Review found missed opportunities to prevent or diagnose cancer earlier in some women but overall the Irish cervical screening programme is performing effectively, according to the final report published today.
In May 2018, The Royal College of Obstetricians and Gynaecologists (RCOG) was asked by the Irish Government to review the screening history of every woman diagnosed with cervical cancer through the CervicalCheck screening programme since it was established in 2008.
In total, the RCOG review analysed 1,659 slides from 1,038 women, or their next-of-kin, who consented to take part in the review. 1,034 of these women had invasive cancer and four women had high-grade abnormal changes.
The expert panel identified missed opportunities to prevent or diagnose cancer earlier in 159 (15%) of the 1,034 women with cancer. In a further 149 women (15%) the RCOG review panel disagreed with the CervicalCheck slide reading, but they did not believe this had an adverse impact on their outcome.
In total, the RCOG review disagreed with the CervicalCheck result in a third of cases they analysed – 308 out of 1,034 women with cancer.
The overall pattern of discordance found by the RCOG review panel is similar to a much larger slide review involving cases of cervical cancer in England, in which the original smear results was compared with the Review result, as part of continuous auditing in the English Cervical Screening Programme.
Colposcopy management was scrutinised in 106 (10%) women with cancer. In a quarter of these cases (27/106) the clinical management was considered by the expert panel to be suboptimal, such that an opportunity to prevent cancer or to diagnose it at an earlier stage was missed.
The RCOG expert panel has made a series of recommendations to support ongoing quality improvements across the CervicalCheck programme.
Professor Henry Kitchener, Lead Assessor of the RCOG Expert Review Panel, said:
“In recognising the serious consequences that screening failures have for affected women, it is important to also recognise the inability of cervical screening to prevent all cases of cervical cancer.
“The findings of the slide review 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 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.
“There is clear evidence from falling death rates that the CervicalCheck programme is working effectively and women can have confidence in the CervicalCheck programme. Regular participation in screening remains the most effective means of protecting women from cervical cancer.”
Professor Lesley Regan, President of the Royal College of Obstetricians and Gynaecologists, said:
“Our primary aim has been to ensure that every woman or her next-of-kin taking part in this review receives an independent analysis of her slide history leading up to their diagnosis of cancer.
“This has been a complex and demanding review but it has been a privilege to have been tasked with conducting this important work, which we hope the women affected will find has provided transparent information about their screening history and cancer diagnosis.
“We hope our findings will contribute to ongoing quality improvements across the CervicalCheck programme and provide confidence in the Irish Cervical Screening programme.”
Notes to editors
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Cervical screening in cases of cervical cancer in Ireland between 2008 – 2018, RCOG Independent Expert Panel Review. Full copies of the report are available from the Department of Health.
In May 2018, as part of the response to issues concerning CervicalCheck – the National Cervical Screening Programme in Ireland, the Minister for Health commissioned the RCOG to conduct a review of the screening histories of women who had participated in the CervicalCheck screening programme, and who had developed cervical cancer prior to 5 May 2018.