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To screen or not to screen

At the same time, evidence-based screening is a powerful preventative tool that can save lives. BreastCheck has been an integral part of the health service’s arsenal in reducing breast cancer deaths since the screening initiative was established in 2000. According to its latest report, BreastCheck successfully delivered over 145,000 screens and detected 986 cancers in the period 2015 to 2016. The expansion of the programme to women aged 65 in 2015 and the plan to extend upward to women aged 69 over time is a testament to the benefits that screening for breast cancer can bring. Although BreastCheck is well established, the programme needs to constantly strive to improve and respond to latest practice and evidence at all levels. HIQA recently revealed shortcomings in governance structures at BreastCheck that have the potential to impact on the quality of the breast cancer screening service. The Authority recommended that the National Screening Service should implement an appropriate governance structure in order to effectively address information management within BreastCheck, as well as developing both a strategy and performance assurance framework for information management.

The case for and against screening is different for different cancers. April is bowel cancer awareness month. Bowel cancer, thanks to screening, is one of the most preventable and treatable types of the disease. The National Bowel Screening Programme, BowelScreen, was introduced because testing was considered relativity straightforward and it had the ability to save lives. Unfortunately, uptake of the programme is low. As part of this month’s awareness campaign, Prof Diarmuid O’Donoghue, Clinical Director of BowelScreen, warned that fewer than 40 per cent of eligible people have availed of BowelScreen in the most recent screening round. Prof O’Donoghue said this percentage urgently needs to increase in order for the full benefits of screening to be realised.

Then there are cancers where screening is being considered. Such is the situation with lung cancer. The Lancet published a European position statement on screening for the disease at the end of 2017. It stated that lung cancer screening with low-dose CT can save lives and should be considered by health services in EU countries. As revealed in this issue of the paper, the National Cancer Control Programme (NCCP) is currently weighing-up the evidence for lung cancer screening. The NCCP’s recommendation, which is due later this year, is awaited with interest.

The recent report by the Irish Cancer Society and National Cancer Registry Ireland into patterns of emergency presentation of cancer between 2002-2015 highlights the importance of diagnosing the disease in its early stages. Screening can play a pivotal role in this. As with everything in medicine, however, the argument for or against screening very much depends on the quality of the available evidence. And, of course, whether funding is available to deliver a well-resourced programme.

On a personal note, I would like to say what an honour and privilege it is to be the new Editor of the Medical Independent. I wish to thank the outgoing Editor Priscilla Lynch and Acting Editor Catherine Reilly for their hard work in continuing Mindo’s recent, though already proud, tradition of in-depth, investigative journalism. It is a tradition the team and I are absolutely committed to carrying on now and into the future.

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