Madam, - As a medical doctor and someone whose family has been affected by cancer, one cannot help but share the concern expressed nationally as to the missed diagnoses of breast cancer in Portlaoise Hospital. However I think it is important to stress the fact that "false negative" diagnostic investigations are not uncommon in modern medical practice. In my opinion, this is a fact that seems to have been rather under-emphasised in coverage of recent events. The briefest review of the medical literature reveals that, internationally, mammograms are falsely reported as negative, in about 10 per cent of cases where a breast cancer is found eventually. A paper from the specialist breast cancer service in St Vincent's Hospital, Elm Park published only last month in The Journal of Surgical Oncologyreported 124 false negative mammograms in the years 1994-2004. Of these, 42 per cent were recategorised as suspicious on retrospective review by the same specialist conducting the Portlaoise review, Dr Ann O'Doherty.
These St Vincent's figures are not in any way unusual or sub-standard, they are very much of international standard; however no medical or radiological investigation is 100 per cent sensitive. With the addition of modern ultrasound scanning to digital mammography, breast imaging is still only about 95 per cent sensitive as in spite the availability of 21st century technology, the human eye is still a necessary part of the procedure and it is not infallible. Even the very best observer will occasionally miss something.
What is important is to keep the number of falsely negative tests to a minimum by having adequate numbers of specialist staff and up-to-date equipment where possible, not to assume that any test result is absolute and to ensure that both clinicians and patients are aware of this fact and to have procedures in place to identify any unfortunate people who are subject to a falsely clear report. This is why centres of excellence in cancer care are so important and have been adopted as best practice internationally. - Yours, etc,
JOSEPH HARBISON,
Marley Drive,
Rathfarnham,
Dublin 16.
****
Madam, - I note your Editorial of November 24th, and appreciate the point made about the primacy of patients' rights over other conveniences. This represents not only good medicine but also good manners and a basic respect for human dignity, which is often found wanting in the current healthcare climate. I also welcome your statement pointing out that "no screening system is perfect", a point made previously by other correspondents to your paper.
With respect to the future and development of cancer centres, you state that the Government accepted a report seven years ago that recommended the development of eight breast cancer treatment centres. This is not fully correct in that the document produced by Prof Niall O'Higgins and his group in 2000 (Development of Services for Symptomatic Breast Disease) actually recommended the development of 13 such centres, including my own hospital in Sligo.
The more recent National Cancer Strategy has reduced this number to eight for reasons that do not appear to be fully transparent. - Yours, etc
TIM O'HANRAHAN,
Consultant Surgeon,
Sligo General Hospital.
****
Madam, - Your Editorial of November 24th informs your readers that "seven years ago the Government accepted an official report that recommended the establishment of eight specialised centres of excellence for the treatment of breast cancer." This statement is blatantly inaccurate.
The report to which you are referring was written by Prof Niall O'Higgins and was published in March 2000. It recommended the establishment of 13 breast cancer centres - not eight! During the seven years that followed, none of these facilities was created as a result of a lack of funding and resources. Now the Government has promised to build only eight such centres, thus completely ignoring the recommendations made in the 2000 report.
One of the missing five centres was to have been located in Sligo - the home constituency of Minister of State Jimmy Devins, whom you also mentioned in your Editorial. His opposition to the current plan is thus totally justified.
Other recommended locations were to include Tullamore (Midlands centre) and Drogheda (North Eastern centre). Both of these areas have now been left with no proposed centres. It is a pity that The Irish Times has not seen fit to comment on the disgraceful abandonment of entire regions of this country. - Yours, etc,
Dr RUAIRÍ HANLEY,
Francis St,
Drogheda,
Co Louth.