the NHS will contact you by letter. Your letter will tell you if:
- you were incorrectly removed from cervical screening
- you were correctly removed from cervical screening
- it wasn't possible to tell for certain
There's no need for you to contact anyone. If you're not contacted, this means you’ve not been excluded from cervical screening. If you’re eligible, you’ll be invited for screening. You should continue to attend as normal.
Read more about eligibility for cervical screening
The time between cervical screenings has recently changed for some people.
Read more about how often you’ll be invited for cervical screening
Non-urgent advice: Contact your GP straight away if you experience any of the following symptoms:
- unusual discharge
- bleeding after sex, between periods or after the menopause
These symptoms are usually caused by something other than cervical cancer, but it's important to have them checked.
What will happen if I’ve been removed from the programme in error?
This will depend on your age and the result of the investigation of your notes.
Patients under the age of 71 who’ve been incorrectly excluded from cervical screening will be invited for screening.
Patients aged 71 or over who’ve been incorrectly excluded will be invited for an examination.
If your record has been reviewed, you’ll receive a letter which will explain what your next steps will be.
What is being done to stop this happening again?
New safety measures have been put in place in the cervical screening programme. These will make sure that no one is incorrectly excluded from screening, and that an incident like this does not happen again.
The laboratories now do an extra check with the doctor who carried out the hysterectomy before excluding anyone from cervical screening. This is to make sure that the person's cervix was completely removed during their hysterectomy.
If your record has been reviewed as part of this investigation you’ll receive a letter. Please read the information carefully and decide whether you want to attend for a test or examination. It’s normal to feel anxious. Don’t let it put you off. Talk to your GP or nurse as they can help with any concerns, embarrassment, or past experiences.
If you'd like to bring a friend, or need an interpreter, you can ask for this when making your appointment. You can also ask for a female doctor or nurse.
In partnership with NHS Scotland, Jo’s Cervical Cancer Trust has made its national helpline available to anyone with concerns.
You can get more information, advice and support by phoning the free Jo’s Cervical Cancer Trust Helpline on 0808 802 8000
Check the helpline opening hours
Please be aware Jo’s Cervical Cancer Trust does not have access to NHS records so will not be able to provide clinical information about your screening history or hysterectomy or book any appointments for you.
Read more about cervical screening
Read about ways you can make your cervical screening appointment better for you
Source: NHS Scotland
10 March 2023
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