I wish to reaffirm the response given in December 2020 to the previous Parliamentary Questions on this referred to by the Deputy.
As set out on the previous reply, I wish to reaffirm that the HSE confirmed that CervicalCheck is not in opposition to the actions of the Supreme Court or of the Government.
As explained in the previous reply, the HSE, National Screening Service (NSS) and CervicalCheck programme have been recently communicating about the contents and recommendations of Expert Reference Groups’ (ERG) reports, which were published by the HSE in October 2020, which set out the future framework for clinical audit of interval cancers in our cancer screening programmes (CervicalCheck, BreastCheck and BowelScreen). The commissioning of these reports by the HSE arose from recommendations in the Scally Scoping Inquiry Report.
Implementation of the recommendations of the ERG reports is now underway, with implementation groups already established by the HSE, which include patient representatives, as well as clinicians and other screening services staff.
Important actions across all programmes will be to adapt and enhance the information provided to participants so they can better understand the benefits and limitations of their screening test, and so make informed decisions as partners in their own healthcare. Some of the challenges in achieving better public understanding of screening stem from the fact that cancer screening programmes are population health measures, designed to improve outcomes on a population-wide basis, and not designed to be diagnostic on an individual level.
As highlighted in the ERG reports, interval cancers, ie any cancer that is diagnosed after a previous normal screening test is carried out and before another screening test is carried out, are an unfortunate but inevitable fact given that no screening test is 100% accurate, and false negatives do occur. While screening offers the benefit of detecting many cancers at an earlier stage, this is sadly not always the case.
A cancer diagnosis is a very stressful and often devastating event for anyone, and where such a cancer is diagnosed in a person who has participated in a screening programme, it is also important that the manner of the disclosure and discussion of a patient’s screening history does not add further undue stress. The ERG reports set out a number of guiding principles for clinical audit which will underpin the development of the future framework for clinical audit and review. This includes the principle that communications with patients diagnosed with cancers must be respectful and open. In terms of the design of patient-requested case reviews as part of the implementation of the ERG reports, these will be developed in a consultative and collaborative manner with patient representatives.
In relation to CervicalCheck, the introduction last year of the HPV screening test is a significant milestone for our cervical cancer screening programme, as this test is more sensitive and typically detects 18 out of 20 abnormalities, compared to the 15 out of 20 the smear test typically detects. Going forward, this will mean in overall terms, even with the most effective and sensitive screening programme, that approximately 2 in every 1000 screened will still not be detected and interval cancers will still occur. This is undoubtedly, and sadly, unfortunate, and devastating for the individuals concerned.
This is also why it is so important that the public understands that screening is a population health measure for people who are presumed healthy and do not have symptoms. An important message for the public, including anyone who may be between screening tests or waiting for a rescheduled appointment, is to be aware of, and act upon, any symptoms associated with the conditions they are screened for. Anyone with concerns about symptoms should always contact their GP who will arrange appropriate follow-up care.
It is also important to re-iterate that all of the recent major reviews and reports state that our national cancer screening programmes, including CervicalCheck, meet international standards, are valuable in improving the health of our population, and that the public can have confidence in them.
In terms of a population perspective, when we consider that over 6,000 women are detected and referred for early treatment each year, cervical screening continues to have significant value for population health.
As Minister for Health, my priority is to continue the work to restore the CervicalCheck screening programme as a leading international cancer screening programme, to improve public trust and confidence in screening, and further the global aim to eradicate cervical cancer.