Introduction of new cervical cancer test ‘held up by backlog’

The introduction of a new, more accurate test for cervical cancer is being delayed by a massive backlog of smear tests, an Oireachtas committee has heard.

HPV testing, which would improve detection of pre-cancers, was first promised last September but now seems unlikely to be introduced this year.

This is because a backlog of cervical smear slides, now standing at 78,000, must first be cleared before the new service can be introduced, HSE officials told the health committee on Wednesday.

The delay in examining smears at the CervicalCheck screening service has lengthened further, with women now waiting up to 27 weeks for test results. Testing laboratories are taking an average of 93 days to report on smears.

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The number of women seeking smear tests grew last year to 370,000, from 280,000, according to Anne O’Connor, interim director general of the HSE.

Controversy

The increase was prompted by a decision by Minister for Health Simon Harris to offer women repeat smears if they had concerns in the wake of the controversy over the CervicalCheck programme.

Defending the decision, Department of Health secretary general Jim Breslin said it was made in the context of a rapidly evolving situation and anxiety around CervicalCheck.

Mr Harris did not receive any advice “to the contrary”, suggesting he not go ahead with the measure, prior to making the decision, Mr Breslin said.

The decision was based on a “worthwhile and honourable” desire to respond to concerns, though some of these were based on misinformation, he said, adding that it was only when the Scally review was published that clarity emerged.

Of the recommendations made in the report by Dr Gabriel Scally, the HSE has implemented 29, while another 53 are being progressed, the meeting heard.

Fianna Fáil health spokesman Stephen Donnelly asked when HPV testing, which is more accurate with a lower rate of false readings, was going to be introduced. The Minister had promised it would be introduced in September last year and, later, in January 2019, he pointed out.

Ms O’Connor said she was unable to give a date for the introduction of the new service. The challenges in accessing adequate cytology would first have to be addressed.

HSE national director Damien McCallion said the backlog would first have to be eliminated and a “stable” service established before the new test could be provided.

Delayed treatment

Mr Donnelly asked whether women whose test results were in the backlog risked having their treatment delayed. About 1,200 of the 78,000 women affected could have pre-cancerous abnormalities, he pointed out.

Dr Peter McKenna, HSE clinical director of the women and infant health programme, said that while the waiting time was far from ideal and there would be women with abnormal smears, for the vast majority their treatment would be the same.

Labour's Alan Kelly called for the supports currently provided to the group of at least 221 women affected by the CervicalCheck controversy to other women whose diagnosis with the disease was picked up by the National Cancer Registry.

Dr McKenna said deaths from cervical cancer would not be reduced by focusing on cytology alone. Patients with symptoms needed rapid access to gynaecology clinics, but currently there were 28,000-30,000 women on their waiting lists.

He said the number of inappropriate referrals to colposcopy clinics from primary care had increased since the controversy. Last year, the clinics received about 10 referrals a month of woman with an abnormal cervix or bleeding; now, they were receiving 60 a month.

More than 1,070 women who were diagnosed with cervical cancer have given their consent to have the Royal College of Obstetricians review e-examine their slides.