>Ireland now finds itself at the centre of a global debate about what to do when cancers are inevitably missed by screening, and the options are not straightforward.
>As revealed in last week’s Business Post, the International Agency for Research on Cancer (IARC), a World Health Organisation (WHO) body, is working with the HSE to conduct a review of the country’s cancer screening programmes, amid concerns that unique public trust and litigation issues here arising from the CervicalCheck controversy pose a threat to screening globally.
>IARC’s concerns relate chiefly to the volume of litigation in Ireland relating to screening programmes, mostly contained to CervicalCheck. With 360 claims lodged against the CervicalCheck programme, Ireland is now a global outlier both in the amount of litigation of screening underway, and in the newly-rooted public perception that all missed cancers in screening equate to negligence.
>“We are concerned that the controversies surrounding the cancer audits in the CervicalCheck programme in Ireland not only could potentially derail the well-organised cervical, breast and colorectal cancer screening programmes in the country, but also may have a ripple effect across Europe,” Partha Basu, deputy head of early detection, prevention and infections at IARC, told the Business Post.
>…
>Fiona Murphy, the chief executive of the National Screening Service, said the fallout from the 2018 controversy had been extremely damaging to the reputation of Ireland’s screening programmes, and that there had been a failure to communicate adequately that screening was not a diagnostic tool.
>…
>“Consistently, in cervical cytology you would expect about five out of 20 of the women who end up developing cancer to not be detected by the screening programme,” said Susan O’Reilly, who headed up the expert reference group which reported on CervicalCheck interval cancers (cancers that develop in between screens) in 2020.
>“It was not stated clearly enough by the HSE at the time that this was not a foolproof programme. There is no all-clear in screening. A clear screen simply means we haven’t found anything today, not that there is nothing there.”
>…
>Under national HSE patient safety guidelines, it ordinarily would not have been required to disclose the findings of this audit to patients, as an open disclosure policy only related to “unintended or unanticipated” adverse clinical incidents or harms. Missed cancers in a screening programme did not meet that definition, due to the certainty of their occurrence.
>In fact, internationally, most screening programmes examined by the expert reference group on interval cancers have a policy of not disclosing the results of their audits to patients, as they are regarded as educational exercises to improve service quality and staff performance, not a process to uncover wrongdoing. Some of those regions even have legislative protection from disclosure.
>…
>The lack of understanding of screening by the political system was demonstrated early on when Simon Harris, then minister for health, offered repeat smears to women, which suggested there was something inherently wrong with Ireland’s screening programme, and clogged up a system that was already trying to offer smears to its target population for that year.
>…
>That report eventually made numerous recommendations to improve screening in Ireland which are still being implemented today. But it did not identify evidence to suggest that the foreign labs involved in analysing samples had been operating to a lower standard than what would have been expected.
>Scally is now preparing his final review of the implementation of his recommendations. Reflecting on the entire episode, he told the Business Post that all screening has a negative aspect to it, which was not well communicated by the HSE in 2018.
>“Getting the balance right between earlier treatment for conditions and the negatives of over-treatment and invasive investigations is difficult,” Scally told the Business Post. “They also get things wrong. Screening often involves human judgment. The boundaries of where that judgment lies can be difficult and once you introduce a human aspect you always run the risk of error.”
>…
>The chief issue of concern for O’Reilly of the expert reference group on CervicalCheck is the idea of mandatory disclosure of programme-wide audit results. This is something being considered as part of the new Patient Safety Bill currently making its way through the Dáil, and it isn’t yet clear whether statistically certain errors within screening programme will be included as notifiable events for mandatory disclosure.
>“If we are to have mandatory disclosure for something that is not considered an adverse event, it would do untold damage to all screening programmes, not just CervicalCheck,” she said. “If we have automatic disclosures relating to the programmatic review of interval cancers, that could be so harmful that it could destroy the screening programme.”
Whole article is over 3700 words.
Not surprising. People getting outraged and complaining about things they don’t understand is a major problem these days. So many people just have a vague idea of “HSE fucked up and killed loads of women” and no clue about what actually happened.
It doesn’t help when politicians (e.g. Holly Cairns) jumping in on issues around medical screening with very little knowledge of the topic.
There’s no doubt that cervical check has saved many lives. Whilst no screening program is 100% effective the HSE destroyed the faith in the system when it transpired that false negatives were not reported to the affected patients. The subsequent cover up and denial means that they are having to be ultra careful now so it’s pushing the number of follow up checks. Also covid impacted capacity for two years.
Simple , cancer and other diseases should be taught in schools . How to check yourself and how to prevent it. Getting screened, and the process of getting help from GP to hospital care .
It could be covered in general with on line information and booklet , the actual people who work in our Health system are brilliant. Mistakes happen , in all large organizations but when it happens in health it can be devastated results for the individual .
4 comments
Some snippets for those without a sub:
>…
>Ireland now finds itself at the centre of a global debate about what to do when cancers are inevitably missed by screening, and the options are not straightforward.
>As revealed in last week’s Business Post, the International Agency for Research on Cancer (IARC), a World Health Organisation (WHO) body, is working with the HSE to conduct a review of the country’s cancer screening programmes, amid concerns that unique public trust and litigation issues here arising from the CervicalCheck controversy pose a threat to screening globally.
>IARC’s concerns relate chiefly to the volume of litigation in Ireland relating to screening programmes, mostly contained to CervicalCheck. With 360 claims lodged against the CervicalCheck programme, Ireland is now a global outlier both in the amount of litigation of screening underway, and in the newly-rooted public perception that all missed cancers in screening equate to negligence.
>“We are concerned that the controversies surrounding the cancer audits in the CervicalCheck programme in Ireland not only could potentially derail the well-organised cervical, breast and colorectal cancer screening programmes in the country, but also may have a ripple effect across Europe,” Partha Basu, deputy head of early detection, prevention and infections at IARC, told the Business Post.
>…
>Fiona Murphy, the chief executive of the National Screening Service, said the fallout from the 2018 controversy had been extremely damaging to the reputation of Ireland’s screening programmes, and that there had been a failure to communicate adequately that screening was not a diagnostic tool.
>…
>“Consistently, in cervical cytology you would expect about five out of 20 of the women who end up developing cancer to not be detected by the screening programme,” said Susan O’Reilly, who headed up the expert reference group which reported on CervicalCheck interval cancers (cancers that develop in between screens) in 2020.
>“It was not stated clearly enough by the HSE at the time that this was not a foolproof programme. There is no all-clear in screening. A clear screen simply means we haven’t found anything today, not that there is nothing there.”
>…
>Under national HSE patient safety guidelines, it ordinarily would not have been required to disclose the findings of this audit to patients, as an open disclosure policy only related to “unintended or unanticipated” adverse clinical incidents or harms. Missed cancers in a screening programme did not meet that definition, due to the certainty of their occurrence.
>In fact, internationally, most screening programmes examined by the expert reference group on interval cancers have a policy of not disclosing the results of their audits to patients, as they are regarded as educational exercises to improve service quality and staff performance, not a process to uncover wrongdoing. Some of those regions even have legislative protection from disclosure.
>…
>The lack of understanding of screening by the political system was demonstrated early on when Simon Harris, then minister for health, offered repeat smears to women, which suggested there was something inherently wrong with Ireland’s screening programme, and clogged up a system that was already trying to offer smears to its target population for that year.
>…
>That report eventually made numerous recommendations to improve screening in Ireland which are still being implemented today. But it did not identify evidence to suggest that the foreign labs involved in analysing samples had been operating to a lower standard than what would have been expected.
>Scally is now preparing his final review of the implementation of his recommendations. Reflecting on the entire episode, he told the Business Post that all screening has a negative aspect to it, which was not well communicated by the HSE in 2018.
>“Getting the balance right between earlier treatment for conditions and the negatives of over-treatment and invasive investigations is difficult,” Scally told the Business Post. “They also get things wrong. Screening often involves human judgment. The boundaries of where that judgment lies can be difficult and once you introduce a human aspect you always run the risk of error.”
>…
>The chief issue of concern for O’Reilly of the expert reference group on CervicalCheck is the idea of mandatory disclosure of programme-wide audit results. This is something being considered as part of the new Patient Safety Bill currently making its way through the Dáil, and it isn’t yet clear whether statistically certain errors within screening programme will be included as notifiable events for mandatory disclosure.
>“If we are to have mandatory disclosure for something that is not considered an adverse event, it would do untold damage to all screening programmes, not just CervicalCheck,” she said. “If we have automatic disclosures relating to the programmatic review of interval cancers, that could be so harmful that it could destroy the screening programme.”
Whole article is over 3700 words.
Not surprising. People getting outraged and complaining about things they don’t understand is a major problem these days. So many people just have a vague idea of “HSE fucked up and killed loads of women” and no clue about what actually happened.
It doesn’t help when politicians (e.g. Holly Cairns) jumping in on issues around medical screening with very little knowledge of the topic.
There’s no doubt that cervical check has saved many lives. Whilst no screening program is 100% effective the HSE destroyed the faith in the system when it transpired that false negatives were not reported to the affected patients. The subsequent cover up and denial means that they are having to be ultra careful now so it’s pushing the number of follow up checks. Also covid impacted capacity for two years.
Simple , cancer and other diseases should be taught in schools . How to check yourself and how to prevent it. Getting screened, and the process of getting help from GP to hospital care .
It could be covered in general with on line information and booklet , the actual people who work in our Health system are brilliant. Mistakes happen , in all large organizations but when it happens in health it can be devastated results for the individual .