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

The Irish Times - Weekend Review - - NEWS REVIEW - The 221-plus Cer­vi­calCheck Pa­tient Sup­port Group can be con­tacted as the 221plus.ie web­site or email info@221plus.ie

Grow­ing num­bers

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

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