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THE CLINICAL DIRECTOR of CervicalCheck has said that she’d be surprised if women didn’t have questions after Vicky Phelan’s court case over an incorrect smear test made headlines yesterday.
Phelan, who’s a 43-year-old Limerick mother-of-two, was awarded €2.5 million over a missed abnormality in a smear test in 2011.
When she returned for a routine smear test three years later in 2014, she was told she had cervical cancer. After a number of tests, she was told she had between six and 12 months to live.
In a statement to TheJournal.ie, the screening programme said “a small additional number of women” had been in touch yesterday after widespread publicity of the case, and that it was committed to answering women’s questions so that they’d have confidence in the smear programme.
Questions were raised about CervicalCheck’s process after it emerged that a 2014 qualitative review of the 2011 smear test showed that abnormalities in her smear test had been missed. Despite this, Phelan was not told about the missed abnormality until 2017.
Speaking to TheJournal.ie, CervicalCheck director Professor Grainne Flannelly said that she empathised with Vicky Phelan’s situation.
I can understand her frustration, I honestly can. It took time and you think, ‘How could it take so long to do that?’
It did take a long time, we deeply regret that it took a long time for this lady to be told.
Having a cervical cancer diagnosis is a very difficult thing and has a big impact on the woman and her family. We profoundly regret that this has happened.
She added that at the time, they were implementing a new process of reviewing historical smears. She said that since then, the process of reviewing smear tests, informing clinicians and their patients has since been “smoothened out”.
Late last night the HSE said that since 2008, a total 1,482 cases of cervical cancer have been notified to the CervicalCheck programme.
In 442 cases, a review was warranted and of those cases, 206 cytology reviews suggested a different result that would have recommended an investigation to occur at an earlier stage.
This broke down as 173 cytology reviews suggesting that a referral to colposcopy might have been recommended earlier and for 33 cases a repeat smear might have been recommended to occur earlier.
The Minister for Health Simon Harris and the Director General of the HSE Tony O’Brien met today and agreed that an international peer review of the CervicalCheck programme would be undertaken in order to ensure ongoing confidence in the programme.
The Director of the National Cancer Control Programme has been ordered to establish this review as a matter of urgency.
Missed abnormalities vs misdiagnosis
Flannelly said that after headlines about the case, there was a need to clarify and highlight certain aspects of the screening programme.
The first thing to say is that cervical screening programmes aim to prevent many cancers developing – that’s why we get up in the morning.
“We cannot prevent all cancers, but the smear test works really well in intervals – that’s not to say that it’s the perfect test.”
The average gap between smear tests depends on the age of the person: for younger women, incidents of pre-cancers are higher, so they need to be done every three years. For older women it’s every 5 years. There’s no need for smears more often than that based as those times are based on how fast pre-cancers develop.
Another important distinction is that these screenings are not designed to diagnose. They select women who would benefit from further examination. It actually works better if you have a pre-cancerous abnormality rather than a cancerous problem.
She said that in relation to the 2014 review of Phelan’s smear, when a woman who has received a smear test is later diagnosed with cancer, the screening programme reviews those initial tests to inform their process.
“We control the quality of the test as much as we can. Quality control reviews are embedded at all levels of the programme and we think that’s really important part of the process.
We need to learn from patients and women who develop cancer by looking at those smear tests and by looking back at their cancer and how they were diagnosed. This is not so much a review because there is a problem, but a quality assurance approach that was put into place in 2010. It’s a continuous process – it happens all the time.
It’s been suggested that there are other women whose smear tests were incorrectly interpreted and who weren’t informed.
In an interview on RTÉ Morning Ireland yesterday, the head of the National Cancer Control Programme Dr Jerome Coffey said that the decision on whether doctors should tell their patients the result of a review was “between the physician and the patient”.
Speaking to reporters yesterday, Minister for Health Simon Harris said that “it’s absolutely essential that we establish that those doctors told their patients of the outcomes of those audits”.
“So today, Cervical Check will write to those doctors to confirm that they have informed their patients.
We can’t just presume they did, or expect or hope that they did, we have to make it absolutely sure that they did so that women can have absolute confidence in relation to that.
Responding to reports that clinicians had been told to withhold information of incorrect smears from patients, Flannelly said that their direction to clinicians was that whatever the outcome of the qualitative review was, women needed to be given the option of knowing the results of their smear test reviews.
She added that in around half of similar cases in the UK where women receive serious cervical cancer diagnoses, women don’t want to know the results of those reviews.
Women who have had a cervical cancer diagnosis can want to focus on their treatment – not everyone wants to have the results of a review after a diagnosis.
Battling cervical cancer
She said that as it stands, one in 5 women haven’t had their smear test, “so it’s very important that the message gets out that women should be a part of this programme”.
She added that the CervicalCheck programme compared favourably to the NHS, and is still one of the most effective ways of preventing cervical cancer.
Every year around 250,000 women have smear tests through Cervical Check and that the programme has found over 50,000 women with pre-cancerous changes.
“It’s really important that women are reassured by our programme. They need to know that we take our quality metrics seriously and it’s maintained within a very narrow target.
“We’re trying to reassure women that quality underpins every aspect of the screening programme and that it holds its head high in context of other screening programmes around the world. It’s not perfect but we’re constantly trying to make it better.”
Car crash tv for donaldson,the only thing coming out of his mouth was the protocol and had nothing to back up his claims.they are been found out for the spoofers that they are.hopefully there is a big change in northern Ireland after this election
@doyle: once a blue nose always always a blue nose. It will never get better unfortunately.
@Paul Gorry: I’m putting the monkey on us for the final. Very confident now i have to say.
@Vonvonic: iam glad it’s your monkey. Best of luck.
@doyle: DUP could be in big trouble if todays poll figures are accurate, because if the DUP and Alliance are level on 18.2% in first preference votes, then you must assume that Alliance will be far more transfer friendly than the DUP.
Early retirement for Jeffrey?
If this was a private company and they had to forsake their salaries or go back to work there is no question what they would do !
@Michael Loughnane: It was funny the only person in the audience to speak out in support of Jeffrey and the DUP’s stance on the Protocol was an Englishman.
@Joe Johnson: And that English man, Dan Boucher, is an ex Tory party activist who stood for the Torys in Wales but failed to get elected and has now joined the DUP. Possibly being lined up to take Jeff’s MLA seat so Jeff can continue as an MP in Westminster. He was also a prominent writer for Brexit Central.
Naomi Long was blindingly good tonight as was the SDLP guy. The Unionists are at each other’s throats. I hope the electorate take heed.
@Mary Conneely: Long and Eastwood were good. O’Neill afraid to open her mouth in case she put her foot in it. Beattie is the voice of reason in the Unionist camp and Eastwood is the best of the nationalist bunch, even with him being threatened with legal action by the Shinners. Sure who aren’t they threatening with legal action.
@GrumpyAulFella: Donaldsons disaster of a night as you failed to mention have shown up the dup big time..Sinn Fein an all island government soon..amazingly had only a handful of seats few years back but thanks to ff/fg mishandling the country putting it mildly they are the biggest party in the country.It must really hurt die hards like you to see Sinn Feins rise at your party’s demise.Leo and the boys think the turnaround is due to a savvy Sinn Féin social media campaign but its there total inept to do their jobs is what brought them down
@Brian Burns: You can only say that with certainty 5 years after the next general election but what’s the betting the mantra then will be 5 years wasn’t enough for SF to implement the changes needed to make our society a fairer one? I suppose a political change will be a good start but it will take some effort to get everyone on board to stop the waste and to build a more equal republic. Here’s hoping.
@Brian Burns: I’m surprised FG were not out canvassing for the DUP or the UUP
@Brian Burns: my party’s demise?? What party are you referring to? I’m afraid that 33% of the vote in the Republic, with no party willing to touch you with a barge pole will see your comrades stay on the back benches mo chara.
@GrumpyAulFella: your despise of sf,a party never in government is a result of media manipulation my friend,a subservient man who defends the government of the day without any critical thought,the polls speak for themselves, the media don’t fool the young so much as the old.Times are a changing me oul pal our day will come
@Tom Leddy: That old chestnut we hadn’t enough time,inherited a poisoned chalice nonsense that fg gave us first five yeArs after Bertie and the boys were ousted was a joke.If SF can’t implement change in five years move onto social democrats etc till some party stands up for the people..
@Shaun Gallagher: their mates in the journal did dup canvassing for them oul Jeffrey got great coverage here lately
@GrumpyAulFella:And I assume by your statement thatyou vote for FFG. I’m surprised that you haven’t also mentioned Maria Cahill like your handlers.
Sad people. They’re making it so that noone with any self respect could possibly pretend to care. Sad Sad Sad ulster unionism.
@Vonvonic: I thought they all done well except Jeffrey. He should of jumped at the chance to rejoin the UUP because the DUP hardline approach is not working anymore. The young people just think their Dinosaur attitude is from another era.
Hope that Alliance keep building election on election from here on in, a future merger/pact between them and the SDLP down the line might be the best way to go on the longer term path to normality and an eventual United Ireland as more of the TUV/DUP dinosaurs die off
90 seats, 38 constituencies! Madness. Bigger the table, less work gets done. DUP sliding can be a blessing or a hindrance as orange need representation and without it we could see a bit of anarchy. Alliance is obviously a more balanced keel so hope it manifests in the votes.
But 90 seats? – Mad Ted !
@Noel Lynn: Until 6 years ago, it was 108. High numbers were necessary to achieve the proper proportional representation and to get the Good Friday Agreement over the line.
The Alliance are just moderate unionists. They always vote that was when push comes to shove.
@Neil A Campbell: they are middle of the road with representation from many communities, not just Unionists.
@Neil A Campbell: they are middle of the road with representation from many communities, not just Unionists. That’s what makes them interesting to voters.
@Con Cussed: just as FFG/Lab are existentially committed to a 26 County state so are Alliance to a 6 County statelet. They are certainly not United Irelanders.
Jeffrey’s boycott. Sticky wicket. I see what you did there.
You can be first minister in 26.6% of the vote. It’s ludicrous
@Rory: As a result of a backroom deal, there will soon be a new Taoiseach of the Republic; a Taoiseach coming from a party which only received 20.9% of the vote. Becoming Taoiseach backed by a party which only received 22.2% of the vote, and who´s leader said in the very first press statement after the results “the people voted for change, there will be no coalition with Fine Gale” … ;-)
@Rory: Have a good look at Minister Eamon Ryan.
@Rory: insanity. But this is going to be fun to watch. The Shinners have an awful habit of slagging off Donnelly’s third level education background. I don’t think O’Neill even wen’t beyond grammar school and she’ll be the FM of Northern Ireland.
@GrumpyAulFella: read michaels reply then read yours..you have lost the room again you ain’t making sense again so you double down on your hateful anti SF rhetoric..some buzz off ya tho
@Michael Mike Mathäß: nobody will reply to that factual well spoken comment Michael get out of here
@GrumpyAulFella: Anyone who uses the name Shinners shows his party colours immediately. Intelligent people dont refer to Find Gael as blueshirts or compare Fianna Fail with brown envelopes and corruption of the highest order. Using insults instead of facts is not conversation, it just shows your lack of education in how to put your point across no matter how farcical.
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