As you will probably know from the media, there is currently concern over the CervicalCheck cervical screening programme. We, the Royal College of Obstetricians and Gynaecologists (RCOG), have been commissioned by the Irish Government to conduct an independent review of the screening history of all women who have developed cervical cancer since the national cervical screening programme was established in 2008. A previous review of this type conducted in Ireland (the CervicalCheck clinical audit) found over 200 cases where abnormal cells in cervical cytology samples (‘smears’) had originally been reported as normal.
This new review will be conducted by the RCOG independently of the Irish programme. Every woman who has been diagnosed with cervical cancer since September 2008 whose cancer was registered with the National Cancer Registry of Ireland before 5 May 2018, and who has had one or more tests under the CervicalCheck programme, is being offered a review of her case.
If you wish to have your cervical screening case reviewed, you will need to provide consent to allow the expert panel to have access to your samples and your clinical records. Your previous samples will then be identified, sent to a UK laboratory to be re-checked and then returned to the original laboratory.
If you ask for your case to be reviewed, there will be a number of possible outcomes and answers:
What if the review agrees with an original result that was negative?
There would be no further action. Unfortunately, samples do not always detect underlying abnormal cells, and so the screening process may fail to prevent a cancer.
What if the review shows abnormal cells, and your original sample had also been reported as abnormal?
Your clinical records would be reviewed to check whether the original abnormality had been correctly managed.
What if the review shows abnormal cells, and the original result was negative?
This could suggest that an abnormality was not detected when it should have been, depending on the extent of the disagreement. The importance of this is that you were not referred for further investigation and treatment which could have prevented the cancer or led to earlier treatment.
What if you had a smear which was correctly reported as negative, but you did not attend a later invitation for a smear test?
If there is more than three to five years since a previous smear its protective effect can be lost.
What if the review finds that there is diagnostic uncertainty regarding the appearance of the cells?
This means it is simply not possible to come to a reliable conclusion about whether an abnormality could have been detected.
Following completion of the entire review, the panel will prepare individual reports for each woman in the review. They will also prepare a report which takes account of all of the results in order to determine in what proportion of cases the review agreed with the CervicalCheck result, and in what percentage there was a disagreement which may have been responsible for failing to prevent cancer.
If you agree to participate in the review, you will be asked if you wish to receive your personal report. If there has been a missed abnormality or another type of error which could have been responsible for failing to prevent cancer, the findings of your report will be explained to you in person by the clinician responsible for the management of your care. This will give you an opportunity to have a detailed discussion and ask anything you wish to.
For the avoidance of doubt, this is of course a review for which there is no charge to the patient. The cost is being met by the Irish Health Service. The RCOG has been asked to undertake the review simply in order to provide the assurance of our independence.