Cancer screening: risks and benefits


Sir, – Stephen Collins’s article “Cancer screening attacks jeopardising lives of thousands” (Opinion, August 9th) outlining the risks to cancer screening services in Ireland is timely, pertinent and appropriate considering the very real concerns regarding the viability of these services in Ireland.

First, we acknowledge the distress and concerns of the women and families affected by recent events.

It is important that the public understand that all cancer-screening services are imperfect with recognised false positive and false negative results.

False positive results lead to patients being “over-treated” for benign and pre-cancerous lesions or small cancers which might never lead to clinical harm. False negative results refer to cancers that are missed, hence leading to delayed diagnoses that have clinical consequences for patients.

Each screening programme must strike a balance between both scenarios so that, on balance, cancer outcomes are improved. Undoubtedly, many hundreds of patients with breast, cervical and colorectal cancers have had better outcomes in Ireland as a consequence of our national cancer screening programmes.

The public urgently deserve informed debate regarding the limitations of screening services, acknowledgment of the shortcomings for any individual patient and clarity on the legal scrutiny regarding the appropriate standards of care, which support these programmes. In addition, all screening programmes should be underpinned by constant audit and quality assurance appraisal reflecting advances in the science and methodology of cancer screening and learnings from any perceived shortcomings.

Clearly there are considerable challenges facing the Irish health service. Notwithstanding these, Ireland ranked 11th out of 195 countries in the 2016 Healthcare Access and Quality in the Global Burden of Disease Study (Lancet May 23rd 2018).

Even the best health services will have patients who are failed and we must acknowledge their suffering, learn from past experience and support, in a more constructive manner, those attempting to design and deliver an ever improving health service, fit for the 21st century. – Yours, etc,

KENNETH MEALY, MD, FRCSI, President of the Royal College of Surgeons in Ireland; Prof MARY HORGAN, MD FRCPI President of the Royal College of Physicians of Ireland

C/o Dublin 2.