Friday 18 October 2019

'There have been delays but we are doing our utmost'

Dr Lorraine Doherty, Clinical director of CervicalCheck

Return visits: One in 20 women who receive a BreastCheck mammogram is called back for more tests
Return visits: One in 20 women who receive a BreastCheck mammogram is called back for more tests

Screening is a vital element of our health service. It aims to identify healthy people at risk of a disease before symptoms appear. Early detection generally means early treatment, when there is a much better outcome or chance of survival.

Screening programmes are unique amongst health services in that they identify a whole population of apparently well people and test them to see if they are at risk of a specific disease or, in some cases, already have signs of that disease.

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Organised screening services currently offered include screening for newborns and four population-based programmes - CervicalCheck, BowelScreen, BreastCheck and Diabetic RetinaScreen. Approximately 1.5million people in Ireland are eligible for these programmes, supplied and operated by the HSE National Screening Service.

It is important to understand that a screening test is not the same as a diagnostic test, i.e. a test which is offered to people with symptoms or to those identified to be at risk, and assesses whether they already have the disease or a test can be used to monitor disease progress and response to treatment.

Like all medical tests, screening tests carry a degree of inaccuracy. Screening will not always pick up changes or signs of a disease (a false negative result) and in some cases it will pick up changes or signs which turn out to be benign (a false positive result). People can also develop the disease in between negative screenings.

Like all medical tests, these limitations need to be balanced with the benefits of screening. Screening in Ireland has saved many lives, and in the case of cervical screening in particular, has contributed to reducing the rates of cervical cancer among women in Ireland.

CervicalCheck commenced in 2008, when the incidence of cervical cancer in Ireland was increasing. By 2010, just two years after the programme began, this trend changed and the rates of cervical cancer in Ireland decreased by 7pc year on year between 2010 and 2015. To date, CervicalCheck has provided over three million cervical screening tests and detected over 100,000 abnormalities.

It is estimated that regular cervical screening can prevent 75pc (or 3 out of 4) of cervical cancer cases. Coupled with the human papillomavirus (HPV) vaccine, cervical screening has the potential to eliminate HPV in Ireland; the underlying cause of cervical and other related cancers.

Like all screening tests, cervical screening has limitations. It will not prevent all cases of cervical cancer and unfortunately some women will still develop cervical cancer despite regular screening. We know that for every 1,000 women screened through CervicalCheck, about 20 will have abnormal cervical cells. About 15 of these 20 women will have these cells detected through screening, while about 5 out of these 20 women will not and may develop cervical cancer.

The past year has been very difficult for women who have used CervicalCheck, particularly those women and families who were affected by the issues surrounding the cervical cancer audit process. As highlighted by Dr Gabriel Scally, these system-wide failures impacted hugely on women and their families and learnings and improvements must take place.

As the new Clinical Director of CervicalCheck, I and the hugely dedicated CervicalCheck team are absolutely committed to and focused on delivering the improvement and changes necessary that have been outlined in Dr Scally's report and to continuing to support women and families impacted.

Unprecedented demand

The unprecedented demand for cervical screening in 2018 has led to very regrettable delays in the processing of tests and many women continue to experience significant anxiety as they await their results. We are doing our utmost to reduce these delays and we are making steady progress. Notwithstanding this, we recognise the distress these delays are causing and we remain resolute at processing all outstanding tests as a matter of priority.

Once sufficient progress has been made, we can advance our planning for the implementation of HPV primary screening; a more effective method of cervical screening.

Despite these very real difficulties, and the general limitations of screening, we must not forget the huge benefit that screening brings to our population in terms of improving health outcomes and ultimately saving lives.

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