CervicalCheck director warns on viability of screening programmes

Scheme no longer viable if cost of related court payouts exceeds that of programmes

When a woman in a screening programme develops cancer her previous slides are reviewed and abnormalities can be found. File photograph: Getty

When a woman in a screening programme develops cancer her previous slides are reviewed and abnormalities can be found. File photograph: Getty

 

Cancer screening will no longer be viable if the total cost of related court payouts exceeds the cost of running the programmes, the clinical director of CervicalCheck has warned.

Dr Nóirín Russell said it would be more ethical in this situation to reallocate funding to the treatment of patients who have symptoms of cancer.

Ireland is an “outlier” internationally in its approach to compensation of interval cancer cases and the current court adversarial system is not in the best interests of patients, families or doctors, according to Dr Russell.

The comments are made in a letter to Aontú leader Peadar Tóibín, which is sharply critical of Dáil remarks the TD made in October.

“I worry that comments such as those you have made makes women feel they have been wronged by the system,” the letter states.

“It is a huge psychological blow to receive the diagnosis of cancer and to think that you might have been wronged makes that feel even worse. This is the best that any cancer screening programme in the world will ever be and therefore perpetuating the idea that these are ‘mistakes’ is harmful to women and their confidence in the programme.”

When a woman in a screening programme develops cancer her previous slides are reviewed and abnormalities can be found.

“However a discrepancy found on review does not imply that the same finding should have been made under routine screening conditions,” according to Dr Russell, who highlighted the phenomenon of retrospective bias, as the reviewer knows the woman has developed cancer.

“It is therefore misleading and not factually correct to say that these were ‘mistakes’ or ‘missed readings’ or to suggest that they confirm evidence of negligence. They are instead regrettable but expected findings in a cervical cancer screening programme.”

‘Fuels mistrust’

While Mr Tóibín suggested a re-examination of CervicalCheck might be needed due to what he termed a high “mistake rate”, Dr Russell replied that his call “inappropriately fuels mistrust in screening, causing damage to the public”.

A 2018 report found no quality-related reasons to discontinue contracts with any of the labs used by CervicalCheck, she pointed out. “There is no test in any laboratory anywhere in the world that will detect all abnormalities and hence there will always be false negative results.”

In response to the letter, Mr Tóibín expressed alarm that CervicalCheck was saying something “in complete contradiction” to the Government and the courts in relation to the controversy.

Last year, then taoiseach Leo Varadkar apologised to the CervicalCheck women for “a litany of failures” in the operation of the screening programme.

Vicky Phelan said on Thursday the 221+ group that represents women affected by the controversy would be writing to the Government-appointed steering committee for CervicalCheck in relation to Dr Russell’s letter.