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HSE board backs legal protection for BreastCheck audits

The HSE board has agreed that legislative measures should be taken to ensure the continuation of programmatic reviews of interval cancers in the BreastCheck programme, the Medical Independent (MI) has learned.

Board meeting minutes show in early 2020 it discussed a recommendation from the expert reference group on the management of interval cancers in the BreastCheck-screened population, which said programmatic review of interval cancers should not be carried out in the future “unless anonymised or with legal protection”.

The board was concerned about “loss of valuable learning arising from the recommendation not to carry out programmatic review of interval cancers in the future, with the consequent loss of EUREF  [European Reference Organisation for Quality Assured Breast Screening and Diagnostic Services] accreditation, unless anonymised or with legal protection. The board considered this will be to  the ultimate detriment of the quality of the screening programme and to women who engage with the programme in the future.”

According to minutes, the board was of the view that “appropriate legislative measures should be taken to ensure and support this crucial aspect of the programme. The board requested that this matter is referred back to the safety and quality committee for further discussion and consideration of a submission to the Minister supporting new legislation.”

Commenting on the background to the board discussion, a HSE spokesperson told MI: “Since 2010, CervicalCheck was notified by hospitals of cervical cancer cases. These women were then included in the CervicalCheck audit. The Scally Report identified gaps in this notification process and made a series of recommendations in order to ensure that all cervical cancer cases are known to the programme. Dr Scally made a specific recommendation that audits should be an important component of cervical screening based on good clinical practice.”

This led to the establishment by the HSE of expert reference groups to recommend how interval cancer audit processes in the screened population should be carried out for all three National Screening Service cancer screening programmes, informed by best international practice.

“There is an expert reference group addressing breast cancer audit, and a combined expert reference group for cervical and bowel cancer. These groups are made up of patient advocates, patient representatives, representatives from screening and cancer control, and other relevant healthcare professionals,” according to the HSE’s spokesperson.

To inform the work of these expert reference groups, technical working groups for each individual screening programme were established.  

“Following a rigorous systematic literature review; international survey findings and learnings gleaned from international external experts; as well as the outcome of the independent expert review by the Royal College of Obstetricians and Gynaecologists (RCOG); the development of the final reports are being prepared.”

However, the Covid-19 pandemic has impacted the groups’ work and interrupted progress, added the HSE spokesperson.

The “draft reports” contain a wide range of recommendations. Once the reports have been formally adopted, the HSE “will put appropriate processes in place to ensure the timely implementation of those recommendations”.

All interval cancer audits and programmatic reviews were “paused” while new processes were developed by the expert reference groups.

“We are awaiting the final recommendation from the groups before considering the commencement of future interval cancer audits.”

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