Insensitive actions risk damaging public confidence in life-saving cervical screening service

THE policy of open disclosure that we are now told is in place in the HSE promises an “open, timely and consistent approach to communicating with service users and their families when things go wrong in healthcare”.

But the failure to inform mother-of-two Vicky Phelan for three years about the findings of an internal report, which examined how her 2011 smear test returned a false negative, breaches this ethical obligation.

It would not have made any difference to her prognosis.

She had been diagnosed with cancer after developing symptoms in 2014.

But it would have been an expression of respect and compassion for a woman who is now terminally ill with the disease.

The insensitive action may now serve to damage confidence in the CervicalCheck programme, which offers free screening to women between the ages of 25 and 60. It is striving to get an 80pc take-up of tests.

The 2015-2016 report showed a 79.7pc take-up.

But that figure masks lower coverage in many counties including Clare, Kilkenny, Laois, Leitrim, Mayo, Monaghan, Roscommon, Tipperary and Ms Phelan’s own county of Limerick.

The widest coverage is needed if the death rates from cervical cancer are to fall.

It is targeted at women who have no symptoms and can pick up abnormal changes in the cervix before they become cancerous.

Around 300 women are diagnosed with invasive cervical cancer annually and 90 die from the disease.

Cervical screening is reliable, but not infallible.

It has a recognised risk of delivering false negative or positive results.

There is also the chance of interval cancers which women can develop between the screenings which vary from three to five years.

Since 2010, CervicalCheck has been doing internal look-backs on the cases of women who had a test and developed cancer.

This is good practice as it allows for the test to be checked again to see if errors were made, and how it can improve future readings. But it must be shared with patients.

The retrospective look in 2014 involved 15 cases, including that of Ms Phelan.

It emerged last night that 206 women developed cervical cancer after having a misdiagnosed smear in the free national screening programme and should have had further medical investigations.

CervicalCheck said it has now improved practice and the three-year delay which followed the 2014 report has been shortened.

The decision on how the information is given to the patient is left to the judgment of the consultant.

Complacency may have set in for the service – but it is vital that women do not lose confidence in it.

Over 50,000 women who have had a test through the service have been treated for precancerous abnormalities.

And more than 1,200 cancers have been detected.

The next step must be to follow through on a recommendation by Hiqa to change its method of testing which will improve accuracy.

It found that changing to primary HPV testing would reduce the number of screenings each woman has in her lifetime.

It would also provide better accuracy in detecting precancerous abnormalities and early stage invasive cervical cancer.

Women would experience no change in how the cervical screening sample is collected. Women with a negative HPV test could be reassured they are at very low risk of developing pre-cancerous abnormalities in the next five years.

‘‘ Over 50,000 who have had a test have been treated for precancerous abnormalities