Deeply sad to hear a lovely young woman this morning (RTE 1), who has previously spoken out about the concealment of her negative result three years ago, telling us this morning that she is dying of cervical cancer, and in terrible grief over leaving her six children, and her own life.
EDIT: IT NEEDS TO BE SAID HERE THAT THIS OP, WRITTEN BY ME, IS WRONG START TO FINISH. 12/5/19
This is the status as I understand it now -
Pap tests wherecells are reviewed for abnormality are a diagnostic test forcervical cancer or for pre-cancerous changes. (Where used fortesting HPV they are a diagnostic test for HPV. Presence of sometypes of HPV indicates risk of cervical or penile cancer.)
When wholepopulations are screened for these cell changes (as in Ireland),there is a standard rate of abnormalities that are missed inscreening.
In most states, whena woman is diagnosed with cervical cancer, if she had smear tests inthe past they are normally reviewed in a ‘look back’. Thisapplies the group of women involved in the ‘scandal’ in Ireland.
In most states theresults of the review are not shared with the patients because thepurpose of the review is to monitor standards of screeningperformance, not to treat the women. The ‘look back’ is notdiagnostic as the woman’s cancer is already diagnosed. It is tocheck if obvious cancers are being missed.
In Ireland itappears there was no clear direction from Cervical Check to Gps orConsultants as to whether or not they should inform women of the lookback and its results. Some were informed and some were not. Thosewho were informed started to sue.
Cervical Checkanticipated there would be a furore over the ‘withholding’ ofinformation from some, and risk would result to screening services,but they mishandled communications and didn’t clearly explain theissues to the public.
The media spreadconfusion by constantly omitting to say that the group of womenconcerned were all already diagnosed and receiving treatment.
When a young womanwho has been having regular smear tests done gets full blown cervicalcancer, there is obviously quite a high chance that a previous smearor smear has been misread or that the slide was in some wayinadequate. Statistically speaking this is a relatively small groupof women.
So far as I can see,no one has said that the labs Cervical Check uses were performingdifferently to the previously accepted norm.
The recent judgementthat ‘absolute confidence’ was required by the person viewing theslide before they are said to be negative (rather than positive orunclear) is based on an English judgement of about 10 years ago,which caused consternation there too. However, there is not the samecompo culture and legal costs are lower, so the impact would be moresevere in Ireland.
https://onlinelibrary.wiley.com/doi/...06.00392_3_3.x
Original OP -
No one can say there was no warning that women would die because of Ireland's substandard cervical test system.
Three women have definitely died, and there is no knowledge at this stage of the total number of people who will do, due to non-reporting of positive tests, and to the substandard testing process.
Ireland came late to providing cervical testing at all - decades after it was free on the NHS. Cervical testing was for those who could afford to pay. Poor women who couldn't afford testing died in large numbers.
Doctors walked from Cervical Check ten years ago when the decision was made to outsource a new public service to a not-fit-for-purpose test-reading service in the US, because it gave the lowest tender price. They said that the problems would emerge in ten years time (the time it often takes for a cervical cancer to develop and become fatal). The then head of Cervical Check, Tony O'Brien, dismissed this, saying that those complaining had vested interests in labs in Ireland. (There is also huge lack of clarity as to how Irish based labs are overseen - it may well be that conflict of interest is rife, but that is a separate issue). There was also warning from a WHO agency that lack of open disclosure legislation in Ireland would put patients' health at risk. O'Brien then went on to take a job in a US health firm while still purporting to run the HSE.
Fianna Fail drove the outsourcing (Mary Harney as we know in charge, in the Department of Health). The tender process must have made it clear that the level of accuracy offered was only suited to annual checks, not the one in three years tests in Ireland.
Fine Gael, and Varadkar, as Minister for Health, blocked legislation to require open disclosure of results / medical files to patients. Cosy relations appear to have existed between Varadkar and Tony O'Brien (now HSE head) with Varadkar collecting a donation from a US firm linked to O'Brien.
O'Brien is being allowed to continue at the head of the HSE without the obvious action of suspending him on pay without prejudice.
The HSE has been operating without a Board for years and the Department of Health is stunningly silent in all this (what does it actually do?).
Ireland's very heavily funded health services have thousands of great people working in them, but for others, their jobs and positions are primarily acted on as opportunities for self enrichment.
Two years ago Susan Mitchell wrote this piece in the Sunday Business Post.
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