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A new way forward in the National Screening Service

The National Screening Service (NSS) is developing a new way forward on interval cancers.

In 2018, Dr Gabriel Scally’s Scoping Inquiry into the CervicalCheck screening programme was established after the results of a look-back audit of the programme were either not, or were very poorly, communicated to women who had gone on to develop an interval cancer.  An interval cancer is a cancer that occurs after a previous negative screening test result and before the next screening test is due.

In October 2020, we welcomed the recommendations of the Expert Reference Groups’ Interval Cancer Reports and committed to implement those recommendations in full, in partnership with the people we care for, and our professional screening teams around the country.  They set out a new and comprehensive approach to reviews of interval cancers in people who have been screened by Ireland’s breast, bowel and cervical cancer screening programmes.

The NSS is committed to a full disclosure of interval cancer reviews for all participants in screening.  Sadly, we cannot say that interval cancers will not happen to other people. Screening detects or prevents most but not all cancers.

The Scally report was critical of many aspects of cervical cancer screening, with a focus on organisational and governance issues. The HSE and NSS listened and learned and today, almost all actions from the Scally report are complete.  Significant effort and investment has been made to strengthen the programme with substantially more professional leadership across all disciplines – Clinical, Public Health, Colposcopy, Laboratories, Primary Care, Quality Assurance and Training.

Our screening programmes are governed by quality assurance committees and clinical advisory groups. They are underpinned by quality assurance standards and key performance indicators (KPIs) that are benchmarked to international best practice.  International reviews have offered reassurance that our cancer screening programmes did and do operate to the highest international standards.

But we have more to do.

Expert reviews have confirmed that despite best efforts, no screening programme or test is 100% accurate. Unfortunately, some people will still develop disease (in the case of CervicalCheck – cervical cancer) even if they attend screening regularly.  This is a relatively small number but the fact remains that approximately 90 women die every year in Ireland from cervical cancer. Half of these women will have participated in screening and some of that group will not have had that cancer detected despite screening.  The success of the screening programme is that that the number of deaths has dropped every year and will continue to do so, and our hope is that in time cervical cancer can be eliminated.

As part of our implementation of the Expert Reference Group Reports on Interval Cancer Review, we have begun the process of designing how we disclose look-back information to patients who develop an interval cancer.

This must and will include openness, disclosure, and a willingness to engage properly and appropriately with patients about aspects of their care, however uncomfortable, and to apologise where harm has occurred.  We are also keen to listen and to learn. We have patients on our working groups to help us design the disclosure process, and we are keen to engage with anyone who wishes to talk to us about our work. We want to work together to create a truly patient-centred process for disclosing information on interval cancer in a way that minimises the harm felt for everyone.

Better communication of screening

At that time of the Scally report it was noted that we also failed to let all people know is that screening is not diagnostics; at its essence it is a high-volume, cost-effective, population-based, risk-reduction system. It benefits many but not all.

We need and will do more to communicate what screening can do but also what it cannot, what to expect, and when to take further action.

We need to get this right. And we need to do it together. Despite all of the limitations, screening is worth it.

Fiona Murphy

For more information on interval cancer please see here 

 

 

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