BreastCheck ‘quite different’ to CervicalCheck despite errors in Kay O’Keeffe case

In the weeks after the CervicalCheck scandal broke on the steps of the High Court in April 2018, following a case taken by Vicky Phelan, senior health officials had major concerns the controversy would spread to impact other screening services.

The settlement and apology for Phelan, who died late last year, exposed major issues with the State’s cervical cancer screening programme, and its practice of subcontracting the reading of tests to private laboratories abroad.

It quickly emerged that more than 200 women were affected, where smears tested between 2008 and 2018 could have given a different result and women warned they were at increased risk of developing cancer.

More controversially, in 162 cases women had not been told about the results of internal CervicalCheck audits, which had revealed errors in the reading of their smear tests.

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At an Oireachtas committee hearing a month later, Prof Ann O’Doherty, national clinical director of BreastCheck, expressed serious concern that any significant increase in legal cases and associated costs, could threaten the existence of the breast cancer screening programme.

On Wednesday, the State apologised to the family of Kay O’Keeffe, who died aged 63 of breast cancer, after abnormalities in her BreastCheck mammograms were not detected.

Two opportunities were missed to intervene earlier for the Tipperary woman in 2011 and 2013, with the Health Service Executive (HSE) admitting errors had occurred, in a High Court case taken by her husband, Patrick “Patsy” O’Keeffe.

In June 2014, O’Keeffe found a lump on her breast and was diagnosed with incurable stage-four breast cancer. She died on May 12th, 2017.

It was a devastating personal tragedy for O’Keeffe and her family. But clinicians’ fears of a wave of cases taken against the breast cancer screening service in the wake of the CervicalCheck scandal have not come to pass.

While there have been upwards of 360 legal cases taken against CervicalCheck, some 20 cases have been filed over alleged cancer misdiagnosis in the BreastCheck screening programme.

The State Claims Agency, which manages the legal cases, said to date 12 of these have been concluded.

Cian O’Carroll, who represented Phelan and many other women in CervicalCheck cases, said it was clear the breast cancer screening service did not have similar widespread problems.

The medical negligence solicitor said the oversight of BreastCheck appeared to be much more impressive, and likely one reason why there was only a small number of legal cases over alleged failings.

“It is quite different to CervicalCheck where the key clinical service was outsourced to for-profit laboratories, with very little oversight or quality assurance,” he said.

The vital importance of the screening programme in helping to try to detect cancers or risks early, is not in dispute.

Despite a major report by Dr Gabriel Scally concluding there had been “a whole-system failure” in CervicalCheck, the public health expert said it was crucial screening services continued.

The BreastCheck programme, to catch abnormalities or suspected cancers early, was introduced in 2000. Since then it has detected more than 15,000 cases of breast cancer.

The scale of the screening programme has steadily increased over the last two decades, with nearly 160,000 women attending for mammograms screenings last year.

Interval cancers, which are those missed during previous screenings or where cancer develops in between screenings, are rare.

“Unfortunately, breast screening does not find signs of all breast cancer. There will still be people who go on to develop cancer despite screening. Interval cancers are unavoidable. They happen in every screening programme,” a HSE spokeswoman said.

Rates of interval cancer in the BreastCheck service are about two women per 1,000 screened a year, which is similar to levels seen in other screening services internationally.