Cervical Cancer Elimination Expert Group minutes: April 2025

Attendees and apologies

• Prof. Anna Glasier (Chair)
• Sir Lewis Ritchie
• Dr Tasmin Sommerfield
• Prof. Maggie Cruickshank
• Dr Tim Palmer
• Dr Lorna Willocks
• Dr Sharon Hanley
• Dr Simon Cuthbert-Kerr    
• Heidi Douglas
• Alexander Cruickshank
• Dr Kimberley Kavanagh
• Blair Harrison
• Dr Cheryl Gibbons
• Dr Kate Cushieri
• Maxine Lezna
• Caroline French

Apologies

• Dr Azmat Sadozye
• Dr Victoria Flanagan
• Dr Claire Cameron
• Nicola Barnstaple
• Dr Calum Robertson
• Dr Kirsty Roy
• Dr Douglas Rigg
• Samantha Harrison    
• Felicity Sung
• Gareth Brown
• Julie Hoey
• Laura McGlynn
• Kirsty Stewart

Items and actions

Welcome from Chair - introductions and apologies

It was noted that this meeting would focus on finalising the Expert Group’s interim report to the Minister for Public Health and Women’s Health, which is to be submitted at the end of April 2025. The Chair thanked members for their contributions thus far. 

Once finalised, this report will serve as a basis for collaborating with key stakeholders to develop the group’s preliminary recommendations and work towards a final report, likely to be ready in Autumn 2025. 

Minutes of previous meeting (sign off) and actions update

The minutes of the previous meeting were agreed with no amendments raised. 

The group reviewed the action log and provided updates on any open actions. 

Review and sign-off of Status Report of Cervical Cancer Elimination Expert Group

It was agreed that the report should not be made public as stakeholders must have adequate time to feed into the recommendations and plan for implementation of any final recommendations. 

The group reviewed the draft report, with discussion focused on any points requiring review for accuracy or clarity. In discussion, the following points were raised:

Study on invasive cervical cancer incidence following bivalent human papillomavirus vaccination

• the study developed by Public Health Scotland (PHS), in collaboration with the Universities of Strathclyde and Edinburgh, shows that no cervical cancer cases have been detected in fully vaccinated women following the human papillomavirus (HPV) immunisation at age 12-13 since the programme started in Scotland in 2008
• it is important to note that this paper was based on data up to the end of 2020 and that there may well be some cases which have not yet been detected, therefore the conclusions of the study should not be overstated
• this point aligns with existing screening literature, which explains that the HPV vaccine doesn’t protect against all strains of HPV and that screening is therefore still essential

Cervical screening uptake statistics

• screening uptake statistics contained within the report are currently being reanalysed by PHS, due to recent identification of data quality issues 

Impact of migration/immigration on HPV vaccination uptake

• due to the digital systems currently in place, it is difficult to track vaccination histories for those who move from one Health Board area in Scotland to another as well as for new entrants to Scotland
• while the impact of migrations/immigration on vaccination uptake is uncertain, it does make the job of vaccination teams harder in terms of knowing whether a person has already been vaccinated or not

Scottish Cervical Call-Recall System (SCCRS)

• while there is functionality on SCCRS to flag HPV vaccination status, this is for data analysis purposes only and does not enable screening to be targeted by HPV vaccination status
• given that Community Health Index (CHI) data is fed into SCCRS on a daily basis, the ability to identify the eligible cohort for screening is contingent upon the accuracy of the CHI registers being maintained by GP practices
• a pilot is currently underway within NHS Lothian focused on “cleansing” CHI register data to improve accuracy

Public perception of cervical cancer elimination

• it is important to note that the term “elimination” (which refers to disease incidence below the WHO elimination threshold) does not mean that cervical cancer will be eradicated, however the term may be perceived this way by the public
• Cancer Research UK therefore opt to use terminology that is less likely to be misconstrued, such as: “reduce cervical cancer cases to the point where almost nobody develops it”; “make cervical cancer a rare cancer” or “elimination of cervical cancer as a public health programme”
• there appears to be a difference in the perceived importance of breast screening relative to cervical screening among members of the public, whereby mammogram appointments are considered important to attend in a way that cervical screening appointments are not

Colposcopy practices, palliative care, treatment targets and subgroup analysis

• it was agreed that the data around colposcopy waiting times should be examined, as these may vary by Health Board
• the group discussed whether to include recommendations around consistency of colposcopy practices, particularly around the monitoring of colposcopy at a national level, quality assurance, benchmarking and performance targets
• it was noted, however, that Scotland already offers high-quality colposcopy services that exceeds the standards of many other developed countries
• it was noted that palliative care, while a vital component of comprehensive cancer management, is not included in National Cancer Registry figures (this is run on an individual basis by each Health Board) and therefore is not measurable against the WHO treatment targets
• given the high treatment rates and the number of cancer cases per year (342 in 2021) subgroup analysis may be possible by deprivation, but opportunities for other forms of analysis (e.g. by ethnicity) would be limited
• the rate of referral to colposcopy, waiting times and treatments rates are ultimately dependent on vaccination uptake, the performance of the screening test and the criteria for colposcopy referral
• higher waiting times for colposcopy in Scotland relative to other parts of the UK are more likely to be a result of the criteria for colposcopy referral, and the fact that the screening pathway is different in Scotland, rather than any issues with the accuracy of screening tests
• there may be benefit in discussing what the group considers to be a “false positive” result of a screening test (e.g. whether a referral to colposcopy for a woman who tests positive for HPV but has not developed high-grade CIN should be considered a “false positive”) at a future meeting

Next Steps 

The group agreed that recommendations from subgroups to be included in the final report must be precise and actions clearly assigned in order to ensure the recommendations are translated into practise.

The group must also consider what data will be needed to expand the model, as the group is expected to estimate a date by which time the rate cervical cancer will reach the elimination threshold. 

As per the group’s previous discussion, modelling must consider when elimination is achieved within the most deprived groups. 

The group agreed it would be helpful to include the potential impact of introducing self-sampling (as a percentage increase in screening uptake) into the model. However, it is complicated to estimate what the impact of self-sampling on screening uptake may be, as engagement with the offer of self-sampling will depend on the form that the offer takes. It may also be that, rather than bringing in women who would otherwise not have come forward for screening, the offer of self-sampling is taken up by women who would otherwise have attended a screening appointment, nullifying the (estimated) positive impact on screening uptake. 

Date of Next Meeting and AOB

Next meeting

As well as a discussion of the modelling work, the next meeting will likely focus on the future of the group itself and how best to ensure that the recommendations of the group are translated into actions. This may involve the establishment of an “Implementation Group”. 

The group may also wish to take some time to discuss the Cervical Cancer Elimination by 2040 – Plan for England, published on 28 March by NHS England. 

AOB

It was noted that a meeting is being arranged with Sexual Reproductive Health (SRH) Leads around Scotland to discuss cervical screening within SRH services. The meeting will likely take place in the coming weeks. 

It was agreed that the next meeting of the Expert Group would take place on Wednesday 28 May (10:30 – 12:00)