Lorraine Courtney:
Misguided outrage threatens to destroy screening service
LONG before the Scally report our cervical screening programme was in a precarious position because of months of reckless promises from our leaders and public misinformation about what the screening programme was supposed to do.
The Scally report says that we shouldn’t set up a Commission of Investigation. We shouldn’t. Despite some of Dr Gabriel Scally’s more damning findings, our CervicalCheck programme was among the best in the world. But there will always be tragic misses in screening.
We have a horrible story where women developed cervical cancer despite being screened and given the all clear.
Nineteen of the women have died and others are terminally ill.
CervicalCheck carried out an audit of women who had been diagnosed with cervical cancer. Not all of these women were told about the audit and Vicky Phelan went public with her case against the HSE and Texas-based Clinical Pathology Laboratories.
What came next was a predictable cycle: assertions that abnormalities were missed. Litigation followed.
The public wanted an inquiry set up. Promises were made that it will never happen again by people who should know better.
Regrettably, it will happen again because “mistakes” are an inevitable part of any screening process. We must also remember that it was a look-back audit.
Back in May our Taoiseach, also a medical doctor, promised that no woman caught up in the CervicalCheck cancer screening scandal would have to go to court. He said that the State would take over the women’s cases, seek settlements by mediation and pursue the labs for damages so the women would not have to go through the process themselves.
The Taoiseach gave an interview to the ‘Six One News’ on May 11. He said: “What we propose to do is to offer mediation in every case so that women can avoid having to go to court and the trauma of a court hearing.”
If the lab refused to mediate and wanted to fight the case, he promised that in that situation the State would settle and pursue the lab later. He gave the women affected false hope and expectations.
This was reductive political posturing from a qualified medical doctor who should have known better. He then backtracked. He had to. He later admitted: “False negatives are part and parcel of screening and all of them are not negligence. Indeed, most of them are not negligent.”
Too many women thought that if they got regular smears and the results were negative, they wouldn’t develop cancer. But cervical smear testing is never going to be 100pc. It is a bit like wearing a seat belt: in an accident it might just save your life, but then again, it mightn’t.
Most results lie on a spectrum. At one end, the patient almost certainly has the disease, at the other, she doesn’t. In between is a grey area.
So, someone must decide the cut off between normal and abnormal. Making the test too sensitive by calling even the slightest abnormality a cancer will make sure you don’t miss any abnormalities but will generate lots of patients with a positive test but no cancer.
Basically, a small number of false negative results are the price for a screening service that is economically and logistically viable, but still picks up most cancers.
The result of Leo’s political posturing and threats to sue US labs might well be no screening service at all.
CervicalCheck has detected more than 50,000 high-grade pre-cancerous changes in women – it has saved women’s lives. We can’t destroy a functioning programme because of misguided outrage – now we don’t know if these labs are going to renew their contracts with Ireland or not.
Collapse of the CervicalCheck programme is a real possibility, even more so if we go ahead and establish a Commission. We can’t let it fall apart.