Minister for Health Simon Harris TD has today (3 December) published the Aggregate Report of the Independent Expert Panel Review led by the Royal College of Obstetricians and Gynaecologists (RCOG).
The Minister said:
The key conclusions of the Expert Panel are that the CervicalCheck programme has undoubtedly saved the lives of many of those who participated in the Review that the programme is working effectively and that women can have confidence in the programme.
For 308 of the 1,034 participants, the Review found a different cytology result from the original CervicalCheck result. The Expert Panel notes that these findings are in line with those seen in the English screening programme.
The Panel emphasises it is important to recognise the serious impact that screening failures have on the lives of women and their families. However, it also acknowledges that failures are, unfortunately, inevitable given the limitations of cytology-based screening and should not be taken to suggest the programme overall is not working.
While the Review also found that in a small number of cases, there was suboptimal colposcopy management, it concludes that women can have confidence in the clinical standards which apply to the day to day practice of colposcopy across the country.
The Minister said:
Since 2008, CervicalCheck has carried out more than 3 million screening tests and detected and treated over 100,000 cases of abnormal cervical cells.
This Review was led by the Royal College of Obstetrics and Gynaecology and was undertaken in response to the issues that emerged in 2018 in relation to CervicalCheck. The Review examined the screening histories of 1,038 women who were screened by CervicalCheck since 2008, 1,034 of whom had gone on to develop cancer.
The process of communicating her individual results to each woman or next of kin who consented to the Review has been ongoing since September, and the results of participants have now been provided to them in accordance with their choice.
The Review provides a comprehensive examination of the overall performance of the CervicalCheck programme.
For 308 of the 1,034 participants, the Review found a different cytology result from the original CervicalCheck result. It says that these findings are in line with those seen in a review of the English screening programme, and are not in themselves a cause for concern.
The Expert Panel also examined the colposcopy management of those participants where there was an interval of more than six months between their initial colposcopy and their diagnosis of cancer. The Panel concluded that the small minority of cases in which suboptimal colposcopy contributed to a missed opportunity to prevent or diagnose a cancer at an earlier stage is probably inevitable when cases that end in cancer are reviewed, but this should not be taken to conclude that colposcopic practice in the CervicalCheck programme is substandard.
The Panel emphasises that it is important to recognise the serious impact that screening failures have on the lives of women and their families. However, it also acknowledges that these failures are, unfortunately, inevitable given the limitations of cytology-based screening and should not be taken to suggest the programme overall is not working.
The Panel note that, in all probability, the high proportion of very early screen detected cancers in the Review would not have been detected at the stage they were, without cervical screening.
The Panel concluded that women can have confidence in the CervicalCheck Programme.
The Expert Panel has made 10 recommendations, which have been accepted by Government. The Minister has today written to the HSE to request it to give consideration to these recommendations including in the context of specific work already ongoing.
The Minister for Health recognises the overriding priority of patient safety and quality across our health services. Integral to this is the need for continuous learning and improvement in the delivery of those services, including the performance of audit, notwithstanding the need to ensure that the specific requirements around audit in population based programmes like screening need to be contextualised within the wider environment in which these programmes operate, including in light of the findings of the Cross Judgement and the ongoing process on Tort Reform and the Management of Clinical Negligence claims chaired by Judge Meenan.
A key recommendation arising out of the Scally Inquiry into CervicalCheck in 2018 was that ‘common, robust and externally validated approaches to the design, conduct, evaluation and oversight of audits should be developed across the screening services.’ In response to this recommendation, the HSE established two Expert Groups, one for audit in cervical and bowel cancer screening and one for audit in breast cancer screening, with a view towards implementing audit (including open disclosure of same) in the National Screening Service. These Expert Groups are independently chaired and comprise patients, patient advocates, a patient ethicist, screening clinicians and international experts. The Minister has today requested the Expert Groups to incorporate consideration of these recommendations in their ongoing work.