Cancer found after screening fail

Diagnosis made more than three years after patient missed invitation for free check because of IT problem

Aperson was diagnosed with bowel cancer more than three years after they should have been invited to take part in a free screening programme.

Two other patients also missed were diagnosed with cancer 33 and 25 months after invitations should have been sent. One of the group died.

A review carried out for the Ministry of Health was unable to say what, if any, effect being missed from screening had in the three cases.

The ministry did not reveal the diagnosis timeframes for the three patients and initially refused to do so when asked by the Herald. The Ombudsman intervened and the information has now been released.

In response, Bowel Cancer NZ says it’s likely the patients would have had a lesion present at the time they should have been invited to take part in screening.

“It is likely given the normal timelines for cancer growth that [if screened] they may have had better outcomes,” said Frank Frizelle, the group’s medical adviser and surgeon.

Problems with how addresses were updated on an IT system used during a pilot in Waitemata meant thousands weren’t invited to participate in free screening. Eight people wrongly missed from screening later learnt they had bowel cancer.

Clinical records were reviewed by Dr Maree Weston, a consultant colorectal and general surgeon at Counties Manukau DHB.

When mail was returned and no alternative address found, the people were removed from the screening pilot. At a later point they came into contact with the health system and their address was recorded in the National Health Index system.

However, the screening pilot couldn’t access the system, and a new invitation was not sent out.

“It is my opinion that in five of the eight cases [offering a screening test at the time of their address being updated would not have] altered the outcome for those patients,” Weston’s November 2017 report stated.

“For the other three a significant amount of time had elapsed between the date of their address update and the date of diagnosis of cancer (33, 41 and 25 months respectively). It is impossible to conclude that an earlier diagnosis would have been made.”

In April the ministry said it had found another issue that meant many more people may have been missed from the Waitemata pilot, which ran from 2011 until the end of last year.

More than 30 people had developed bowel cancer, the ministry said, and work was ongoing to determine what, if any, difference being missed from screening made in those cases.

In an update given to the Herald,

Dr Jane O’Hallahan, clinical director of the ministry’s national screening unit, said clinical review had found screening was unlikely to have had any impact in most instances — but in at least three cases it may have.

That brings the number of people who may have caught their cancer earlier had they been included in screening to at least six.