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Cancer Screening Programmes

Dáil Éireann Debate, Wednesday - 5 December 2018

Wednesday, 5 December 2018

Ceisteanna (33)

Stephen Donnelly

Ceist:

33. Deputy Stephen S. Donnelly asked the Minister for Health the risks posed to women by the increase in waiting time of up to 20 weeks or more to receive CervicalCheck screening results, the failure to transfer all samples to slides within the six weeks required and the colposcopy waiting lists now being over one year in some areas; and if he will make a statement on the matter. [51152/18]

Amharc ar fhreagra

Freagraí ó Béal (6 píosaí cainte)

I am taking this question on behalf of my colleague, Deputy Donnelly.

The delay in receiving smear tests results which has arisen as a result of out-of-cycle smears and a general increase in uptake is a priority concern for me, my Department and the HSE. The HSE is working to source additional capacity, notwithstanding global challenges with cytology capacity and resources, and also works closely with the laboratories in maximising their capacity to deal with the demand. This issue will take some time to resolve.

On the Deputy's direct question about the risks posed to women, we should hear from some of the medical voices on this matter. I note the comments of Dr. Mary Short, director of women's health at the Irish College of General Practitioners, who said there should not be undue concern about the delay. I raise her comments not to minimise in any the genuine challenge but to try to provide some reassurance for women. Dr. Short has said the smear test is not a diagnostic test but rather is used to look for pre-cancerous cells that can be treated in a colposcopy clinic, that the timeline between pre-cancerous cells and cancer can be more than 20 years and that, therefore, there should not be undue concern about the delay.

On the transfer of smear test samples, the subject of the second part of Deputy Donnelly's question, I have received confirmation from the HSE that since the end of July, this has been happening in the vast majority of cases. Between April and October, there was a 0.29% rate for expired samples and vials, similar to the rate for the same period last year when there was a rate of 0.25%.

There may be a small number of cases where the vial used to contain the sample expires, or where a sample may be insufficient. In such cases, a woman and her GP are advised by letter of the need for a repeat smear test after three months.

I can also reassure the Deputy in relation to colposcopy waiting times. While clinics have experienced a surge in activity due to increased demand, in October 89% of women referred to colposcopy, who were classified as having high-grade abnormal cells, received appointments within four weeks. That is just below the national target of 90%. Similarly, 92% of those who had low-grade cells were seen within eight weeks, exceeding the target of 90%. CervicalCheck has advised that it is unaware of any woman waiting a year for an appropriate referral to colposcopy.

I wish to deal with a couple of aspects of the Minister's response. The waiting time to get one's screening result back is up to 20 weeks. Many of the women were part of the CervicalCheck disaster or issue that arose and they are having a repeat smear test because they are worried. They are worried because they think that their previous screening may not have been done correctly or that their cancer may have been missed. The Minister made a political promise that women could have access to additional smear tests. He did not resource that promise fully or properly and now the wait has increased from five or six weeks, which was the normal waiting time, to sometimes in excess of 20 weeks. Those women who are waiting, who are concerned or worried, are now having to wait a considerably longer time to get the reassurance the Minister promised them. I have spoken to some of the women who are waiting on their results.

In addition, if one gets a smear result that is of concern or is abnormal, one is then referred to a colposcopy clinic. We do not have enough histologists to examine the biopsies so there is a backlog. There is then a wait of up to 18 months to see a gynaecologist or to have further treatment. A problem is brewing for the Minister and it is only going to get worse. Could the Minister please advise to the House what additional resources he will provide and when we will have them?

It is important to remember why I took the decision, which was widely supported in this House, of offering people a repeat smear test. That is because one of the number one queries coming in on the helpline to CervicalCheck was women saying they had a smear test and they would like another one. It is also important to say I did not offer it without a GP consultation so the GP had to feel that as part of the reassurance process the woman would benefit from it.

I assure Deputy Lisa Chambers that it is not a resourcing issue in terms of a financial resource; whatever resource is required financially will be provided in budget 2019. I have made allocations for such resourcing. It is a capacity issue. There are conversations going on as we speak between the HSE, between Damien McCallion, the acting national director of CervicalCheck, and the laboratories to see what additional capacity can be put in place. I am optimistic that we will have additional capacity to reduce the time. Based on the medical advice available to me I am saying that while the wait is undesirable, in particular for women who are understandably concerned after all of the attention on this issue, the medical advice is that it is not necessarily dangerous and poses a very low risk to women. I need to say that as a reassurance to women.

The large majority of women whom Deputy Lisa Chambers says have been referred to colposcopy clinics are being dealt with in a speedy manner. A total of 89% of women who were referred to colposcopy, who were classified as having high-grade abnormal cells, received their appointments within four weeks and 92% who had low-grade abnormal cells received their appointments within eight weeks, which is above the national target. I accept there is a challenge here and it is one we are working our way through but it was a necessary step to try to reassure women.

No one is suggesting that it was not a good thing to offer the additional smear tests but I take issue with the fact that the Minister did not resource them properly or provide the necessary capacity to deal with them. The GP system is already overwhelmed. The waiting time has increased from six weeks to 20 weeks. Even if one can get a colposcopy appointment within four or eight weeks, one is still waiting 20 weeks to get the smear test result back, which means the wait to get the biopsy done is far longer. When the biopsy is done, one needs a histologist to look at the sample and we do not have enough histologists to examine the samples, which means the waiting time for colposcopy results are increasing. After all of that one must try to get an appointment to see a consultant to get treatment.

The big scandal with CervicalCheck was mainly to do with disclosure and not telling people about their misdiagnosed smear test results. What we have now brewing is the possibility that somebody waiting a significant additional time to get results back from a smear test could find themselves waiting much longer to get a colposcopy, have their biopsy looked at and a far greater time wait to see a consultant. All of that does pose a risk to women, even if it is to a small number of them; it does not matter if it is only one. Having conversations is not really an adequate response. Where are those conversations going and when will the Minister have additional capacity? When will we see the waiting time reduced from 20 weeks back to the five or six weeks that used to be the case?

We came within hours of the collapse of the cervical screening programme because laboratories did not want to be involved in screening in this country any more in a situation where contracts were due to expire the following week. That would have meant we would have had a pause on screening. That was the priority issue to resolve for the HSE. I pay tribute to those involved, in particular to Damien McCallion for the work he did in ensuring screening could continue.

Deputy Lisa Chambers is correct. I do not intend to in any way minimise the concerns and anxiety that any wait would have on the result of a smear test. We are actively working night and day to try to increase capacity in that regard. I genuinely assure the Deputy that is the case. I also assure her that there is no resourcing issue in the sense that any finances that need to be made available will be made available. It is a capacity issue. I expect that the HSE will make progress in the coming weeks in terms of additional capacity, but this will take some time to work through. The encouraging thing is that even after all of the very important issues that were raised about CervicalCheck, more women are now using the programme than before. Women who had not engaged with the programme previously are now engaging with it so we are seeing some good come out of a very difficult situation in that women who had not signed up for them before are now getting smear tests.

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