Cer­vi­cal screen­ing

The key ques­tions

The Irish Times - Tuesday - Health - - Health Lifestyle -

What is the chance of a false neg­a­tive test re­sult?

On av­er­age, for ev­ery 1,000 tests car­ried out, 959 tests will be neg­a­tive, but 4 of these will be a false neg­a­tive.

What is the chance of a false pos­i­tive re­sult?

On av­er­age, for ev­ery 1,000 tests car­ried out, 41 of these will be pos­i­tive, re­quir­ing a re­peat test or re­fer­ral for col­poscopy. Of the 41 tests, 12 will be con­firmed as CIN re­quir­ing treat­ment (true pos­i­tives). The re­main­ing 29 will be con­firmed as false pos­i­tives.

If I have a nor­mal smear test re­sult, what is my chance of de­vel­op­ing cer­vi­cal cancer in the next three to five years?

As­sum­ing 250,000 women at­tend for screen­ing each year in Cer­vi­calCheck, in women with a neg­a­tive screen­ing test, 39 will go on to de­velop in­va­sive cer­vi­cal cancer within 3.5 years and 90 will go on to de­velop in­va­sive cer­vi­cal cancer within 5.5 years. This in­cludes true neg­a­tives and false neg­a­tives.

What was the con­tro­versy with Cer­vi­calCheck and the Scally re­port?

The con­tro­versy sur­round­ing the Cer­vi­calCheck pro­gramme re­lates to the iden­ti­fi­ca­tion of false neg­a­tive re­sults by the screen­ing pro­gramme. An au­dit was un­der­taken to check the qual­ity of the pro­gramme. This au­dit in­volved re­view­ing pre­vi­ous cer­vi­cal screen­ing tests in women who had sub­se­quently de­vel­oped cer­vi­cal cancer. The fo­cus was on false neg­a­tive re­sults, ie, women who had a nor­mal screen­ing test but went on to de­velop cer­vi­cal cancer.

The Scally re­port re­viewed this process and high­lighted the dif­fi­culty in con­duct­ing these au­dits due to a con­cept called ‘re­call bias’, ie, those re­view­ing the slides as part of the au­dit may be aware the woman went on to de­velop cer­vi­cal cancer.

The re­port was crit­i­cal of the process, par­tic­u­larly that the women in­volved were not in­formed of this au­dit and that the HSE pol­icy on Open Dis­clo­sure was not gen­er­ally fol­lowed. The re­port also high­lighted the sig­nif­i­cant de­lays ex­pe­ri­enced by women and many ex­am­ples of poor com­mu­ni­ca­tion with the women af­fected and their fam­i­lies.

We do not yet know if Ire­land has a dif­fer­ent rate of false neg­a­tive re­sults for cer­vi­cal cancer screen­ing com­pared with other coun­tries.

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