Thursday 14 November 2019

Ciara Kelly: 'Catch 22 dilemma of unaudited cervical checks'

CAMPAIGNER: Vicky Phelan at the launch of 221+ Cervical Check Patient Support Group, at Farmleigh, Dublin
CAMPAIGNER: Vicky Phelan at the launch of 221+ Cervical Check Patient Support Group, at Farmleigh, Dublin
Dr Ciara Kelly

Dr Ciara Kelly

A another woman with cervical cancer was in court last week after her smears were misread under the CervicalCheck scheme.

I can only imagine how difficult it is to go through our judicial system while suffering from cancer and my sincere sympathy goes to her and her family at what must be a dreadful time.

I heard Cian O'Carroll, her solicitor, speaking about the case afterwards and one of the things he highlighted was the fact that since 2018, when the issues around CervicalCheck became public, that auditing has stopped in our screening system and he is calling on the Government to reinstate it.

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But in my view that won't be happening and that is partly to do with the legal profession.

I've written previously about the fact that cervical screening has inherent in it a certain rate of misread smears.

That is the same for our screening system as for every other screening system in the world. Ours, despite what you might hear, has not been found to be any worse in terms of false negatives, which are smear tests marked normal that actually contain abnormalities.

Screening, even at its best, is a leaky sieve. But it still catches the majority of problems and saves countless women's lives.

Smear tests and HPV vaccinations are the two pillars we have in our battle to prevent the terrible disease that is cervical cancer.

Audit of the system is where, when a woman is diagnosed with cervical cancer, a look back at her old smears occurs to see if they were read correctly or incorrectly.

Audit is in effect quality control, it is a check done to see if the system is functioning to an acceptable standard. It is done to check the system, not for any other reason. I've pointed out previously that not all screening systems bother with audits, and they are the poorer for it because no quality control is being done and therefore standards can drop.

Alternatively, in those countries which do audit - with the exception of the UK - they operate a policy of non-disclosure of results.

This is for a variety of reasons. Some are altruistic - very little good can come for a woman knowing she had a misread smear, a 'what if' is a terrible thing to live with.

But they are also to do with the fact litigation can occur from disclosure, as we are seeing here, and considering the high rate of misread smears inherent in the system if that were to occur over every false negative the screening system would be financially unviable.

In the UK, where disclosure of audit results is given, they explain to women the high rates of misreads within screening and the fact that knowing doesn't normally bring anything but grief and in those circumstances about half the women decide they don't want to know their audit results.

We never made a proper policy around what to do with audit results here, which is why they were not disclosed or were disclosed inadvertently in a completely ill-judged and inappropriate manner to women. But now that these issues have come to light, we are left with a stark choice:

l Open disclosure of audits with subsequent financial compensation which will in time close down our screening service - we simply can't afford that;

l Non-disclosure of audit results, as in the majority of other countries, which I think would probably at this point be unpalatable to the public here;

l Or stopping audits altogether, which is what has happened.

It became a choice really between stopping screening or stopping audits. Stopping audits is probably the lesser of two evils. But, make no mistake, stopping audits is bad for women.

An unaudited system is one in which standards can drop and that will go undetected. This was always going to be the upshot of the courts being unwilling or unable to accept screening does not provide absolute certainty. All women will now be impacted by this.

We need to remember the personal tragedy of the women involved in these cases is that they got cervical cancer. It is cancer that is doing this. Not cervical screening - that saves lives. It just isn't capable of saving every life. That is the sad truth.

I do not know where we go from here. But I do know that every woman's health in this country is adversely affected by having an unaudited system. But unless we are willing to accept non-disclosure of results or accept that misread smears - which we will always have - cannot be treated as negligence, then an unaudited system is what we are left with. I warned here previously it would happen and it has.

We need to think long and hard now about what is actually the best course of action here for the common good. And how to achieve the least worse option.

@ciarakellydoc

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