In March, HUS Diagnostic Centre began using a comprehensive service to manage the process of cervical cancer screening – from sending out invitation letters through to reporting the results to the Finnish Cancer Registry. The new My+® screening service can be tailored to support different practices in different municipalities.

In 2021, approximately 270,000 women in Finland will receive an invitation for cervical cancer screening, and the HUS Diagnostic Centre has already provided help to 140,000 of them. Screening is a multiphase process that used to require manual work, but Mylab has developed the My+ screening service to automate and control the process.

A woman attending screening will not notice much change to the procedure, because the invitations and results continue to be sent by post or electronically via the Omaposti postal service as before. But for the laboratory staff responsible for the screening process, this change is significant, as the My+ screening service serves them on a one-stop basis, says Päivi Elo, product owner of My+ pathology at Mylab.

The system creates the reports in accordance with the Finnish Cancer Registry’s new data model, and Mylab is in the process of developing a user interface where users can view the data of individual people and change municipality-specific service settings, Päivi Elo says.

Fewer errors, more information security

The My+ screening service receives data concerning which women to invite for cervical cancer screening, either due to age group or risk status, from the Finnish Cancer Registry. The service generates orders for tests in the laboratory information system and sends any necessary data to the appointment system. The screening service sends out the invitations, and if a sampling appointment is missed, then the system sends a reminder to the patient. Even if a patient moves to a different municipality and does not receive an invitation, they can still participate in screening. Based on screening results and previous data in the system, the system deduces whether the screened patient needs to be referred for further testing. The My+ screening service sends the results of the screening sample and any further tests to the cancer registry.

Use of the service reduces the risk of human error. The data is sent automatically in the background using a secure connection, and data of members of risk groups no longer needs to be hand-picked out of the system; instead, the cancer register assesses whether a woman is part of the risk group based on data received. Use of this service thus improves information security, Elo says.

The service looks promising

Susanna Ihalainen, laboratory nurse and HUS pap test coordinator, believes that the My+ screening service will improve the reliability of the process and save the laboratory staff’s time. At the moment, some of the service’s functions are ready, but not all of them are in place yet, with some still due.

Development took longer than anticipated. During the development stage, we noticed that some of the information we had provided did not reflect the actual complexity of the situation. For example, there are differences in the process in different municipalities, which slowed down product development. HUS Diagnostic Centre usually starts sending out invitations for screenings in January, but since the new service was adopted only in March, sampling times had to be squeezed into a shorter time period.

We also had to notify the public that, as the data is sent from the cancer registry’s invitation service according to birthdate, women born between January 1st and 10th and between December 1st and 10th will receive the invitation at the same time. This might confuse those women born towards the end of January, for instance, because they will receive their invitations much later in the year than they used to.

Ihalainen also explains that HUS Diagnostic Centre no longer needs to create separate annual reports and deliver those to the cancer registry; instead, results are transferred automatically, almost in real time, and printing orders has become easier as well.

No one gets left out of further tests due to human error when the system combs through the data. Moreover, attaching a histological diagnosis to the screening result is now simpler and requires less clicks. The system only provides relevant diagnoses as options, Ihalainen says.

Mylab has understood HUS Diagnostic Centre’s needs and the shortcomings of the previous process very well. Considering the schedule, things have gone well and the service looks promising. We are keen to implement the rest of the functions into our system, she adds.

Pap test not always necessary

Traditionally, cervical cancer screening was done by pap smear tests, where some cells are taken from the cervix and examined under a light microscope. Now, instead of a pap test, the main test is usually an HPV test, where sample cells are checked for human papillomavirus DNA. The HPV test is a suitable primary screening test for women aged over 30. Most municipalities take both HPV and pap samples during screening, and if the HPV test result is negative, the pap smear is not analysed.

The HPV test is done in the microbiology laboratory, whereas the pap smear is examined in the pathology laboratory. Use of an HPV test lightens the workload in the pathology laboratory. Not all municipalities order HPV tests, however; in some places, the pap smear test is the only screening test, Päivi Elo clarifies.

Ihalainen hopes that, in the future, the screening service will also provide an automatic response in cases when the sample is not usable for some reason.

The system could send a letter to notify the patient that they have been invited for a new sampling appointment because of a technical error. Now we inform people with either a phone call, letter or email.

Other cancer screenings to be added

The current My+ screening service contains the cervical cancer screening process. In future, the My+ screening service can be expanded to cover other screenings that include laboratory tests, such as the bowel cancer screening process as well as other cancer screenings.

The configurability of the service is a big advantage, because it can be integrated into different systems and adapted to varying practices in different municipalities. In further development, we can add more languages to the invitation letters, for instance – at the moment, invitations are in Finnish and English or Swedish.

The aim of the service is to produce the whole screening process for the client, decrease the client’s workload at different stages of the screening process, reduce the chance of human error and produce screening data securely from beginning to end, says Päivi Elo, product owner at Mylab.

Mylab and HUS participated in the Laboratory Medicine and Exhibition 2021 on 23-24 November, where Päivi Elo and Susanna Ihalainen, HUS Diagnostic Centre’s pap test coordinator, gave a speech on the subject of Screening process as a service on Tuesday 23 November at 12:45 pm. They and expanded on how the My+ screening service has improved the process of cervical cancer screening.

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