Further to the ongoing CervicalCheck scandal.
Dr Primum Non Nocere writes:
I wanted to add my thoughts on the CervicalCheck scandal from the perspective of a doctor working outside of Ireland.
Without wishing to state the obvious I think that the handing of the cervical cancer audit is very poor by both CervicalCheck and the Government. The Government is doing damage limitation but I’m not sure they really understand the following:
Medicine is inexact. Smear tests are a screening programme. There will be misses.
CervicalCheck are at fault for the following reasons.
Fault 1: They should have told women there was a miss rate. Informed consent is important. Also, knowledge of the miss rate is a crucial part of the cervical cancer prevention process.
Knowledge of the miss rate stops women from ignoring symptoms in the belief that nothing can be wrong as their last smear test raised no issues. It also gives women the option of opting for more frequent smear tests, free elective colposcopy or HPV testing as a back-up.
Fault 2: In addition to informing women that there was a miss rate, Cervical Check should have been able to provide these women with an accurate miss rate.
The CervicalCheck website currently states:
“A cervical screening test is not a diagnostic test. As with all screening tests, cervical screening may not always be 100% accurate. There is a small risk that cell changes will not be picked up in a test. However, any cell changes will usually be picked up in future tests. This is why it is important to have regular cervical screening tests.”
This doesn’t cut it in terms of information which should be provided to women. The words “usually be picked up” do not reflect the normal miss rate for cervical smear tests worldwide, which is significantly higher than this. No wonder these women weren’t concerned.
Fault 3: CervicalCheck wasn’t honest. If they were going to do an audit, they should have decided in advance what they would do with the outcome.
If they didn’t know, they could have looked to their colleagues in the United Kingdom. When an audit into cervical screening practices in Leicestershire disclosed that fourteen patients had died after missed smear tests, the NHS held a press conference, and published the results. Publication of cervical smear test audits disclosing false negative smears is standard practice in the UK.
Not every country can afford yearly screening, HPV testing or free elective coloscopies. It is a cost-benefit issue.
However informing women that medical tests are not infallible, that there is a miss rate for smear tests and providing them with an accurate miss rate prevents them from disregarding symptoms and gives them the information that they need in order to decide whether they should voluntarily opt for additional testing.
It is a crucial part of the screening process and its goal of saving lives.
Dr Primum Non Nocere is a doctor qualified in Ireland, currently practising abroad.
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