ALISON O'CONNOR: It will be a tragedy if our screening programmes do not survive

It was early May during the abortion referendum campaign and a Together for Yes information meeting was taking place in UCC.

The meeting was addressed by an obstetrician, a legal expert, and a woman who shared her personal experience of losing a baby to fatal foetal abnormalities.

Afterwards the general chat turned from the upcoming referendum vote to the CervicalCheck controversy which was dominating the headlines.

There was massive confusion and fear, with politicians and health officials going around like headless chickens, the ground seeming to constantly shift under their feet as they attempted to get factual information that could be relayed to the public for reassurance and keep themselves on the right side of the problem politically.

To say the atmosphere was febrile hardly does the situation justice.

On that particular day, it was reported that the CervicalCheck helpline had received more than 8,000 calls from worried women.

The name of that extraordinary woman Vicky Phelan was becoming nationally known after she settled a High Court case against a US laboratory for €2.5m without admission of liability.

So we spoke about what a scandal it all seemed to be; yet another example, as I coined it, of a “below the female belly button issue” that the Irish State (along with the Catholic Church) had inflicted upon Irish women.

It joined the long line of others including mother and baby homes, Magdalene laundries, access to contraception, the Kerry babies scandal, religious control of maternity hospitals. There was no end to the evidence that could be produced to incite further anger.

I remember thinking at the time that the only good to come out of this awful situation was that it might encourage more people to vote yes in the referendum as it was further proof of how difficult it was to be a woman in Ireland when it came to these issues.

One conversation stands out in my mind, though. It was with a woman who spoke of how, a number of years ago, she had been pregnant when serious cervical
abnormalities were discovered.

She was a public patient, she said, and hugely frightened for the safety of her pregnancy. It was her good fortune, she remembered, to come across a doctor who specialised in the area. She subsequently delivered her baby safely.

During appointments, she remembered conversations where her doctor spoke with passion about how a cervical screening service had to be introduced for the women of Ireland to reduce the incidence of cervical cancers.

That doctor was Professor Gráinne Flannelly, formerly clinical director of CervicalCheck. The previous Saturday night she had resigned from that position with question marks hanging over the screening programme and people feeling rightly appalled at her role in not being crystal clear about the affected women needing to be told their cases had been reviewed by CervicalCheck after they were diagnosed with cancer.

This failure to tell did not affect any subsequent treatment or its timing, but caused huge and understandable anger — not just among those affected, but also the wider public. A replacement for Prof Flannelly has yet to be found by the HSE.

I know very little of Prof Flannelly and I know that for instance, if I was in Vicky Phelan’s position, I would be enraged about the failure to share information with me about my own health.

But a wider perspective must also be brought to a very grave situation where we stand in danger of losing our screening services including breast and bowel, that have saved the lives of so many people.

Since its establishment in 2008, CervicalCheck detected over 50,000 pre-cancerous changes in women without any symptoms, reducing their cervical cancer risk by 90%, while cervical cancer rates in Ireland fell every year since 2010.

In the case of breast cancer screening in Ireland, around 145,000 women are screened each year.

For every1,000 patients with no symptoms who are screened, seven cancers will be found but two will be missed, in line with international standards.

Now our screening service, BreastCheck, is being inundated with legal threats — receiving more than 50 letters from solicitors and former patients seeking medical notes and files in the wake of CervicalCheck controversy, according to the Sunday Business Post.

If action is not taken that screening programme will no longer be viable. The only winners there are legal firms.

In operation almost two decades, BreastCheck up to that point had only received a handful of such correspondence.

Staff are also now threatening to resign because of hostility and confrontation from patients.

This controversy has been going on since April and we are still operating with a level of hysteria, fuelled by a media which in many cases failed to conduct even the most basic of fact checks.

We should get some concrete facts soon — a key one being whether our cervical screening service was operating to proper standards. The report of Dr Gabriel Scally, who is carrying out a preliminary inquiry due to be completed by the end of August, should give us good guidance on this.

He may find there were issues with the laboratories that have been examining the smear tests of Irish women, but many people will be stunned to know that this is by no means a foregone conclusion. It could be discovered that our results, by and large, are just as they should be.

A senior Government politician complained to me in recent days about how ministers, rather than doctors were the ones having to go around giving out the message that while screening was fallible, it is also a life saver. Indeed over three months after the controversy broke we got a statement from the Medical Council this week.

Council president Dr Rita Doyle expressed her concern at the levels of inaccurate information in the public domain. “The fact is cancer screening saves lives every week, however, screening is not a diagnostic exercise and there is an acceptable norm of false negative and indeed false positive results.”

But none of this fallout has occurred in a vacuum.

Government politicians, specifically the Fine Gael ones, are reaping what they sowed in terms of failing to handle our health crisis over years, resulting in a public only too willing to believe the absolute worst of their health service and those working in it.

The very poor political handling then made a bad situation appalling.

This is one part of this perfect storm. Add into the mix the lack of scruples of some in the legal profession, the failures on the part of the media, the opportunism shown by a number of politicians operating under the guise of wanting to get to the bottom of the CervicalCheck scandal but really just being utterly self serving.

There is also the legacy of decades of the Irish State treating women as second-class citizens. On and on it goes.

If a cohesive response which calms the public mood, convinces of the value of screening and offers reassurance is not found soon this is going to cost the State a crippling level of money.

In the midst of it all though there is one concrete fact — screening does save lives — and it would be an incalculable tragedy if our screening programmes did not
survive all of this.


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