THE CERVICALCHECK PROJECT Team wrote to the Minister for Health Simon Harris in October asking him to end the offer of free smear rechecks, as it was putting pressure on the healthcare system.
In a note signed by Harris on 21 October, it says that smear testing levels are at around 20% above the normal volume. By that month, over 83,000 additional consultations were held, with 42,000 out-of-cycle smears, or repeat smear tests, taken.
The letter, released to TheJournal.ie under a Freedom of Information request, says that on top of the increase in women attending their free smear test and going for rechecks, a HSE Acute Operations assessment indicated a 30-35% increase in colposcopy referrals, which is also possibly linked to the increase in smear tests being carried out.
The CervicalCheck Project Team, which is a team of Department of Health officials and cancer experts, said that the investigation by Dr Gabriel Scally of the CervicalCheck screening programme, “offers welcome reassurance” for women about the quality of screening, meaning that “the original rationale for this measure no longer exists”.
It goes on to outline the harm overscreening can do, as outlined in Scally’s report:
“…screening programmes are a balance of benefit and disbenefit. The frequency of screening is a key factor in achieving this balance. Overscreening, with smears taking place too frequently, is likely to tip the balance towards increased harms from screening.”
Dr Scally said that the progression of pre-invasive cervical cancer to the invasive stage takes up to 10 or 15 years, meaning if the tests are performed at the normal timeframe of every 3 years, early signs of cervical cancer are likely to be caught. The note continued:
“Following Dr Scally’s findings, there is no clinical rationale for the continued provision of out-of-cycle smears, and, indeed, to ensure the avoidance of unnecessary harm to women it is essential that these should cease.”
The note emphasises that women are not receiving their results promptly, which is “a cause for significant concern for women”.
With additional smears still running at 20% above normal levels, it is likely that the backlog will increase further if out-of-cycle smear-taking continues and this can only intensify concern among women.
The note ends by saying that it’s “a significant challenge and a priority concern for the Department and the HSE from a patient safety perspective”.
A report into the CervicalCheck controversy, carried out by Dr Scally, was published on 12 September last year. The main aim was to ensure the integrity of the national screening programme in order to restore public confidence in it.
At an Oireachtas committee which questioned members of the HSE and CervicalCheck, it was highlighted that letters sent out to women had stated that the tests “weren’t 100% accurate” but should have put the exact percentage on the forms.
The HSE’s former director Tony O’Brien said that tests may be 70% effective overall (which would be the standard for cervical smear tests internationally).
Scally’s investigation found that the different grades of abnormalities weren’t consistent across the three laboratories used by the CervicalCheck programme, and that the policy and practice in relation to open disclosure is “deeply contradictory and unsatisfactory”.
As part of his review, Scally announced in June that an immediate, initial ex-gratia payment of €2,000 should be paid to each woman involved in the Cervical Check scandal and to the next of kin of the deceased.
The letters from women
Women who are waiting for the results of their smear tests, but have been told they are delayed due to the increase in requests, have been corresponding to Simon Harris outlining their outrage at the wait and to find out when they can expect to get their results.
One woman wrote to Harris on 1 May to say that she was told she would have her results within two weeks, but that time had passed and she still hadn’t received them.
“I am still a young woman, and am going out of my mind with worry about my results. I cannot get any answers at all… not being able to access your results is very worrying for a woman of any age. It is a very frightening time for women in this country.”
At the end of May, another woman wrote:
“I was expecting a letter within 4 weeks. However as 5 weeks had passed I called the clinic and was informed that due to the recent increase in smear tests etc, that results are now taking 3 to 4 months. I’m wondering if Simon Harris is aware of this and of how it’s increasing the stress levels of those people awaiting for results.”
In July, a woman who was told that she would have her results in 6 – 8 weeks contacted her GP and CervicalCheck when she did not receive them:
This morning I again phoned CervicalCheck and was told that results now take up to 9 weeks. When asked how an extra week had been added to the wait time since my last call, the lady in CervicalCheck checked with a colleague and then said that results were taking longer than 9 weeks due to high levels of calls and tests.
When I asked how long, I was told “I don’t know”. When I asked “Could it take 12 weeks?” I was told “I’m sorry, I don’t know.”
I have no idea how long I will be waiting for these results… Why are the results taking so long?
In another letter from July, a woman who had waited 6-8 weeks for her smear test results and still hadn’t received them said that when she asked CervicalCheck for an update, that her smear hadn’t been read yet.
“I am shocked and horrified by this, considering the recent scandals and knowledge that time is of the essence with getting these results back.
What I want to say is that if there is something sinister that comes back in my results, I will be holding the government responsible for the shambolic effort they have made to look after Mná na hÉireann. Once again we are shifted aside in our suffering.
Another woman wrote in the same month, that her smear test had been checked, and she was called back for a second smear. After initially being told that her second smear would take five weeks to come back, this was later revised to 10 weeks.
“This I do not accept,” she wrote. “I feel because the limelight is not focused on the issue anymore as much as when the scandal broke that your Department has not committed to the promises made at the time.”
I would like an answer as to how it is deemed acceptable for a woman to wait so long for a lab result of something that could be a life-threatening illness.
Two women emailed in September and October to express concern that the backlog could cause such a delay, that the smear tests are in storage and could affect the accuracy of the results.
As you are aware, the longer a smear is stored, the more inaccurate the test results are… I cannot believe that CervicalCheck don’t have a system in place to separate the repeat smears from the women that haven’t had their smears done in three years.
I contacted CervicalCheck and they said that there is now an 18-20 week wait for results. There was a news report some weeks ago saying if women’s samples weren’t on slides within 6/52 they were virtually useless and invalid. It’s also the case that after said 18 weeks it might not be a valid sample anyway or inconclusive results might be found and a further smear required.
Another woman who was told she would be waiting 12 weeks for her results wrote to Harris: “You could have and should have put measures in place to prevent these delays and you cannot deny that. So what exactly are you going to do about it?”
In August, another woman wrote: “During the Repeal the Eighth campaign you stated that you trusted women and will support them but your behaviour during this debacle suggests otherwise.”
The note sent by the CervicalCheck project team to Harris recommends that funding should be provided for women to who have concerns about their outstanding smear tests to attend a GP consultation.
Before Christmas, the government announced that it would set up a Tribunal of Inquiry later this year into the claims that have arisen from the CervicalCheck controversy.
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