THE PUBLIC ARE being asked to submit ideas for what other illnesses or conditions the Irish population should be screened for by the State, with the chair of the Government’s population screening advisory group predicting that the pandemic will likely have increased interest in public-health measures.
The National Screening Advisory Committee, which advises the Minister for Health on population screening proposals, made a callout to people this week for their ideas – but its chair has said that “basic criteria” need to be met for a proposal to be considered.
The National Screening Advisory Committee (NSAC) was set up two years ago in response to the CervicalCheck controversy, and is made up of 18 independent experts, mostly in healthcare.
In its 2020 annual report, the chair of the screening committee Professor Niall O’Higgins wrote that “public confidence in cancer screening must be improved”, and that this was an “important objective” for the NSAC.
Speaking to The Journal, O’Higgins said that it can be a challenge to convey the benefits of preventative health measures such as vaccines and screening – but also said he believes there’s an increased interest in personal health that may drive new interest in screening.
There is, however, a high bar for a new screening programme for the general population.
For example: the condition being screened for has to be an important public-health issue; the condition has to be either preventable or can be identified as a very early stage when the prospects of cure are very high; there has to be an understanding of how the disease progresses; and there needs to be a suitable and acceptable test for it.
There also needs to be an acceptable treatment, a policy about whom to treat, and facilities for treatment; and a measurement of the cost of screening against the cost of the whole healthcare system.
It’s also got to be a ‘continuing process’, O’Higgins says: “Screening isn’t just some kind of ‘once and for all’ event, it has to be changed in light of new scientific evolution and discovery.”
There are also downsides to screening that need to be explained and discussed.
“A screening tests may lead to fall a lot of anxiety unnecessarily in people,” O’Higgins says.
“For example, if there’s a test that is positive, but but then when it comes to the final diagnosis of the condition, and it may be a false positive test, and then you put people through a lot of unnecessary anxiety. That’s quite an important downside of screening.”
But public involvement allows that debate and explanation to proceed so that people know the downsides as well as the huge advantages in terms of survival advantage.
Callout for suggestions
The National Screening Advisory Committee (NSAC) this week asked members of the public and groups of health professionals to submit their ideas about what new population-based screening programmes should be implemented, or how ones that already exist should be improved.
Screening means checking people for conditions that they don’t know they have – completely unlike people who have got symptoms or complaints – they go to the doctor.
“But in screening, the State (in this case) goes to the public and says we have a test that may prevent serious illness, or improve cure rates, or reduce premature deaths, or sustain a better quality of life.
Population-based screening – it’s not just for the one, it’s for the many.
A similar screening committee in the UK carries out calls to the public for suggestions.
We want the public to be active participants because we look on screening as something that is in the public ownership.
Ireland has five screening services in Ireland already:
CervicalCheck
The NSAC was developed in response to the CervicalCheck controversy in 2019, which came about after over 221 women diagnosed with cervical cancer found out that their previous smear tests had been audited by the CervicalCheck programme, and deemed a different action could have been taken when reading their smears.
They weren’t told this information until years later. In some cases, women’s GPs and doctors withheld the result of the audit until the controversy first went public.
Though the CervicalCheck programme has gone through a series of changes as recommended by the Scally report in 2019, and has been found by a UK panel of experts to have broadly the same clinical margin of error as others internationally, public health officials are concerned at the level of mistrust that remains towards the programme.
From 2015 to 2017, there were 264 cases a year of cervical cancer in Ireland. Of that number, around 160 women a year are diagnosed via the CervicalCheck programme (around 60% of all diagnoses).
Each year in Ireland, 90 women die of cervical cancer. Without a national cervical smear programme, the numbers could double: 320 women could be diagnosed, and 180 women could die.
When asked whether they are expecting suggestions for the CervicalCheck programme, O’Higgins said that it isn’t the role of the committee to make suggestions, but simply to advise the Minister on new proposals or new suggestions for existing programmes.
In a way, I’ve got a personal feeling that the Covid pandemic by necessity, focused people’s attention on their own personal health in a way that wasn’t expected or anticipated, and that may actually drive interest in new screening programmes.
“It’s quite likely that public awareness of their health and screening is going to be increased as a result of the pandemic,” O’Higgins said.
The call is open to suggestions from the public from 1 November and runs to 23 December, and there will be further calls in future years.
You can submit suggestions at gov.ie/screeningcall.
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