Rutendo is a CRUK Cambridge Centre NAHP Programme member and a clinical research practitioner at Cambridge University Hospitals (CUH). She brings a wealth of experience and knowledge on the current state of cervical cancer screening, and how we can improve awareness and access to screening methods.
What inspired you to pursue a career in clinical research, and how did you get started in this field?
My interest in research stemmed from my final year dissertation during my first degree in which we recruited approximately 60 participants for a clinical physiology-based research project. I followed this through shortly after graduation, working on observational trials such as the NICE-FIT study investigating whether the FIT (faecal immunochemical test) can be used to rule out bowel cancer and UKAGS study to find out more about abdominal aortic aneurysms. I also worked in Bournemouth on the 100K Genomes Project which was looking at the role of genomics in healthcare and has led to groundbreaking insights and actionable results for many patients with rare diseases and cancer.
What role do you play in advancing our understanding of cervical cancer screening and prevention?
Since 2020, I have worked on a range of gynaecological clinical research projects at CUH including those that aim to improve the cervical cancer screening programme and patients’ experience. The Cervical Cell Lifts study aims to improve the methods of collection and analysis of the cells taken from the surface of the cervix to identify more accurately when high-risk cervical pathology is present, which could be used for screening in future. This would ultimately lead to more patient-focused treatment with a reduction in the need for Large Loop Excision of the Transformation Zone (LLETZ) treatments, reducing the morbidity and potential side effects associated with this and improving the patient experience. LLETZ is a common treatment for removing abnormal tissue from the cervix using a thin wire loop..
My role entails facilitating the delivery and coordination of such studies, screening and identification of eligible patients, recruitment, consent, follow up, conducting study-related procedures and collating relevant datasets. I liaise with the clinical teams involved in these patients’ care and the scientists/collaborators who have developed the novel devices and methods being explored in the translational studies we have ongoing at CUH.
What is cervical screening and why is it important for women’s health?
The NHS cervical screening programme was developed in 1988 with hopes to tackle cervical cancer which is the 4th most common cancer in women globally (WHO 2023). It is based on the premise of early detection of pre-cancerous changes in cells within the cervix using HPV and Liquid Based Cytology (LBC) Testing for patients aged 25 to 64, every 3 years on average (National Institute of Clinical Excellence 2017).
What are the benefits of cervical screening in early detection and prevention of cervical cancer?
Cervical screening through regular smear tests enables the early detection of abnormalities within the cells of the cervix which would otherwise go unnoticed as they often do not cause symptoms, and subsequent removal or treatment before cervical cancer develops, which would be more difficult to manage and treat and is associated with higher mortality rates.
It is known that since its introduction, the NHS cervical screening programme has prevented an estimated 70% of cervical cancer deaths (Landy et al 2016).
What cervical screening studies are you involved in and how are these shaping the future of cervical cancer prevention and treatment?
The Cervical Cell Lifts study entails the collection of cervical cells during an examination of the cervix (colposcopy) using a novel technique for analysis of high-risk vs low-risk lesions.
This study explores the use of a triage test that generates a spatial map of the cervical surface at a molecular level. This is done through the lifting of cells from the cervix onto a membrane (cervical cell lift, CCL). The membrane and layer of cells are then analysed in the lab generating molecular maps of the cervical surface to identify any high-grade lesions.
The results of this study will hopefully enable more accurate identification of high-risk cervical pathology when it is present, reducing the need for biopsies and LLETZ procedures and their associated risks.
What are some of the barriers in recruiting patients into cervical screening studies and how can these be addressed?
One of the biggest challenges we face is clinic room availability to conduct research consultations which we hope will be improved with the new Cambridge Cancer Research Hospital. Another issue is patients' hesitance to participate in research due to preconceived ideas about research and a lack of understanding of what involvement looks like – this can often be addressed by spending more time explaining study processes, details of what study participation entails, emphasizing the voluntary nature of study participation as well as the potential impact of the research being undertaken.
Moreover, increasing our diversity in participant recruitment and inclusion of wider population groups including non-English speaking participants in the study to ensure data collected is representative is another but equally important barrier that should be acknowledged. This can be addressed with translated Patient Information Sheets and access to translators for research purposes. Lastly, there are challenges concerning time constraints that we are assessing and addressing. When patients come in for the first time after a GP referral, we often have limited time for research consent discussions to ensure standard appointments are not delayed.
If you can tell your patients one thing about the importance of cervical screening and their participation to research, what would it be?
Regular cervical screening is the best way to detect changes to your cells within the cervix which may otherwise go unnoticed, and early detection could prevent progression to cervical cancer, and better management and treatment options. Unlike many other countries, we are privileged to have an effective screening programme which allows us to do this in the UK, so please make use of it and go for your smear test!
We are not able to improve clinical methods and patient experiences without clinical research participation. In order to make changes to the systems we have in place, we have to conduct research studies to ensure that new methods work better than those we have in place currently, and that is only possible with your contribution.