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Health Minister Simon Harris says limitations of smear screening is a 'difficult, painful reality'

The Royal College of Obstetricians and Gynaecologists review found the CervicalCheck programme was working effectively overall.

Updated Dec 3rd 2019, 5:49 PM

A REVIEW INTO the screening history of every woman diagnosed with cervical cancer since the beginning of the CervicalCheck programme in 2008 has found that there were missed opportunities to prevent or diagnose cancer earlier in the cases of 159 women.

Out of a total of 1,038 women or their families who agreed to take part, the review disagreed with the CervicalCheck diagnoses in 30% of smear tests, or 308 cases (also known as discordant cases).

For half of these women, or 159 cases, the Expert Panel “considered that the CervicalCheck result had an adverse affect on the woman’s outcome”. 

“That is to say, had the abnormalities found on review been recognised at the time, this might have provided an opportunity to prevent cancer or to detect cancer at an earlier stage in 159 cases.”

For the other 149 women of the 308, the review disagreed with the original CervicalCheck slide reading but concluded that it didn’t believe this had an “adverse effect on their outcome”. 

Lead assessor of the report Prof Henry Kitchener stressed that these findings and percentages would “in no way apply to normal screening – it only applies to women who have been diagnosed with cancer”.

Overall, however, the independent review, compiled by members of the UK’s Royal College of Obstetricians and Gynaecologists (RCOG) found that the Irish cervical screening programme is “performing effectively”. 

Speaking outside Government Buildings this evening, Health Minister Simon Harris welcomed the report, saying that it sought to answer women’s questions on whether they could trust the government’s screening programme.

“The answer is clear, and thankfully, is yes,” he said.

He added that the fact that some abnormalities in smear tests are missed is “extremely painful and devastating on a human level”, but added that “no screening programme in the world will detect all cancers. And that is the difficult, painful reality.”

CervicalCheck

The Royal College of Obstetricians and Gynaecologists (RCOG) were called to carry out this review by the government in the wake of the CervicalCheck controversy that came to light after Vicky Phelan won her High Court case in April 2018.

CervicalCheck tests for cell changes in a woman’s cervix. It is not a diagnostic tool – it does not test for cervical cancer.

Phelan and others, including the late Emma Mhic Mhathúna, became advocates for the women affected by cervical cancer, and have been part of the 221+ Patient Support Group. It’s understood that 60 members of this 221 Plus group took part in this review.

The service failed to tell women who had been diagnosed with cancer that their original smear tests had been reviewed after their diagnosis.

In some cases the reviews found false negatives in tests and women in these cases may have benefited from an earlier diagnosis and earlier care.

A previous review carried out by Dr Gabriel Scally found that there were significant failures in the governance structures of the screening programme, describing it as “doomed to fail”. The biggest failure, he said was the non-disclosure of information from CervicalCheck audits to patients. 

Minister for Health Simon Harris was also criticised, and had been warned that his decision to offer free repeat smear tests was “dangerous” and it would put the screening programme at risk.

In the Dáil in October this year, Taoiseach Leo Varadkar issued a State apology to the women affected by failures in the CervicalCheck programme

‘Missed opportunities’

The government commissioned the review by the RCOG in May 2018.

In total, the review analysed 1,659 slides from 1,038 women, or their next-of-kin who consented to take part in the review. 

Of these, 1,034 of the women had invasive cancer and four women had high-grade abnormal changes detected.

In a statement today, the RCOG said: “The expert panel identified missed opportunities to prevent or diagnose cancer earlier in 159 (15%) of the 1,034 women with cancer. In a further 149 women (15%) the RCOG review panel disagreed with the Cervical Check slide reading, but they did not believe this had an adverse impact on their outcome.”

The review disagreed with the CervicalCheck result in a third of the cases it analysed – 308 out of 1,034.

The RCOG – which is based in London – said this overall pattern found by its review panel is similar to a much larger review involving cervical cancer cases in England. 

It also scrutinised colposcopy management in 106 women with cancer, and found that clinical management in a quarter of these cases was “suboptimal” and that an opportunity to prevent cancer or to diagnose it at an earlier stage was missed.

Deaths from cervical cancer in Ireland, meanwhile, rose by around 4% per annum in the years before the CervicalCheck programme began, and have dropped by 6.9% since it was introduced.

Professor Henry Kitchener, the RCOG’s lead assessor, said it was important to acknowledge the inability of cervical screening to prevent all cases of cervical cancer.

“There is clear evidence from falling death rates that the CervicalCheck programme is working effectively and women can have confidence [in it],” he said. 

He added that regular participation in screening remains the “most effective means” at protecting women from cervical cancer.

Concerns

Sinn Féin’s health spokesperson Louise O’Reilly said today that “serious concerns” had been raised by some women about the RCOG’s investigation after RTÉ reported in some cases slides were mislabelled or women were told their original slide was unavailable for review and then later told it had become available. 

“It is not on that such mistakes were made with such a sensitive issue in a scandal that has been characterised by failures and mistakes,” she said. 

The scandal itself was a failure of huge proportions and things did not improve for women thereafter as the screening programme was marked by delays and further mistakes.

With reporting from Gráinne Ní Aodha, Michelle Hennessy

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Sean Murray

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