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Press Release

Minister for Health publishes Report of the Independent Expert Panel Review of Cervical Screening

Published: 3 December 2019
From: Department of Health

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:

"I want to pay particular thanks to the Expert Panel who conducted this Review and especially to all of the women and their next of kin who agreed to participate in this thorough examination of the performance of the CervicalCheck programme.
"The report finds the CervicalCheck programme is working effectively and crucially that women can have confidence in the programme.
"The CervicalCheck Programme has faced a difficult and uncertain period over the past eighteen months. The findings and conclusions contained in this Review should provide reassurance and assist in restoring confidence in our programme and address its importance and quality, as well as the limitations of all screening programmes."

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:

"If we are to achieve our goal of making cervical cancer a rare disease in this country, it is vital that women continue to attend for screening. It is also why we must continue to build on the considerable progress in other areas over the course of this year, with smear test turnaround times now stabilised and implementation of Dr Scally’s recommendations having been strongly progressed.
"In particular, the switch to HPV primary screening is a key plank in helping to eradicate this devastating disease in Ireland. This is why I have today written to the HSE to ask them to consider the recommendations from this Review in the context of this crucial project, and to ensure the successful introduction of HPV primary screening in Quarter 1 next year.
"I have also asked the HSE to consider these recommendations in the design and implementation of future systems of audit within our screening programmes."

ENDS

Notes to the Editor:

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.

This finding suggests that:

  • cervical screening has probably saved the lives of many women who participated in the Review, by virtue of avoiding late diagnosis
  • this will have avoided the need for hysterectomy in many women under the age of 45 for whom continuing fertility was an important consideration

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.

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