A doctor writes: Can women trust CervicalCheck?
Can women have confidence in the national cervical screening programme?
Vicky and Jim Phelan: Ms Phelan settled a High Court action for €2.5 million against a US laboratory over a 2011 smear test, which wrongly gave a negative result for cancer. Photograph: CourtPix
The continuing uncertainty over the management of the CervicalCheck programme in light of revelations in the Vicky Phelan case this week has inevitably shaken women’s confidence in the cancer-prevention service.
Ms Phelan settled a High Court action for €2.5 million against a US laboratory over a 2011 smear test, which wrongly gave a negative result for cancer. She was diagnosed with cancer in 2014 and told of the false negative in the 2011 smear test only in September 2017.
It has since emerged there was a delay in informing a total of 206 women that they were part of a look-back process to see if their original cervical smears had been correctly read which is clearly not acceptable. It doesn’t help that CervicalCheck cannot confirm, even now, that all of these women have been informed. The serious communication lapse has prompted a commitment from Minister for Health Simon Harris to introduce mandatory open disclosure legislation. Unsurprisingly, women in the 25-60 years target group are asking questions about the screening programme.
Q. I have an appointment for a cervical smear test on Monday. Should I turn up or should I delay having the test done?
A. You should turn up. There is no evidence to date to suggest the clinical elements of the screening programme are faulty. The quality of smear-taking by doctors and nurses is not in question. According to Dr Gráinne Flannelly, clinical director of CervicalCheck, the three contracted laboratories which currently look for abnormalities in smears have passed all quality control tests and are operating to the highest international standards.
Q. But if this is the case, how is it that so many women had to be called back for further investigations?
A. Like all screening programmes, the results are never 100 per cent accurate. A percentage of initial tests will be inadvertently misinterpreted and produce either a false positive result or, as in the case of Ms Phelan, a false negative result. So this aspect of CervicalCheck, once the false result rates stay below an internationally accepted standard, is not a source for concern. In addition, the longer you are part of the cervical screening programme, the greater the accuracy as you move from having a single snapshot of the health of your cervix to a dynamic picture.
Q. I heard the Minister for Health say on radio that he does not have confidence in the CervicalCheck programme. That’s pretty serious, isn’t it?
A. Yes it is. But the Minister was careful to distinguish between the management of the cancer-screening programme and the actual screening process itself. In other words, he is concerned about the overall management of CervicalCheck, but not the clinical components that deliver a result to each woman who is tested.
Q. Have we any evidence that screening for cervical cancer makes any difference?
A. CervicalCheck is up and running for 10 years now. Screening 250,000 women annually, it has an 80 per cent uptake rate which compares well with programmes internationally. During that time the National Cancer Registry has reported a 7 per cent reduction in the number of cases of cervical cancer in Ireland.
Q. Will there continue to be a problem accessing information about my test results and any look-backs I may be involved in?
A. CervicalCheck says it is now committed to an open disclosure policy. It’s audit policy was changed in 2015 to reflect this. Dr Flannelly says she “absolutely regrets” not having an open disclosure policy in place from when the screening programme began in 2008.