Rising legal costs could shut BreastCheck service

Government-funded scheme receives 15 letters from solicitors in the past two weeks


Doctors involved with the BreastCheck service have expressed strong concern that spiralling legal costs could lead to the screening programme for breast cancer being closed down.

The national clinical director of the BreastCheck programme, Prof Ann O’Doherty, told the Oireachtas health committee yesterday her unit – which is one of four in the country – had received 15 solicitors’ letters in the past fortnight.

She said she had been working for 30 years in breast cancer screening and up to now would never have had more than one medico-legal case a year involving solicitors.

Her great concern was that litigation would cost so much that BreastCheck would be told to stop its screening service, she said, and that all resources would be diverted to the symptomatic breast cancer service.

She told the committee that BreastCheck had identified over 11,500 breast cancers since the programme began in 2000.

She said it offered screening mammograms to women every two years. Initially the programme had been aimed at women aged 50-64 but, more recently, it had been extended to age 69.

Surgical adviser to the National Cancer Control Programme, Prof Arnie Hill, told the committee the BreastCheck programme was the best part of the health service and was well funded, well set up and something of which the country should be proud.

He said his concern was that the events in the past month (regarding the cervical cancer screening programme) had the potential “to force the country to stop screening”.

If the screening programme cost €40 million a year “and if you are paying out €100 million in medico-legal costs, the taxpayer is going to say stop the screening programme and that means women will die from breast cancer”.

Prof Hill said, “If you line up 100 women with breast cancer and do a mammogram on all of them, in 10 of them it will not show.

“In this country if those 10 get a great solicitor [they] can get a very large sum of money, ranging up to €1 million and I suspect it will go higher in the years ahead.

“That is unsustainable,” he said.

The committee also heard while open disclosure had been HSE policy since 2013, it was unlikely to be implemented in BreastCheck until early next year.

However, doctors said where a woman developed breast cancer subsequent to receiving a mammogram she would be offered a review of the test but this was rarely taken up.

Prof O’Doherty said while mammography was the best screening test available for early detection of breast cancer, it was neither 100 per cent sensitive nor specific.

She said not all cancers were detected by screening mammography, which had inherent false negative rates.

“Women attending the programme are informed of this in all documentation provided by BreastCheck and, in fact, sign a consent for screening that includes the statement that not all cancers will be detected,” she said. “Women are advised in the normal screening results letter to attend their GP if they develop any symptoms and should be referred to one of the eight symptomatic breast cancer centres.”