Letter to the Editor: Affirming the integrity of cervical screening

The ethical justification for a rule requiring a cytologist, who is examining a slide in the course of screening for cervical cancer, to have full confidence that cells on that slide are neither cancerous nor potentially cancerous before reporting the cells as negative for disease, is the paramount importance of protecting women using the cervical screening service from the disastrous — even fatal — consequences of allowing the presence of such cancerous, or potentially cancerous, cells to go unreported.

It is indeed true that the inevitable result of insisting on such a criterion for screening is that there will be more “false positives” (ie, reports of possible cancer after such screening that are found on further investigation to be unfounded) than a less rigorous criterion of screening would entail. 

But the corollary of adopting this criterion of screening, is that women can have confidence they are being afforded the maximum protection which a screening service can provide.

It goes some way to restore the confidence in the screening process which has been shattered by the appalling breaches of duty on the part of the medical profession and the HSE which have shocked the country.

Any less demanding criterion of screening could only be supported by a utilitarian justification that the screening service will be run more efficiently if it gives less protection to vulnerable women by permitting a more relaxed criterion of screening.

In other words, that the lives of vulnerable women, which will inevitably be lost to cancer by adopting a less rigorous criterion of screening, are not worth the expense entailed in insisting upon the criterion of “absolute confidence” that the cells examined are neither cancerous nor potentially cancerous before reporting the cells as normal.

Moreover, this formulation of the criterion of screening in terms of “absolute confidence” on the part of the screening cytologist that the cells before him, or her, are normal, before reporting to that effect, has been in use for some 20 years in England and it is wholly unacceptable to suggest that Irish women are entitled to a lesser standard of protection.

It is disappointing that the positive reaffirmation of the integrity of the cervical screening programme by Mr Justice Cross is sought to be undermined by people who either have not read the judgment, or, if they have done so, have failed to understand it.

Dr John White, SC

Belfast

This reader's opinion was originally published in the letters page of the Irish Examiner print edition on 14 May 2019.

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