CervicalCheck will not catch up on number of screenings missed this year

Cancer screening programme facing reduced capacity due to Covid-19, committee hears

The Oireachtas health committee was told that no screening programme would pick up all potential cancer cases and none were designed to do so. Photograph: iStock

The Oireachtas health committee was told that no screening programme would pick up all potential cancer cases and none were designed to do so. Photograph: iStock

 

The CervicalCheck programme will not be able to catch up on the number of women who were unable to undergo screening this year due to the restrictions caused by the Covid-19 pandemic, its clinical director has said.

Dr Noírín Russell told the Oireachtas health committee on Wednesday that CervicalCheck had resumed screening on July 6th and that more than 270,000 invites had been sent out this year. She said more than 117,000 women had been screened in primary care up to the end of November.

She said CervicalCheck forecast that by the end of the year it would have screened about 50 per cent of the number of women it would have expected if there had been no Covid-19 pandemic.

Asked by David Cullinane of Sinn Féin how long it would take to catch up to deal with women who had missed out on screening, she said this would not be achievable.

Dr Russell said catch up would mean doing double the work and screening twice as any women per month as normal. She said due to Covid -19 there was reduced capacity across the programme and it would not be possible to catch up.

“That pause is going to be a permanent pause.”

Dr Russell also strongly maintained that no screening programme would pick up all potential cancer cases and none were designed to do so.

“When a potential case of cancer is not detected in screening, this does not mean that the screening test has failed. It illustrates the boundaries of the test. Furthermore, when these women go on to get cancer and their cytology slides are reviewed retrospectively, there is a four-in-10 chance that abnormalities will be seen that were not seen at the time of screening. This is called retrospective bias. It is important that as a society we acknowledge this uncomfortable truth.”

She said she had been a doctor on the frontline who dealt with women who had undergone screening and who had subsequently developed cancer.

She said this was a difficult and absolutely challenging place to be as a woman.

However, she said the smear test would never detect all cancers and every year there would be women who have an interval cancer, that is women who develop cancer after having had a normal screening test.

She said the Supreme Court had found that screening tests were not expected to detect 100 per cent of cancers. She said the Supreme Court had also outlined that a competent screener could be doing their job to the best of their ability with the tools that they have and a cancer may still not be detected.

Dr Russell said there were questions for broader Irish society.

“Do we accept as a society that we continue with screening because for the majority it reduces the risk of developing cancer?

“If we do that we have to acknowledge there will be women who are screened for cervical cancer who will have a negative result and who will go on to develop cancer. That is a minority but it is really, really tough as a woman if you end up in that minority. And we as a society have to decide how we look after women in that minority. We also have to decide whether we are going to treat some people with cancer differently than others.”

Dr Russell said every year 24,000 people in Ireland were diagnosed with cancer and that about 22,600 received their diagnosis on foot of symptoms.

She said 1,400 people were diagnosed with cancer on foot of a screening programme.

Separately, the Irish Cancer Society told the committee that the performance of some cancer services was getting worse due to historical underfunding, a lack of capacity in the system and an under resourced and incomplete workforce.

It said while cancer services received substantial additional resources in the budget this year, “the scale of the challenge is immense and, while increased funding is absolutely vital, money alone will not solve all the problems”.

Covid-19 has had “a devastating effect on a system that for many years, had insufficient capacity to be able to assure people that they would get diagnosed and treated for their cancer as fast as they should”, it said.

Prof Risteárd Ó Laoide, director of the National Cancer Control Programme said there had been a decrease in the number of cancers diagnosed at the rapid access clinics during the first wave of the Covid-19 pandemic. However, he said there had been an increase since then, and at the end of September, there had been about 90 per cent as many primary cancers diagnosed at these clinics as in the same period last year.