Wednesday 20 February 2019

Dr Ciara Kelly: What is the solution to health screening crisis?

Our health screening programmes are at real risk of being abandoned
Our health screening programmes are at real risk of being abandoned

Ciara Kelly

I've grave concerns about health screening in Ireland. Not just cervical cancer screening, but also breast cancer screening, colorectal screening, retinal screening - all of them. And not the concerns you might have - that our screening is terrible, has misled people, engaged in cover-ups and been embroiled in scandals. No, not that. My concern is that we're on a path that may actually lead to health screening here being abandoned.

I've worked in medicine for 20 years and I understand the limitations of screening. I understand that high-volume, broad-stroke testing has false negatives - tests that are marked normal but where an abnormality is, in fact, present. And also false positives - tests that are marked abnormal, but no actual abnormality is present, but women are unfortunately put through unnecessary further tests and lots of anxiety as a result.

These are significant limitations and every possible effort should be made to keep them to a minimum, but they'll always exist to some extent. No screening programme in the world has eliminated them - it's the nature of screening. But, more importantly, I understand the huge benefits of screening. I understand the benefit of having a test that's acceptable in terms of invasiveness, and that's relatively fast and cheap, so that the whole population can be tested in a timely and affordable way. And its central benefit - that it has reduced the incidence of cancer by up to two thirds, and has saved thousands of lives - is a vital public health service. Screening has stopped innumerable Irish people from dying of cancer.

My concern about screening in Ireland isn't that it's bad - although it should be as good as it can be. My concern is about cowardly politicians who are afraid to speak up about the limitations and benefits of screening, for fear they won't be popular. My concern is about ambulance-chasing solicitors, advertising on social media - suggesting that anyone who's ever had a smear test or a mammogram may now have a legal case - and about a media which loves headlines containing words like scandal, outrage and disgrace.

Between them all - including the lawyers for whom this is big business, politicians who want to score points against opponents, and media outlets in pursuit of ratings - the pervasive view about our screening systems has become that they are scandalously bad.

When the truth is, this damning conclusion has not yet been established at all.

I'm now concerned about people who don't understand the immutable limitations of screening, and so think it can be 'fixed', and about people who would happily rubbish its reputation in a populist vote-grab, and - and this may be a hard pill to swallow - about people who would see the screening systems sued into oblivion every time a previous false negative is discovered in a patient who has been diagnosed with cancer, and millions paid in compensation.

If that's the road we're going down - then screening will stop. It will simply become unaffordable.

So, if you understand that there's no way to eliminate false negatives entirely from a screening programme - which means it's inevitable there will be people with cancer who've had them - then you will understand that financial compensation around that could end up costing more than the screening system itself, which would cripple health budgets. So screening will stop. Make no mistake and everyone loses.

Me saying this isn't because I don't care about those women who have cervical cancer now. Of course, I do, who doesn't? No one would have done anything differently in their shoes. I think Vicky Phelan and Emma Mhic Mhathuna and others have shown incredible bravery and integrity in how they have advocated for women in all of this. I cannot imagine how hard this has all been for them, and their families. But we still need to have a very hard conversation about where we go from here. If we can't eliminate false negatives - how do we proceed? That is the real question.

Because health screening saves lives - irrespective of its limitations. And, currently, all our screening programmes are at real risk of being abandoned. And who is that good for?

@ciarakellydoc

Ciara presents 'Lunchtime Live' on Newstalk, 12-2 weekdays

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