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New Testing Programmes

Volume 450: debated on Thursday 19 October 2006

To ask the Secretary of State for Health (1) what progress has been made with the introduction of human papilloma virus testing and liquid cytology testing; and what plans she has for future implementation; (93800)

(2) what funding was allocated to the implementation of liquid based cytology in the last three years; and what funds have been allocated for the next three years;

(3) which hospitals (a) have introduced liquid based cytology and (b) are scheduled to introduce liquid based cytology over the next year;

(4) how many women in each strategic health authority have (a) taken up liquid cytology testing for cervical cancer and (b) enrolled on human papilloma virus testing; and if she will make a statement;

(5) what assessment she has made of the merits of liquid cytology testing for cervical cancer since the use of the technique commenced.

Good progress has been made with the implementation of liquid based cytology (LBC) across the national health service cervical screening programme. As at September 2006, of the 142 laboratories that process cervical screening samples 67 have fully implemented LBC and 35 are intending to implement LBC by March 2007.

Some £1.2 million was allocated to the implementation of LBC in 2003-04 and £6 million in 2004-05. From 2005-06 onwards, funding is in primary care trust baselines and cannot be disaggregated.

The following hospitals have fully implemented LBC:

Scunthorpe General Hospital

York District Hospital

Diana, Princess of Wales Hospital (Grimsby)

Doncaster Royal Infirmary

Royal Hallamshire Hospital

Leeds Teaching Hospitals

Calderdale Royal Hospital

University Hospital of North Durham

Royal Victoria Infirmary (Newcastle)

Kettering General Hospital

Chesterfield and North Derby Royal Hospital

Kings Mill Hospital (Mansfield)

Nottingham City Hospital

Pilgrim Hospital (Boston)

Birmingham Women’s Healthcare

Princess Royal Hospital (Telford)

County Hospital Hereford

Chase Farm Hospital (London)

University College Hospital (London)

St. Mary’s Hospital (London)

West Middlesex Hospital (London)

Ealing Hospital (London)

Northwick Park Hospital (London)

Queen Mary’s Hospital (Sidcup)

St. Thomas’ Hospital (London)

Mayday University Hospital (London)

St. George’s Hospital (London)

Kingston Hospital

St. Helier Hospital

Darent Valley Hospital

Medway Maritime Hospital

William Harvey Hospital (Ashford)

Epsom General Hospital

Partnership Pathology Services (Guildford)

Great Western Hospital (Swindon)

Royal United Hospital (Bath)

Cheltenham General Hospital

Gloucestershire Royal Hospital

Southmead Hospital (Bristol)

Musgrove Park Hospital

Derriford Hospital

Royal Cornwall Hospital (Treliske)

Royal Devon and Exeter Hospital

Torbay Hospital

Norfolk and Norwich Hospital

West Anglia Cytology Services

Whiston Hospital

Leighton Hospital

Macclesfield District Hospital

Royal Liverpool Hospital

University Hospital Aintree

Warrington Hospital

Arrowe Park Hospital

Countess of Chester Hospital

Cumberland Infirmary (Carlisle)

West Cumberland Hospital (Whitehaven)

Blackburn Royal Infirmary

Burnley General Hospital

Chorley and District Hospital

Royal Lancaster Infirmary

Southport General Infirmary

Victoria Hospital (Blackpool)

Birch Hill Hospital (Rochdale)

Royal Bolton Hospital

Royal Albert Edward Infirmary (Wigan)

Tameside General Hospital

The following hospitals are due to have implemented LBC by 31 March 2007:

North Tees General Hospital

Leicester Royal Infirmary

Northampton General Hospital

Birmingham Heartlands Hospital

Good Hope Hospital (Birmingham)

George Eliot Hospital (Nuneaton)

Whittington Hospital (London)

North Middlesex Hospital

Royal Free Hospital (London)

Havering Hospitals (London)

King George Hospital (London)

The Royal London Hospital

Whipps Cross Hospital (London)

Hammersmith Hospitals (London)

Kings College Hospital (London)

Lewisham Hospital

Princes Royal University Hospital (Orpington)

Queen Elizabeth Hospital (Greenwich)

John Radcliffe Hospital (Oxford)

Royal Berkshire Hospital

Stoke Mandeville Hospital

Wexham Park Hospital

Wycombe General Hospital

Pembury Hospital (Tunbridge Wells)

Preston Hall (Aylesford)

Bedford General Hospital

Luton and Dunstable Hospital

Queen Elizabeth II Hospital (Welwyn Garden City)

Watford General Hospital

Queen Elizabeth Hospital (King’s Lynn)

Bury General Hospital

Manchester Cytology Centre

Royal Oldham Hospital

Stepping Hill Hospital (Stockport)

It is not possible to say how many women have been screened using LBC techniques in each strategic health authority. Statistics on the programme are collected annually, and those programmes who converted to LBC would have done so at different times during the years of roll-out. As 72 per cent. of local screening programmes will have implemented LBC by 31 March 2007, we would expect nearly three million women to benefit from their cervical screening samples being processed with LBC techniques in 2007-08.

LBC techniques began being introduced into the programme following a National Institute for Health and Clinical Excellence (NICE) technology appraisal published in October 2003. NICE is currently considering whether to review the appraisal based on any new evidence, which would include evidence from the national roll-out. Strict quality assurance and data collection are operated within the programme, and we would expect to start seeing an effect of LBC on the rate of inadequate samples when the statistics for 2005-06 are published in December 2006.

Women are only offered human papilloma virus (HPV) testing in the NHS as part of clinical trials. As part of the pilot of LBC, which took place between 2001 and 2002, we also piloted the use of HPV testing as triage for women with mild or borderline test results. Following the receipt of the independent evaluation report of the HPV arm of the pilot in 2004, the advisory committee on cervical screening set up a dedicated working group to advise on how best to introduce HPV testing into the NHS cervical screening programme. A protocol for HPV testing sentinel sites has been developed, and the sites are expected to begin operations in 2007.

There is currently insufficient evidence to support the use of HPV testing as a primary screening tool. In addition to the pilot, the Government are funding two large studies looking into HPV testing as a primary screening tool:

trial of management of borderline and other low grade abnormal smears, funded by the Medical Research Council. This study was set up to determine the most appropriate way to deal with HPV positive results and associated psychological issues. The study is due to report in 2007; and

a randomised trial of HPV testing in primary cervical screening, funded by the Department’s health technology assessment programme. This trial is investigating the use of HPV testing as a primary screening tool. The study is due to report in mid-2008.