Senior medic says HSE’s Tony O’Brien dismissed his concerns about cervical smears

A senior medic has claimed his concerns about the cervical smears were dismissed by the now outgoing head of the HSE Tony O’Brien, when Mr O’Brien was CEO of the national cancer screening service.

Dr David Gibbons said he expressed fears about the consequences of outsourcing smear tests to the USA 10 years ago in a meeting with Mr O’Brien.

“I was worried that there was going to be a problem,” he said.

However, Dr Gibbons alleges his concerns were dismissed and he subsequently resigned his position on the quality assurance committee of the national cervical screening programme, he said. He was chairman of the committee’s cytology/histology group.

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Speaking to RTÉ’s Morning Ireland, Dr Gibbons explained that, in 2008, some backlog smear samples were outsourced to the US for cervical cancer testing. When the figures of the results were being collected, he became concerned.

Dr Gibbons said the figures from the United States were showing one-third fewer high-grade dysplasias compared with Ireland. High grade dysplasias are smear samples which identify as having pre-cancerous cells.

He also said he had concerns about a “mismatch” of systems because Ireland tests for cervical cancer every three years while the US tests smear samples annually.

In Ireland, women aged 25 to 44 are invited routinely for a free smear test every three years and following two consecutive normal smear test results women aged 45 to 60 are invited routinely every five years.

Dr Gibbons said he warned that this would result in sub-standard smears and he predicted in 2008 that up to 1,000 women could be affected a year and that this would come apparent “10 to 15 years down the line”.

He said: “As chair of the QA [quality assurance] committee I went to Tony O’Brien and expressed my concerns and I warned that over a 10-year period this would cause problems.

“He dismissed my concerns so I resigned.

“I said that I thought outsourcing was dangerous, but they continued outsourcing despite our advice. The issue then became a political football. Unfortunately this is where we’re at now.

“We estimated that 1,000 cases a year would be missed.”

A comment has been sought from Mr O’Brien.

Meanwhile, the HSE has told RTÉ that when the national cervical screening programme was established, the process that was chosen followed the best international practice of countries that had well-established cervical screening programmes.

“Considerable time and research was given to the choice of laboratories that were selected in an open competitive process, that are subject to a rigorous quality assurance (QA) process.”

It said one of the many reasons smear samples were outsourced was due to an insufficient number of accredited Irish laboratories, which posed a significant quality assurance issue.

“In relation to the grading system, it is important to note that the classification system chosen by Ireland is the one that is recommended by the World Health Organisation and is widely used successfully by many other countries.”

The HSE also said that the international peer review of the CervicalCheck programme will examine all aspects of the programme, which includes both the screening process and laboratory performance as part of its work.