The findings of the CervicalCheck slide review conducted by the Royal College of Obstetricians and Gynaecologists (RCOG), UK, are “in line with the patterns of discordance reported in the English Audit of Cervical Cancer and are not in themselves a cause for concern”.
The expert panel also examined the colposcopy management of those participants where there was an interval of more than six months between their initial colposcopy and their diagnosis of cancer.
The review, which has been published this afternoon, states “the detailed scrutiny of colposcopy did identify cases where management of abnormal smears could have been better, and this reinforces the need for vigilance and adherence to CervicalCheck clinical practice guidelines”.
However, the review says women “can have confidence in the clinical standards which apply to the day to day practice of colposcopy across the country”.
This review was led by RCOG and undertaken in response to the issues that emerged in 2018 in relation to CervicalCheck. It examined the screening histories of 1,038 women who were screened by CervicalCheck since 2008, 1,034 of whom had gone on to develop cancer.
For 308 of the 1,034 participants, the review found a different cytology result from the original CervicalCheck result. The expert panel noted that these findings were in line with those seen in the English screening programme.
The expert panel emphasised it is important to recognise the serious impact that screening failures have on the lives of women and their families. However, it also acknowledged that failures are unfortunately “an inevitable” given the limitations of cytology-based screening and should not be taken to suggest the programme overall is not working.
The expert panel has made 10 recommendations, which have been accepted by Government. The Minister for Health Simon Harris has today written to the HSE to request it to give consideration to these recommendations including in the context of specific work already ongoing.
Among the recommendations are that efforts should continue to “inform women of the limitations of cervical screening, while at the same time reinforcing the message that the Irish National Screening Programme is in line with internationally respectable programmes and is reducing cervical cancer incidence and deaths. HPV primary screening and HPV vaccination will ensure cervical cancer becomes a rare disease in Ireland.”
In addition, the expert panel stated that a policy of prior cytology slide review following every diagnosis of cancer is an important audit exercise and should be an integral part of the programme. “This should be conducted within a culture of candour with full disclosure of audit findings,” according to the review.
The expert panel further recommended tighter scheduling in colposcopy management. “We identified cases where there were delays in initial referral, between visits, and in scheduling treatment. It is recognised that some delays are due to non-attendance, but cumulative delays appeared in some cases to lead to a missed opportunity to prevent cancer,” stated the review.
Commenting today, Minister Harris said: “If we are to achieve our goal of making cervical cancer a rare disease in this country, it is vital that women continue to attend for screening. It is also why we must continue to build on the considerable progress in other areas over the course of this year, with smear test turnaround times now stabilised and implementation of Dr Scally’s recommendations having been strongly progressed.
“In particular, the switch to HPV primary screening is a key plank in helping to eradicate this devastating disease in Ireland. This is why I have today written to the HSE to ask them to consider the recommendations from this review in the context of this crucial project, and to ensure the successful introduction of HPV primary screening in quarter 1 next year.
“I have also asked the HSE to consider these recommendations in the design and implementation of future systems of audit within our screening programmes.”