Concern rising legal claims will affect CervicalCheck viability

“Serious concern has arisen recently that the growth in number of legal claims against CervicalCheck will affect its viability”, according to the national cervical screening programme. Prof Susan O’Reilly, Chair of the CervicalCheck and BowelScreen Expert Reference Group issued the statement in her foreword to the Interval Cancer Report on CervicalCheck published yesterday (Wednesday, October 21).

The effect of this was two-fold: recruitment and retention of professional staff may worsen, or the costs of litigation may greatly exceed the resources available to sustain the Programme, putting CervicalCheck at risk of collapse, she cautioned.

“We recognise that our recommendations will offer more comprehensive audit processes than are typically conducted in other cervical screening programmes.

“In the absence of established international standards, we have proposed an approach which is an improvement on current practice and which should help build patient and public confidence and trust as well as providing the education and training of professional staff,” added Prof O’Reilly. In her foreword to the Expert Reference Group report on BowelScreen she stated that, fortunately, interval cancers arising between had been rare in Ireland.

The national annual post-colonoscopy colorectal cancer rate would be a new programmatic key performance indicator (KPI) and would be monitored against an agreed standard.

“BowelScreen has the potential to reduce deaths from colorectal cancer by 36 per cent after 10 years of screening, but only if there is growth in participation of men and women.

“This effective and affordable programme is sustainable. Its full benefits will be realised as uptake grows from 41 per cent today to a much higher proportion of the eligible population,” she urged.

Prof Risteárd Ó Laoide, the Chair of the BreastCheck Expert Reference Group, stated that evidence from international accreditation, international expert opinion, and review of KPIs presented to the Expert Reference Group had confirmed that the breast screening programme in Ireland was operating to best international standards.

He added that breast screening reduced the number of deaths from breast cancer in Ireland by approximately 120 per year.

The report had outlined a new strengthened, more robust model for the performance and disclosure of individual interval cancer case reviews, keeping the provision of information, patient choice and patient consent at the centre of the process.

The newly published expert reference group reports have set out recommendations for a new approach to reviews of interval cancers in people who have been screened by Ireland’s breast, bowel and cervical cancer screening programmes for the National Screening Service (NSS) and the Board of the Health Service Executive (HSE).

The reports were commissioned as part of the Scally Review in 2018.

In 2019, the HSE established two expert reference groups: one for BreastCheck and one for both CervicalCheck and BowelScreen. These groups had been asked to “define the future audit processes and review guidance for interval cancers in the National Screening Service based on international evidence and best practice”.

In a recent update, HSE Board Deputy Chair Prof Deirdre Madden told Board members that the reports recommended continuation of interval cancer rates as a key metric of cancer screening programmes for BreastCheck, and calculation of the rate for cervical and bowel screening programmes in accordance with international developments.

All three expert reference groups recommended the provision of information to participants to enable them to make an informed choice to consent to screening; the need to build and promote public understanding and trust in screening and resources needed for implementation.

HSE Board members heard the reports also recommended development of programmatic audits which were anonymised and blinded.

The Expert Reference Group report recommendations are to support the NSS in establishing an independent and safe system to support future management of interval cancers.

Dr Colm Henry, Chief Clinical Officer of the HSE, yesterday thanked both Prof Ó Laoide and Prof O’Reilly, and all those who worked on these reports.