Breast cancer screening service’s future may be at risk over legal claims

A sharp rise in legal claims over alleged misdiagnosis against the national breast cancer screening service is fuelling concerns about the future viability of the service.

Nine claims against BreastCheck are currently under active management by the State Claims Agency, more than at any time in the history of the service since it was set up in 1998.

The agency received six claims alleging a misdiagnosis by BreastCheck last year, compared to none in 2017 and 2014; and one in each of the years 2016 and 2015, according to figures it provided to The Irish Times.

Meanwhile, the State Claims Agency says it has settled one other case against BreastCheck. Although the settlement did not include a confidentiality agreement, it declined to state the figure involved.

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“The State Claims Agency does not publish details of individual settlements. This is to protect any individual from being identified,” according to a spokesman.

Asked whether it seeks confidentiality agreements as part of Health Service Executive settlements, the spokesman says this is not the agency’s policy and there had been no change in this policy.

‘Absolute confidence’

Health sources say the number of cases, while small compared to litigation involving cervical cancer screening, is unprecedented and a cause of concern for the future of the programme.

The figures cover the period up to mid-February, before the judgment by Mr Justice Kevin Cross in a High Court case taken by cervical cancer patient Ruth Morrissey. He found screeners should not give the all-clear unless they have "absolute confidence" a sample is clear.

The ruling, which is being appealed, has caused widespread concern in screening programmes, which are inherently fallible. Although breast cancer screening saves an estimated 150 lives a year, mammography cannot detect all cancers.

Responding last month to that ruling, the clinical director of BreastCheck, Dr Ann O’Doherty, pointed out screening had to be cost-effective. If the cost of screening plus litigation made it uneconomic, the money involved might be better spent on helping people already diagnosed with cancer, she suggested.

Repeat tests

Whatever the outcome of the Cross appeal, the judgment is likely to result in more women being recalled for repeat tests and, as a possible consequence, surgical interventions. This, along with increased litigation costs, will reduce the cost-effectiveness of the programme.

In such a scenario, Dr O’Doherty warned, the programme could become “unjustifiable and unsustainable”.

Controversy around the screening programmes has already had an impact on BreastCheck, she pointed out, by making it more difficult to recruit radiologists.

Since it was introduced in 2000, BreastCheck has diagnosed more than 12,000 cases of breast cancer, more than half of which are detected at an early stage. It conducts screening mammograms on 165,000 Irish women each year.

In relation to the cervical cancer screening programme, the State Claims Agency says 92 claims have been received alleging misdiagnosis by CervicalCheck. Proceedings had been issued and served in 47 of these cases to mid-February.

All but a handful of cases have still to come to court.