FOUR SMEAR TESTS. NO ABNORMALITY
A series of smear tests by the CervicalCheck programme between 2009 and 2013 found no cause for alarm in Julie O’Reilly’s results. She died of cervical cancer on October 6th – the 19th known fatality associated with the controversy. This is her story, as
Mr Fixit, the man with the right spanner for the job, but what do you do with a problem that can’t be fixed?”
He has questions, too, about how someone with his wife’s symptoms could have ended up dying of cancer. Julie was called for a regular screening under the CervicalCheck programme in January 2009, which found evidence of abnormal cell growth (atypical glandular cells). This is a low- to medium-grade finding that requires the patient to be tested again soon, usually within six months.
In fact, as the later audit found, the slide showed evidence of high-grade squamous intraepithelial lesion (HSIL), a more serious indicator of pre-cancer.
“Had that slide been correctly read, Julie would have been sent for immediate colposcopy ( examination of the cervix) and treatment of pre-cancer,” says Cian O’Carroll, the solicitor engaged by the O’Reilly family.
Due to the issue raised in the first smear, she was recalled for another test in May 2009, and no abnormality was detected. A further test was conducted in November that year, and again, no abnormality was detected. In October 2010, another test produced another normal result.
Yet on review, all three slides were found to show evidence of HSIL, just as with the first slide.
Cancer screening is not an exact science. About four out of every 1,000 tests will produce a false negative, meaning the disease is there but has not been spotted. Not all of these “misses” will be the result of misreading or negligence. It is also entirely possible for a woman to develop cancer in the interval between two tests.
Her last test, in September 2013, came back as normal, both initially and on review.
O’Carroll, who notes a similar pattern in Emma Mhic Mhathúna’s case, believes the slide was read correctly but suggests the taking of the smear failed to pick up the abnormality present.
“As a consequence of these missed opportunities, at the time of her diagnosis Julie not only had cancer in her cervix but she also had significant tumours on her leg. The opportunity for a cure was lost,” argues O’Carroll. In Tony’s view, his wife was “sentenced to death”. “Her fate had been determined years earlier” when the cervical screening programme was being designed.
“The people I blame are the previous administrations who made the decisions when this happened, when the tenders were going out and the contracts were signed for the CervicalCheck programme.
“They’re the ones who decided on the companies to use and the price that was set. I’d love to have answers from that point of view. What happened there?
“My wife might be here if they had picked up something back in 2009 and followed it through.”
Tony’s anger is compounded by what he feels were failings in the care provided for his wife, separate from those relating to the screening programme. There were delays in being seen, despite her symptoms, he says, a s we l l as e x a mpl e s of insensitivity.
Julie had already begun her chemo at St Vincent’s Hospital before an appointment came through to see the doctor in Beaumont Hospital, he points out.
After she died Tony was driving home when a doctor rang asking if he wanted an autopsy to be performed. “I hadn’t even got home. I couldn’t believe the insensitivity of the doctor ringing so soon. I want to start grieving. That decision could have waited till Monday.”
He has met Dr Gabriel Scally, the Northern Irish public health doctor who carried out the scoping inquiry into the controversy, and says he is a “very honorable man”.
However, Dr Scally’s report has not answered his questions and “there’s more work to be done”.
Tony says he wants to know more about the outsourcing of Irish cervical smears to overseas labs – something Dr Scally is still investigating – as well as the training provided to the staff involved.
Were these staff properly trained, and was the work done too cheaply, he wants to know.
Asked how he is coping, he replies: “I’m not, really.” He has taken a break from work and moved in with his daughter. He hasn’t consented to Julie’s slides being re-examined for a further review aimed at establishing where negligence occurred, saying he has lost trust in the system.
Julie’s ashes were buried in her mother’s grave in the Isle of Man under a bouquet of red roses. “You shined like a diamond and gleamed like gold / And your hand was always warm to hold,” her daughter Gaby recounted in a poem she wrote for the memorial service. “Heaven has opened its doors for a perfect angel to walk through.”
Six months after the CervicalCheck controversy erupted – with Vicky Phelan’s (right) settlement of her High Court case against a testing lab for ¤2.5 million – the exact impact on the health of other affected women remains unclear.All that we can say with certainty is that the number of CervicalCheck women will continue to grow, and that more of these women will die. The HSE has so far bracketed 221 women as being affected by the controversy, but this group is generally referred to as being “221-plus” in recognition that more names will be added to it in time.The HSE carried out an audit of women who had been diagnosed with cervical cancer. This happened after their cancer was diagnosed. Most of the women were not told about the audit until the controversy erupted this year.In the case of the 221-plus women, it was found that they could have got a different result from their screening result at the time of the smear test.The HSE has admitted there was a communication breakdown in relation to relaying the results of the audit to affected women. There is less clarity on the impact of these “discordant” test results on the health of the women.The case of Emma Mhic Mhathúna, who“She said to me once, ‘What if we hadn’t made the decision to come back to Ireland in 2007, – would things have been different?’,” says Tony O’Reilly of his late wife Julie, above