CervicalCheck urged to start patient-requested reviews for invasive cancer diagnoses

CervicalCheck should begin patient-requested reviews for all invasive cancer diagnoses, including those not detected during routine screening, an expert report has recommended.

Enhanced review structures have also been urged for both bowel and breast screening programmes.

The recommendations are contained in three reports published by two HSE-appointed Expert Reference Groups on Wednesday, following the 2018 report by Dr Gabriel Scally into the CervicalCheck controversy.

They were specifically tasked with reviewing the management of interval cancers – those discovered between negative screenings.

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The report dealing with CervicalCheck has said a process of patient-requested reviews of invasive cancer should be facilitated following receipt of written consent from the patient.

However, it noted that, based on international experience, such reviews could take more than 12 months to complete.

Such reviews should be made available to all women, including historic cases of those who did not participate in any other National Screening Service or Royal College of Obstetricians and Gynaecologists cytology review processes.

It has also recommended an anonymous, retrospective programme review of cytology in patients with invasive cancers, for which a legislative framework would need to be established.

Objectives

The report’s objectives included the need to determine best internationally accepted processes for reviewing and reporting interval cancers, and to develop guidance on how audits and individual case reviews should be undertaken.

At a briefing on Wednesday, Prof Susan O’Reilly, chairwoman of the CervicalCheck and BowelScreen expert reference group, said patient-requested reviews of their cases would be a “first for CervicalCheck”. Both bowel and breast screening programmes already offer some form of case reviews.

“There is no standard international consensus or standardised approach to clinical audit of interval cancers or indeed to disclosure to patients,” she said of the group’s findings.

“In cancer screening, 11 out of the 17 international programmes that responded to us review cytology [cancer screening], the others did not. And their approach to reviewing cytology was really focused on quality assurance and professional information and, for most of them, it did not relate to disclosure to patients.”

In some programmes, there is legislation banning disclosure in order to ensure such reviews can take place for the benefit of public health. Only one of the 17 programmes that do disclose cytology review outcomes do so directly to patients.

However, Prof O'Reilly said that following the adoption of recommendations in each of the three reports, Ireland would become a "leader internationally in the provision of a comprehensive approach to clinical review and audit".

Between 2008 and 2018, more than three million cytology tests were carried out by CervicalCheck in 1.2 million women aged 25-60 years, detecting over 64,000 high-risk pre-cancerous changes and 1,500 cancers.

International studies indicate false negative rates of up to 55 per cent when smear tests of women subsequently diagnosed with an interval cervical cancer were reviewed, the report noted.

Its authors have also recommended a revision of informational materials provided to women outlining the benefits and limitations of screening, the occurrence of interval cancers, and how women can request a review of their case, if desired.

“Any woman with a negative screening result who is subsequently diagnosed with an invasive cancer should have access to any information necessary in order to better understand her diagnosis,” it says.

“Recent commentary, including the Scoping Inquiry into the CervicalCheck Screening Programme conducted by Dr Gabriel Scally, was critical of the manner in which information was provided to women. All women must have access to a patient-requested review…the Expert Reference Group did not recommend restricting reviews to women with interval cancers, as international experience has concluded that all invasive cancers should be reviewed.”