Cervical cancer: nothing less than full disclosure

The CervicalCheck scandal continues to develop, raising new questions that extend beyond the failure to share information with some 208 women about their cancer screenings.

Having begun with revelations that Limerick woman Vicky Phelan was not informed about an incorrectly reported 2011 smear test until 2017, we now know that 208 women were identified in a look-back process as having received a false negative result. Some 162 of these had not been informed about the process and 17 women have died from an, as yet, unconfirmed cause. Confidence was further undermined on Tuesday when it emerged that a "considerable" number of other cases may not have been audited at all.

False positive and false negative results are inherent features of all health screening programmes. But the false negative rate is especially high in cervical screening, where slides of the woman’s smear are placed on a microscope and assessed by the human eye.

Following a report by the Health Information and Quality Authority (Hiqa) last May, CervicalCheck is in the process of changing its screening criteria, starting in October. Hiqa looked at the potential benefits and costs of 32 screening strategies for preventing cervical cancer. It recommended moving to a system of testing smears for the presence of the human papilloma virus (HPV) in the first instance, with the current method of cytological testing used as a follow-up in women found to be HPV positive. HPV is the cause of 70 per cent of cervical cancers. Based on best international practice, Hiqa also recommended screening take place every five years for women aged 25-60 years.

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Given the many questions that have arisen about the quality of screening in some laboratories, the Department of Health must now look at bringing forward the implementation date for the new cervical cancer screening system.

The issue of pausing CervicalCheck could also be examined. With thousands of women likely to take up Minister for Health Simon Harris’s offer of free repeat testing, both GPs and laboratories will be temporarily swamped. A temporary cessation of routine screening could facilitate the expeditious analysis of these smears. However, such a move risks derailing a programme that, in 10 years, has detected more than 50,000 pre-cancerous changes in women without any symptoms, in the process reducing their cervical cancer risk by 90 per cent.

This is not the first health scandal of recent years to involve a failure to be open and honest with patients. Politicians, HSE managers, civil servants and clinicians must ensure they put all relevant information about the scandal into the public domain as quickly as possible. Nothing less than full and frank disclosure will suffice.