Sunday 18 August 2019

Lorraine Courtney: 'As CervicalCheck scandal rumbles on we must step up fight to end dangerous system'

Promises: Taoiseach Leo Varadkar and Health Minister Simon Harris. Photo: Frank McGrath
Promises: Taoiseach Leo Varadkar and Health Minister Simon Harris. Photo: Frank McGrath
Lorraine Courtney

Lorraine Courtney

One year on from the cervical cancer controversy, we know that we can eliminate the cancer if we go about it the right way. But our Government's mismanagement of last summer's crisis means we've spent far too much money and have an overwhelmed screening system instead.

The Government's initial response to the CervicalCheck story last April seemed to confuse fact with fiction - the Taoiseach and his ministers fell over themselves to get onside with the public, even if that meant destroying the screening programme itself.

They made promises that they would never be able to keep. The Taoiseach, a medical doctor, promised that no woman caught up in the CervicalCheck cancer screening controversy would have to go to court. He said that the State would take over the women's cases, seek settlements by mediation and pursue labs for damages.

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He later backtracked. He had to, admitting: "False negatives are part and parcel of screening and all of them are not negligence. Indeed, most of them are not negligent." Health Minister Simon Harris offered women free out-of-cycle tests even though this wasn't indicated or supported by any gynaecologist or expert. This short-sighted action has swamped the system.

Last year, the director general of the World Health Organisation (WHO) outlined how a scale-up of HPV vaccination and screening could eliminate cervical cancer by the end of this century. The research, published in the journal 'Lancet Oncology', shows how this could be done by increasing screening and vaccine coverage.

Rapid scale-up of combined high-coverage screening and vaccination from 2020 onwards would result in average annual cervical cancer incidence declining to less than six new cases per 100,000 individuals by 2045. At the end of the century, that would bring the global caseload down to less than four in 100,000 women - a level at which the cancer could be considered effectively eliminated.

However, this estimate is based on moving to a vaccine for girls that protects against nine strains of HPV. The vaccine currently used in Ireland protects against just four. On top of this, the HPV vaccine uptake among girls in Ireland is only 70pc, although this latest figure is a recovery in demand for the vaccine, which was the subject of a vigorous campaign of opposition by parents' groups a few years ago.

Despite the absence of any scientific basis for claims linking the vaccine to chronic illness, uptake of the HPV vaccine here fell to 50pc at one stage. Our government still has a long way to go to convince all parents that the vaccine is safe.

The WHO research also assumes a switch to HPV testing for cervical cancer, which is more effective, reliable and adaptable than traditional smear tests.

However, the promised introduction of HPV testing in Ireland has been delayed by an ongoing backlog of almost 80,000 smear tests in the CervicalCheck programme.

Because of Simon Harris's promise, the number of women getting smear tests rose from around 250,000 on previous years to 350,000 last year. This has meant that some women still hadn't got results more than 30 weeks after their tests and far too many women have had to re-do their test because of the delay in analysing their original samples. Earlier this month, we learned that the HSE is coming under growing pressure to suspend the cervical screening programme so the backlog of unread slides can be cleared.

The development of a national cervical screening lab, which would reduce the need to outsource tests to private operators in the US, is still years away but possibly not the best solution for Ireland either.

Dr Gabriel Scally, who led the CervicalCheck inquiry, has said that he is perfectly satisfied, based on his examination, with the quality in the current labs used by CervicalCheck - Quest Diagnostics in New Jersey, MedLab in Dublin and the Coombe Hospital lab, Dublin. We should listen to him.

The cervical smear test relies on trained professionals interpreting visual changes in cervical cells. This test is prone to the weakness that few abnormal cells may have been sampled by the test and the observer must interpret the changes correctly (it's not as easy as it sounds). It won't be cheap to set up our own lab here and I'm not convinced that we can match US labs on accuracy of results or price.

We could eliminate a cancer that affects around 300 Irish women a year but we must increase and maintain HPV vaccination rates. We need a HPV vaccine programme that protects against nine strains of the virus, not just four. We need to introduce a HPV screening test immediately and ensure that when abnormal tests are returned, effective treatment is readily available.

We must all fight for this. A health system that is still letting women down, despite all the concerns expressed a year ago, is a danger to every one of us. You may not have a cervix, but you do have a stake in how effective the health system is and how its €17bn is spent this year.

We all do.

Irish Independent

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