Cancer screening programmes

 

Sir, – We are involved in the multidisciplinary care of women with gynaecological cancers. It is now over a month since Ms Vicky Phelan brought the reality of advanced cervical cancer into the homes of the country.

Two of the key issues brought to light recently are the overall quality of the cervical screening service and the processes regarding disclosure of audit findings. We trust that the ongoing review by Dr Gabriel Scally and colleagues will address these two core issues and place them in the context of international best practice. We hope that any shortcomings identified will be rigorously addressed.

We wish to engage with the additional implications of the political and media response to this controversy.

It is important to emphasise that cancer screening is performed across a community of healthy, asymptomatic individuals, and is designed to reduce deaths from cancer in the overall population. It differs from a diagnostic test targeted at an area of abnormality in an individual patient. Sadly, false negatives are an inevitable part of even the best screening programmes, regardless of the disease they target or the country they are based in.

For this reason, we echo the concerns raised by the director of the BreastCheck screening service recently. Approaches to redress need to recognise that automatic financial compensation for future false negative cases could lead to all screening programmes being abandoned. Politicians and commentators stating that they understand the limitations of screening should realise that this is not compatible with simultaneously stating that all individuals who have false negatives on audit review should receive uncontested compensation.

There is of course always a need to address the effects of medical harm when it occurs, and recent events highlight yet again the need for reform of the Irish medico-legal system. Individuals wronged by medical practice should not have to take costly and protracted action through the courts system at the toughest time in their lives. Reform of medical litigation in Ireland is long overdue and is only likely to occur via a collaborative cross-party approach or a representative citizens’ assembly.

We trust that all medical bodies will enthusiastically support any required improvements to screening programmes and disclosure processes and will be ready to engage with meaningful reform of the medical litigation processes. In the meantime, all those reacting to this controversy should act responsibly in the sole interest of the health of Irish women. The stakes are extremely high. Irresponsible commentary and poorly planned redress schemes at this critical juncture could lead to cessation of all cancer screening, which would ultimately lead to many more cancer deaths. – Yours, etc,

Dr KATHARINE ASTBURY,

Consultant Gynaecological

Oncology Surgeon,

Galway;

Mr WILLIAM BOYD,

Consultant Gynaecological

Oncology Surgeon, Dublin;

Prof DONAL BRENNAN,

Consultant Gynaecological

Oncology Surgeon, Dublin;

Dr MYRA FITZPATRICK,

Consultant Gynaecologist,

Dublin;

Dr MATT HEWITT,

Consultant Gynaecological

Oncology Surgeon, Cork;

Mr RUAIDHRI McVEY,

Consultant Gynaecological

Oncology Surgeon, Dublin;

Dr CLIONA MURPHY,

Consultant Gynaecologist,

Dublin;

Dr DONAL O’BRIEN,

Consultant Gynaecological

Oncology Surgeon,

Dublin;

Dr MICHAEL O’LEARY,

Consultant Gynaecological

Oncology Surgeon, Galway;

Dr CIARÁN Ó RIAIN,

Consultant

Histopathologist, Dublin;

Dr NÓIRÍN RUSSELL,

Consultant

Gynaecologist, Cork;

Dr TOM WALSH,

Consultant Gynaecological

Oncology Surgeon,

Dublin.