Everything you need to know about Breastcheck, Cervicalcheck and Bowelscreen

Áilín Quinlan talks to Dr Robert O'Connor of the Irish Cancer Society about the three national screening programmes available and why we should be using them

Dr Robert O'Connor, head of research at the Irish Cancer Society

The BreastCheck mobile screening unit.

Expert: Dr Robert O’Connor

Reducing cancer: screening can help increase your survival chances

thumbnail: Dr Robert O'Connor, head of research at the Irish Cancer Society
thumbnail: The BreastCheck mobile screening unit.
thumbnail: Expert: Dr Robert O’Connor
thumbnail: Reducing cancer: screening can help increase your survival chances

Despite recent controversy, cancer screening is still the best way to find cancer before any symptoms appear in your body. Finding cancer this early saves lives. In Ireland there are three free screening programmes run by the National Cancer Screening service. Here is a comprehensive guide to the services on offer and what to expect from them.


Who is it for?

BreastCheck screens women aged 50 to 64 - but it should be recognised that women under age 50 and over age 65 are still at risk of getting breast cancer. Breast screening is where a mammogram, or an x-ray of the breast, is taken to check for signs of early breast cancer. In Ireland BreastCheck invites eligible women for their free mammogram every two years. If breast cancer is found early, it is easier to treat and a woman has a high chance of a good recovery.

How do I register?

You can register and check your details online on breastcheck.ie.

What is involved in the screening procedure?

A mammogram is an x-ray of the breast. The breast is placed between plates and a lever compresses, or flattens, the breast for a few seconds while the x-ray is being taken.

When the breast is adequately compressed more of the breast tissue can be seen, less radiation will be used and there will be no movement, which causes blurring on the x-ray.

What is the screening looking for?

Breast cancer occurs when normal breast cells begin to divide and grow in an abnormal way. Breast screening can show breast cancers at an early stage, when they are too small for you or your doctor to see or feel.

Where is the checking of BreastCheck screens carried out?

BreastCheck mammograms are taken by trained mammographers at each of the screening units. The tests are then read by two trained radiologists.

What are the success rates?

"About four out of five of breast cancers will be detected by x-ray. One in five will not show up," explains Dr O'Connor. "There are a lot of variables and it can be more difficult to pick up small tumours. Figures show that about 3,000 breast cancers are diagnosed in Ireland each year and that about 986 of those are detected annually by BreastCheck."

What do your results mean?

The mammograms are examined by two consultant radiologists and the results are sent to your home and to your GP within three weeks. The majority of women receive a 'normal' result and will be re-invited for routine screening in two years' time. About one in 20 women who receive a BreastCheck mammogram is called back for more tests. In some cases this recall may be for technical reasons, for example, if the image is not clear enough. Most women are given normal results following the tests. A small number of women will require further investigation.

Has this screening been proved to reduce deaths from this type of cancer?

Yes: "Our mortality rates from breast cancer are continually reducing and breast cancer screening is playing a part in that along with advances in surgery and treatment," says Dr O'Connor.

Lives are saved because cancers are diagnosed and treated earlier than they would have been without the screening process.

Are there changes afoot in the screening process?

In Ireland, BreastCheck currently invites women between the ages of 50 and 64 for their free mammogram every two years. There are plans to extend the Breastcheck service - it is expected to be eventually rolled out to all women aged 50 to 69 by the end of 2021.

How does Breastcheck screening compare internationally?

Programme standards, against which BreastCheck's performance is measured, are based on the European Guidelines for Quality Assurance in Breast Cancer Screening and Diagnosis.

"BreastCheck compares favourably with systems internationally," says Dr O'Connor. "Data on detection rates, for example, compares favourably with data from other European countries." See breastcheck.ie


Who is it for?

International best practice recommends that the cervical screening programme should target women aged from 25 or 30 years to 60 or 65 years.

How do I register?

You can register and check your details online at cervicalcheck.ie.

How does the screening work:

A cervical screening test is a simple test that takes about five minutes. It may be slightly uncomfortable but should not be painful. The appointment should generally take about 15 minutes in the doctor's surgery or health clinic. During the test, the woman lies on her side or on her back. The doctor or nurse taking the test will gently insert an instrument called a speculum into the vagina to hold it open. The cervix is the area where the top of the vagina leads to the uterus or womb.

Next, the doctor or nurse uses a small, specialised broom to gently brush off a sample of cells from the cervix. This sample is later sent to the laboratory to be checked. What is the screening looking for?

A cervical screening test, which is also known as a smear test or a pap test is a simple procedure during which a doctor or nurse takes a sample of cells from the neck of the womb, called the cervix. This sample is then examined for early changes on the cells. A test can identify cell changes before they become cancer cells. If these cells are not found and treated, they could become cancerous over time. If low-grade changes are found, the laboratory will also test the sample for certain types of HPV infection. This will help to inform what needs to be done next.

What are the success rates?

The current test picks up about three-quarters, or 75pc of cervical abnormalities that might give rise to life-threatening cancer, according to a report published last year by the Health Information and Quality Authority. It is expected that the change to a screen based on HPV testing will improve the detection of pre-cancers including some adenomas, and bring detection up to about 90pc of cervical abnormalities.

Remember, a cervical screening test is not a diagnostic test for cancer. As with all screening tests, cervical screening is designed to pick up early, easily treatable pre-cancers in the years before they become full-blown cancer. Hence, any woman who has symptoms of cervical problems, such as irregular bleeding, bleeding after menopause or unexplained pain should go to her doctor regardless of screening.

What do your results mean?

Currently, smear tests examine a sample of the cells on the cervix under a microscope. Two trained medical scientists in the labs which provide the screening service for CervicalCheck then check the tests for any abnormalities.

Each smear test result is accompanied by a recommendation to advise what needs to be done next. In most cases smear tests do not show any changes in the cells of the cervix and the result is negative.

This means that you will be called for your next smear test in three or five years, depending on your age. In some cases, smear tests show changes in the cells of the cervix. These changes are common and most are caused by a virus called the human papillomavirus (HPV). HPV is a common virus usually spread by skin-to-skin contact during sexual activity. Any person who has ever engaged in sexual activity is likely to have been exposed to HPV. Most HPV infections will clear up on their own but can persist without symptoms for many years.

If changes in the cells of the cervix are found, they can be low-grade or high-grade.

Low-grade changes are common and most clear up on their own. When these changes are found, your smear test sample will be tested for certain types of HPV infection.

If high-grade changes are found, these are less likely to clear up on their own and you will need a more detailed examination called a colposcopy. A colposcopy is free of charge and the doctor or nurse who took your smear test will arrange it for you.

Has this screening been proved to reduce deaths from this type of cancer?

Prior to the establishment of the CervicalCheck system, the incidence of cervical cancer was rising at 4pc per year, but the advent of screening has led to a fall of 7pc every year since. This is converting to an overall reduction in the mortality rate (numbers of deaths per 100,000) from cervical cancer.

"CervicalCheck has picked up 1,300 cancers, 50,000 high grade (high-cancer risk) pre- cancers and 37,000 low grade pre-cancers in the first eight years of its existence," explains Dr O'Connor.

"It is very clear that the early detection of pre-cancer has improved. As a result of early detection, many cancers are not occurring because they are being picked up in the pre-cancer stage - and when they are picked up, they are picked up much earlier and successfully treated."

Are there changes afoot in the screening process?

Next year, CervicalCheck is moving to a new type of smear test, where women will also be tested for the presence of HPV virus. This will be more accurate than the current smear test. HPV is a sexually transmitted infection that is extremely common.

Where is the checking of CervicalCheck tests done?

Smear tests are sent to one of three laboratories. Two of them are in Ireland - MedLab Pathology Ltd, Dublin and the Coombe Women and Infants' Hospital, Dublin. One of them is in the US - Quest Diagnostics Inc, Teterboro, New Jersey, USA.

How does this screening compare internationally?

"It compares very favourably," says Dr O'Connor. "We have very good uptake. All of the basic measures of Cervical Check quality are in line or better than international norms.

Can cervical cancer be eliminated?

"Yes. Through a cervical screening model that focusses on HPV testing - which the Minister for Health has promised to introduce next year - and a high uptake of the HPV vaccine, we can potentially eliminate cervical cancer among women in Ireland within a generation.

"Should primary HPV testing become a reality in Ireland, it by no means would replace HPV vaccination. Screening can detect cancerous and pre-cancerous cells, but treatment to remove these cells can be harsh and invasive. What's more, detection through screening is no guarantee of survival. Vaccination, on the other hand, can stop these cancerous cells from developing in the first place. The vaccine is safe and proven to save lives, and the more people who are vaccinated, the more effective it will be.

"The women of Ireland deserve the best possible services when it comes to the safe prevention and early detection of cancer. A move towards primary HPV testing gives them this. We call on the screening service to move to this form of testing without delay, while ensuring medical professionals and the general public have the information and resources available to guarantee that women in Ireland receive the best care possible."


Who is it for?

The National Bowel Screening Programme invites men and women aged 60 to 69 to participate in the programme. The risk of bowel cancer increases with age.

Therefore, by participating in the screening programme every two years, it is more likely that should bowel cancer occur it will be found at an early stage.

How do I register?

If you are aged between 60 to 69 years and living in Ireland, you can ring BowelScreen on Freephone 1800 45 45 55 to check your details are on the register. You can also check the register online at bowelscreen.ie.

How does the screening work?

When your details are on the register you will, within two years, receive an invitation to take part in the BowelScreen programme.

The programme will send you a letter asking you to take part in the bowel-screening programme. When you get a letter and want to take part, call the service on the number above and a BowelScreen home test kit will be sent to you with instructions on how to do the test.

You will need to produce a stool and collect a sample on a sampling stick provided in your BowelScreen home test kit. A small sample is all that is neededJust ensure that the label is dated with the day the sample was taken as this is very important.

What is the screening looking for?

The aim of bowel screening is to find bowel cancer at an early stage in people who have no symptoms. Bowel screening starts with a simple home test, called a FIT - faecal immunochemical test - that looks for tiny amounts of blood, which are not visible to the eye, in your bowel motion, also known as a stool. The bowel-screening test does not tell you if you have bowel cancer but it might tell you that you need more tests.

Where is the checking of Bowel Screen tests done?

The FIT tests are checked in Irish laboratories (MedLabs). If the test is positive the person will be invited to undertake a colonoscopy (a camera-based examination of the bowel) in one of 15 accredited centres across the country.

What are the success rates?

"International evidence indicates that the FIT test used by Bowel Screen will detect approximately 70pc of bowel cancers and pre-cancers," explains Dr O'Connor.

What do your results mean?

Once you have sent back your test sample, you will get a letter with the results of your BowelScreen home test in four weeks. About 95pc of people will receive a normal result. BowelScreen offers a colonoscopy test to everyone who has a BowelScreen home test result which shows traces of blood not visible to the eye. A colonoscopy is the best way to diagnose bowel cancer and other conditions and it is carried out in a screening colonoscopy unit in a hospital organised by BowelScreen.

Has this screening been proved to reduce deaths from this type of cancer?

Yes, says Dr O'Connor. "It has picked up a significant number of pre cancers and early stage bowel cancers including cancers that were otherwise showing no symptoms."

How does this screening compare internationally?

"Very favourably," says Dr O'Connor. "We use the most modern, and very sensitive FIT test which is the recognised internationally as the most modern test and the numbers of cancer detected are equivalent if not better than international norms."