Responses to cervical cancer controversy reveal socioeconomic divide

A practice in Cork city centre has received a high volume of calls from concerned women – but not at its sister clinic in Hollyhill

 Dr Nick Flynn has two clinics in Cork city: “The response in both practices is like night and day.”

Dr Nick Flynn has two clinics in Cork city: “The response in both practices is like night and day.”

 

Dr Nick Flynn has two practices in Cork city, one in Hollyhill serving some of the most economically-deprived districts in the city, and the other in the city centre, mostly serving private patients under 40.

Since the cervical cancer controversy erupted, the Union Quay Medical Centre has received a large number of calls from concerned women.

But at the Hollyhill practice, which almost exclusively sees medical card patients, the issue is registering much less.

“The response in both practices is like night and day,” Dr Flynn says. “We are not getting a high volume of calls. We will of course do our best to screen as many as possible but they are unfortunately harder to reach groups to get to attend for screening and for general health concerns.”

Hollyhill, and places similar to it, are lagging equally behind when it comes to childhood vaccines, diabetes checks and repeat prescriptions. “It’s across the board really,” Dr Flynn says.

He says some patients with cervical cancer have been calling the Hollyhill surgery to express worry and concern.

“Some patients with a diagnosis of cervical cancer have been calling the surgery and we haven’t been able to get any information for them yet. They are asking us if they have been affected,” he continues.

“Other patients attending the surgery, women with normal smear test results, are raising the issue when they come in with their kids; but the cervical cancer issue is not the primary reason for their contact with the clinic.”

In contrast, at the private clinic, Dr Flynn says the “phone is ringing all the time”.

Deprivation index

“What we need and what GPs have been calling for is a deprivation index in how we look after patients,” he says.

“For instance if you take 1,000 patients in a poor area and 1,000 patients in a more wealthy area, the patients in the poor area will develop multi-morbidity 10 years before those in wealthy areas. Patients in poor areas are more unwell but they are less likely to attend. We need more resources.”

Dr Flynn says the lack of information from the HSE on the topic of cervical cancer has been very frustrating for GPs.

“We got a memo from the HSE last Thursday saying patients can go to their GP and get another smear but it was just two lines long and there was no information on the administrative process or clinical process,” he says.

Susan Smith, professor of Primary Care Medicine at the Royal College of Surgeons in Ireland general practice and Health Research Board centre for primary care research, noted an English study which identified a lower rate of coverage for breast cancer and cervical cancer screening programmes among women from lower socioeconomic backgrounds.

“CervicalCheck is free for everyone eligible but those in more socioeconomically deprived groups with higher rates of physical and mental health problems are generally less likely to engage in preventative healthcare due to pressures managing difficult lives already,” she says.

‘Ethically questionable’

Dr Austin Byrne, a GP based in Tramore, Co Waterford, says that at his practice, where some 80 per cent of patients have medical cards, concern about the controversy is greater among private patients.

“The educated middle classes are engaging. It’s certainly more women of a certain demographic,” he says, adding that there have been about 25 phone and personal contacts per day on the issue.

About half of those in contact with his practice over the matter have elected to proceed with another smear test.

“I’m genuinely surprised by the measured opinion of women. There is concern – but none of the hysteria conflated with entirely separate issues by politicians.”

Dr Byrne says the decision to introduce extra screening was “wrong, plain and simple”.

“He’s [Minister for Health Simon Harris] wasting likely over €100 million at the drop of a hat. Meanwhile, other areas are starved of resources. The decision to [call people back early for repeat smear tests] is medically incorrect and ethically questionable.”