As a woman and pathologist I heard about concerns regarding CervicalCheck in Ireland with great sadness. I feel so sorry for the women affected and their families. Cervical screening services save lives. I know this and that is why I will continue to be screened for cervical cancer and encourage others to do likewise.
I know the scientific evidence is strong that there are great benefits in terms of detecting early cancers and savings lives through public screening programmes. This evidence shows that there is a decline in the rates of cervical cancer when these services are introduced. In Ireland and in the UK, national screening services for cervical cancer were introduced following public calls for a programme to prevent this terrible disease that affects women in the prime of their lives.
Today there are many women who have a better prognosis – who are now either free from cervical cancer or the disease was caught at a stage where treatments and interventions helped save their lives. In Ireland, the rate of cervical cancer has dropped by 7 per cent year-on-year since CervicalCheck began.
We also know that for all of its benefits, screening is not perfect. It has limitations, will not pick up on every cancer and some women will succumb to the disease.
As a pathologist I am trained to look for these discrepancies in slides that come for analysis
There are lots of statistics in the public domain now that can cause concern and confusion but women should be reassured. The review stated that cervical screening cannot prevent all cases and will fail to prevent some cancers, even in well-run programmes. It also says that CervicalCheck is working effectively.
But discrepancies occur. As a pathologist I am trained to look for these discrepancies in slides that come for analysis. We regularly review previous samples for a woman who develops cervical cancer, even when a negative result has been received previously. This is similar to the system used to review the CervicalCheck samples in the review carried out by the Royal College of Obstetricians and Gynaecologists published this week.
It showed that in the cases selected there was a discrepancy rate of about 30 per cent between the original report and the second one with 159 missed diagnosis opportunities. This type of review is a special type – a “look back” because in these cases they were looking at the samples with knowledge that the women had been diagnosed as having cervical cancer.
The thing about reviews and finding problems is that it is an integral part of what we do in all areas of medicine. We use audits to look at patient outcomes, receive comments and sometimes complaints, and review these to see how we have done. My personal annual appraisal and revalidation process for the UK General Medical Council looks at how safe my practice as a pathologist is, and includes a look at my participation in audit, or reviews of my practice.
We know that humans make mistakes, and we know that humans under pressure make more mistakes
In all these areas, we look at the ideal, we look at how things have gone and we agonise over where it has not been ideal. We worry about the impact on our patients when there is a problem. We learn from these reviews. We learn a lot. We share experiences and where there are common themes we design education programmes that help prevent current and future practitioners making the same mistakes.
We know that humans make mistakes, and we know that humans under pressure make more mistakes. We worry about the international shortage of doctors and how this will affect services and the pressures on staff. We design services to reduce as much of the potential variation and discrepancy as possible. We put in quality-control schemes. We monitor the data from the schemes. We test our pathologists and screening staff on a regular basis, but we still have discrepancies. We still have patients who feel let down.
Being open with patients about problems is a guiding principle in the UK system in which I work. We tell people what has happened and what we can do about it, if we can indeed do anything to help. It can be hard sometimes to admit that there has been a problem and some medical staff find it extremely stressful since often they themselves may feel upset about what has happened. But we train them to do this and we expect them to do this and have guidelines about what we should do and how. Patients often feel most let down when they are not told about a problem as soon as it has happened.
I am incredibly impressed by those women involved in the recent events in Ireland
Screening for cervical cancer is still the best system that we have for early detection and this is why it is important that women continue to have smear tests and attend their GP when they have symptoms about which they are concerned.
At a personal level I am incredibly impressed by those women involved in the recent events in Ireland and pay tribute to those who, despite their own personal experience, have encouraged women across Ireland to go for screening. It is essential to remember that though imperfect, screening saves lives.
- Prof Jo Martin is president of the Royal College of Pathologists London.