Expert Reference Group Interval Cancer Reports

The National Screening Service (NSS) welcomes the publication of the Expert Reference Groups’ Interval Cancer Reports, and supports their recommendations.. The NSS will work to implement those recommendations in full, in partnership with the people we care for, and our professional screening teams around the country.

The expert reports were commissioned as part of the Scally Review in 2018. They set out a new and comprehensive approach to reviews of interval cancers in people who have been screened by Ireland’s breast, bowel and cervical cancer screening programmes.

NSS Chief Executive Fiona Murphy said today: “An interval cancer is one that is diagnosed in a person who has been screened previously. While they are uncommon, they show how every screening programme has limitations, and cannot detect every case of cancer. The NSS welcomes the detailed work undertaken by the expert groups, and we commit to a careful, thorough and full implementation of each of the recommendations.”

The expert reports acknowledge that Ireland’s screening programmes operate to the best international standards and that they reduce deaths from cancer among people in Ireland.  They affirm that world class screening programmes must balance patient trust, staff recruitment and affordability, and that interval cancers are an inherent feature of any screening programme. They emphasise the need to sustain our vital public health screening programmes.

The reports have set out a number of recommendations for the National Screening Service (NSS) and the Board of the Health Service Executive (HSE). Their recommendations will support the NSS in establishing an independent and safe system to support future management of interval cancers.

Dr Colm Henry, Chief Clinical Officer of the HSE said: “The HSE has now implemented more than 90% of Dr Scally’s report and today marks an important milestone in that process. I want to thank both Prof Risteárd Ó Laoide and Prof Susan O’Reilly, and all those who worked on these reports.  Their work will contribute to improving further our screening services, which make such a real and substantive contribution to reducing the incidence of cancer in the Irish people.”

BreastCheck report chair Professor Risteárd Ó Laoide of the NCCP said: “Evidence from international accreditation, international expert opinion, and review of BreastCheck – the National Breast Screening Programme has confirmed that the breast screening programme in Ireland is operating to the best international standards. Breast screening reduces the number of deaths from breast cancer in Ireland by approximately 120 per year.

“The report has outlined a new strengthened, more robust model for the performance and disclosure of individual interval cancer case reviews, keeping the provision of information, patient choice and patient consent at the centre of the process.”

CervicalCheck and BowelScreen reports chair Professor Susan O’Reilly said: “It has been my privilege to work with the professionals, patients, advocates and international experts who participated in this complex and sensitive project. I would like to thank all of them for their engagement in the development of the recommendations in our reports, which we are now pleased to publish.”

Patient advocate review group member Bridget Doherty said: “I am happy that the NSS has undertaken to implement all of the reports’ recommendations, and that the screening programmes are committed to working in partnership with patients as they make these important next steps.”

Donal Buggy, Irish Cancer Society, Director of Services Delivery said:

“These reports contain recommendations which will strengthen the BreastCheck, CervicalCheck and Bowel Screen services’ approach to the categorisation and reporting of interval cancers. The Irish Cancer Society looks forward to the full and early implementation of the recommendations.”

Dr Gabriel Scally said: ‘’I was impressed by the quality of the reports and pleased to note the public and patient representation on the working groups.  I hope, for example, that the results of the international survey of cervical screening is published in the professional literature. I was pleased also to see the support for reform in the legal system being voiced, and changing the approach for all screening services would be a good place to start.’’

Fiona Murphy added: “I would like to thank all of those who contributed to the reports, including patient advocacy representatives, screening clinicians, international screening experts and research experts, as well as my NSS colleagues. I am confident that their work will enable us continue our successful drive to prevent cancer and save lives through population screening.

“We will update our websites with details of the implementation process, which will take some time as we work through a comprehensive transformation process to meet these new aims. People do not need to take any action.  We will provide progress reports on implementation to anyone who registers with us on our information line, Freephone 1800 83 21 88, or by emailing info@screeningservice.ie.   When our new processes have been designed we will get in touch with people affected”

Reports

 

Notes

Interval cancers

Interval cancers occur in all screening programmes. NSS strive to prevent or diagnose as many cancers as possible but acknowledge that all international programmes report a number of interval cancers each year. A small number of interval cancers are recorded by each cancer screening programme yearly. Interval cancer reviews are important for teaching and learning in screening programmes internationally.

Scally report implementation

In 2018, the Scally reports into CervicalCheck made 58 recommendations shared between the HSE, the Department of Health and the National Cancer Registry of Ireland. The HSE is responsible for 42 of these recommendations.

In 2019, as part of the recommendations, Dr Colm Henry, Chief Clinical Officer of the HSE, commissioned expert reviews of all interval cancer management processes for the three HSE cancer screening programmes.  

Two Expert Reference Groups (ERGs) were established to review interval cancer management processes. The groups were tasked with defining the future processes and reviewing guidance for interval cancers based on international evidence and best practice.

The ERGs were made up of patient representatives, advocacy group members, representatives from screening and cancer control, and other relevant healthcare professionals.

Before the COVID-19 pandemic hit, the HSE had completed 105 of the 116 actions assigned to the organisation.

The publication of the Expert Reference Groups’ reports mark the completion of three more of the Scally reports’ actions.

 

Common recommendations:

·       to continue to adapt information on consent to help participants make informed choices about screening

·       to build understanding and trust in screening programmes, and help the public understand the benefits and boundaries of screening

·       to provide access to patient-requested case reviews

·       to implement blinded, anonymous programmatic reviews for quality assurance, professional education and international benchmarking of standards

·       to set out a clear interval cancer rate measurement for benchmarking

·       to determine the cost of implementing the reports’ recommendations

·       to propose a legal framework for screening.

Implementation:

·       Independent working groups are being set up for each programme to establish, or update and strengthen interval cancer management procedures and reviews.

·       Working groups will focus on the need for clear information for patients, guidance for clinicians, completion of any disclosure process and appropriate training and support.

·       Implementation progress update will be provided end of January 2021.

·       Patients who were previously affected by an interval cancer and have any questions can call the Freephone information line on 1800 83 21 88 or email info@screeningservice.ie

BreastCheck Expert Reference Group recommendations include:

·       People should continue to be provided with all the information they require in order to help them make an informed choice to consent to participate in the BreastCheck programme.

·       BreastCheck should continue to conduct patient-requested case reviews for patients presenting with new interval cancer diagnoses, under a new, strengthened review model.

·       The findings of all patient-requested individual case reviews should continue to be disclosed using the BreastCheck standard operating procedure.

·       The development of technology which will allow blinded, anonymised radiological assessment of all interval cancers. In the absence of such technology, legislation that would facilitate this activity is recommended.

Recommendations for the CervicalCheck programme include:

·       People should continue to be provided with all the information they require in order to help them make an informed choice to consent to participate in the CervicalCheck programme.

·       CervicalCheck should establish a process to conduct patient-requested reviews of all invasive cancers (both interval and screen-detected cancers) and establish a standard operating procedure for this.

·       The findings of all patient-requested reviews should be fully disclosed. It is further recommended that the responsibility for disclosure of the review outcome rests with the treating clinician, generally the colposcopist or oncologist.

·       Clinical programmatic reviews should be conducted only where either (1) such clinical reviews are both blinded and anonymised; or (2) legislation protecting the confidentiality of programmatic reviews is passed by the Oireachtas.

·       The CervicalCheck programme should develop a new key performance indicator (KPI), the interval cancer rate.

·       Communication with the National Cancer Registry Ireland (NCRI) should be strengthened to enable a more timely validation of invasive cervical cancers.

Recommendations for the BowelScreen programme include:

·       Communication with the National Cancer Registry Ireland (NCRI) should be strengthened to enable a more timely validation of interval cancers and the calculation of the interval cancers rate in the BowelScreen programme.

·       Processes should be put in place to calculate the post-colonoscopy colorectal cancer (PCCRC) rate in BowelScreen based on international best practice.

·       Calculation of the post-FIT kit analysis interval cancer rate to inform the determination of the FIT threshold, and to inform international scientific opinion on the sensitivity/specificity of FIT screening.

·       Local screening units will continue to openly discuss the diagnosis, treatment plan and review of the screening colonoscopy with the patient following diagnosis of a PCCRC.

BreastCheck - Offers free breast screening (mammograms) to approximately 550,000 eligible women aged 50 to 69 on an area by area basis every two years. Since 2000, BreastCheck has provided more than 1.9 million mammograms to women and detected over 12,200 cancers; more than half of which were diagnosed at an early stage.

CervicalCheck - Offers free cervical screening to almost 1.3 million eligible women living in Ireland aged 25 to 65. CervicalCheck has provided over 3 (almost 3.2 million) million cervical screening tests and detected over 115,000 abnormalities, many of which could have developed into cervical cancer if not detected through screening. 1,529 cancers detected in the first 10 years of CervicalCheck.

BowelScreen - Offers free bowel screening, through an easy to use home test, to approximately 500,000 men and women aged 60-69 every two years. BowelScreen has detected 930 cancers and detected and removed 25,350 pre-cancerous growths. These pre-cancerous growths are known as polyps or adenomas and if left untreated they can develop into bowel cancer.

The NSS continues to encourage all people who are between screening appointments, or waiting for rescheduled appointments, to be aware of, and act upon, any symptoms associated with the conditions for which they are being screened. We ask that those people contact their GP, who will arrange appropriate follow-up care.

For other queries patients can call the NSS Freephone information line on 1800 45 45 55 or email info@screeningservice.ie

Last updated on: 21 / 10 / 2020