The Irish Times view on the CervicalCheck controversy: HPV testing is urgently needed

HPV vaccination is Ireland’s best chance of eliminating cervical cancer as a public health problem

There is now a serious bottleneck in the reading of cervical smear tests after the number of tests increased from 280,000 in 2017 to 370,000 last year. The increase is largely the result of a decision by Minister for Health Simon Harris to offer women repeat smears if they had concerns in the wake of the controversy over the CervicalCheck programme. Photograph: Tom Honan

There is now a serious bottleneck in the reading of cervical smear tests after the number of tests increased from 280,000 in 2017 to 370,000 last year. The increase is largely the result of a decision by Minister for Health Simon Harris to offer women repeat smears if they had concerns in the wake of the controversy over the CervicalCheck programme. Photograph: Tom Honan

 

Events surrounding CervicalCheck continue to cast a shadow over the health service. A serious bottleneck has developed in the reading of cervical smear tests after the number of tests increased from 280,000 in 2017 to 370,000 last year. The rise is largely the result of a decision by Minister for Health Simon Harris to offer women repeat smears if they had concerns in the wake of the controversy over the CervicalCheck programme.

The Oireachtas health committee heard this week that some 78,000 women were waiting up to 28 weeks for results and it was taking laboratories three months to report on smear tests. The time it now takes to be informed of a test result is causing unnecessary worry to women.

Although it is widely accepted at this remove that there was no clinical rationale for retesting, the motivation behind it was understandable. Taoiseach Leo Varadkar told the Dáil this week that the chief medical officer had supported the original decision. The cost of the additional testing is about €10 million.

The National Cervical Screening Programme offers regular smear tests to 1.2 million eligible women aged 25 to 60 in the Republic. But it is important to emphasise that a smear test is not an individual diagnostic cancer test; rather it is a screening tool that looks for signs of possible future disease.

CervicalCheck has been effective. Prior to its introduction, cervical cancer rates in Ireland were rising by 4 per cent annually. This trend has been reversed, with an annual drop in incidence of 7 per cent.

However, a better test has become available and is being introduced by screening programmes globally. Testing for the presence of the human papilloma virus (HPV) results in a lower number of false negative results compared with the traditional reading of a smear.

Speaking at a conference at the Royal College of Physicians of Ireland in November, Prof Marion Saville, an Australian expert in HPV and screening, said the introduction of testing would help to get a better handle on the disease and, together with a high uptake of HPV vaccination, was “Ireland’s best chance of eliminating cervical cancer as a public health problem”.

Which makes it difficult to comprehend the disclosure by the HSE at the Oireachtas committee that it plans to clear the backlog of smear tests before it introduces HPV testing. Despite an original ministerial promise that a HPV programme would be in place by last September, the HSE now says it is unable to give a starting date for the new testing regime.

This not alone prolongs unnecessary anxiety for women but also effectively risks delaying the elimination of cervical cancer here. Is the Government willing to stand over this outcome?

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