CERVICALCHECK, the national cancer screening programme, is hoping that ‘open and frank’ discussions with women who have been diagnosed with interval cancer may reduce distress for women, avoid litigation, and prevent any undermining of public confidence in the system.
The director of the screening service said CervicalCheck is keen to work with patient advocates to ensure the service is geared towards their care and outcomes.
Consultant obstetrician and gynaecologist at Cork University Maternity Hospital, and newly-appointed clinical director of CervicalCheck, Dr Nóirín Russell, was speaking after a review on interval cancers was published by the HSE in recent days.
Interval cancers are those that are diagnosed in between a negative cancer screening test and a subsequent test. Under new HSE guidelines, CervicalCheck patients diagnosed with interval cancers will be granted the option of a review of their case in future.
The guidelines also state that all cases of interval cancer in all three cancer screening programmes — cervical, breast, and bowel — will be reviewed, even if a patient does not choose to do so, but that they can remain anonymous.
CervicalCheck was under the spotlight in 2018 after it emerged that several women diagnosed with cervical cancer had not been informed of a review that found they had received false negative test results earlier in the process.
Speaking to The Echo, Dr Russell said CervicalCheck will take on the recommendations of this latest review, and that the service is keen to work with patient advocates.
“We’re delighted with this review as it sets out what we’ll do in future,” she said.
“The report said women should be able to request a review if they develop cancer while they’re in the programme.
“We’re aiming to do anonymous audits across the programme to be able to release statistics to show the programme is working as well as any cancer screening programme can, and to reassure women of that.
“Offering patient-requested reviews is not something that is usually done.
“Doing so will make us world leaders in this difficult area, explaining to women on a cervical screening programme who develop cancer why this has happened to them.
“Hopefully that will support women, to hear that CervicalCheck isn’t lagging behind, but is, in fact, jumping ahead of other countries.”
Dr Russell said that receiving news of a possible false-negative test as a result of a review is a difficult thing to hear, and CervicalCheck is keen to work with patient advocates to ensure they have a say in how such news is delivered.
“The role of the lookback review is to provide answers for women and hopefully give some closure,” she said.
“This was widely misunderstood in 2018 when some people believed that the diagnosis of cancer was withheld from women.
“Studies in the UK have shown that when women on a screening programme develop cervical cancer and have their previous smears reviewed, there is a 30%-55% chance that abnormalities will be seen when ‘looking back’ that were not obvious at the time of the screening test.
“However, a discrepancy found on review does not imply that the same finding should have been made under routine screening conditions. When a review is carried, the reviewer knows that the patient has cancer, and hence this heightens vigilance and the reporting of abnormalities — this is known as retrospective bias.
“It’s a difficult thing to have to tell a woman that, looking back retrospectively, there may have been an abnormality in cells that was not detected. It is also hard to find the right time to have a conversation about this.
“That’s one of the main reasons we’re really looking forward to working with patient advocates and patients who have gone through this process before.
“We want to ask people who had interval cancers how we can help people who will get this diagnosis in the future, and how we can make it less difficult to receive such news.”
The Cork consultant emphasised the importance of ensuring such reviews do not impact the wellbeing of the women being treated for cancer.
“The key for us is ensuring that women are informed and that the review or lookback doesn’t impact on treatment or care,” she said.
“A lot of women don’t want to know the results because it’s not affecting their treatment.
“It’s a hard bit of news to get — it is hard to hear that although you did everything right and attended for your screening tests, you were in the 25% of cancers that are not detected as opposed to being in the 75% of cancers that screening detects.”
Dr Russell said implementing the review process within CervicalCheck will take time.
“It will take time to have the actual process in place because we need to be guided by patients and determine how they want this process to go,” she said.
Looking at the long-term viability of the screening service, Dr Russell said legal action as a result of interval cancer reviews is certainly a possibility but that she hopes being ‘open and frank’ will avoid such scenarios.