Statement from RCSI President Mr Kenneth Mealy on judgment by Mr Justice Cross

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Kenneth Mealy

We wish to acknowledge the great distress caused to the women and families impacted by the issues that have emerged in relation to cervical screening in Ireland.

Cancer screening plays a very important role in protecting people’s health, reducing incidences of cancer and detecting cancer early. Many hundreds of patients with breast, cervical and colorectal cancers have had better outcomes in Ireland because of our national cancer screening programmes.

It is, however, important to recognise that all cancer-screening services have limitations that lead to false positive and false negative results. False positive results can lead to patients being ‘over-treated’ for benign and pre-cancerous lesions or small cancers that might never lead to clinical harm. False negative results refer to missed cancers which result in delayed diagnoses and have clinical consequences for patients. Each screening programme must strike a balance between both scenarios so that, on balance, cancer outcomes are improved.

We are concerned that the standard of ‘Absolute Confidence’ mentioned in the judgment by Mr Justice Cross will be impossible to attain and may have multiple unintended consequences including additional unnecessary tests and procedures on patients who do not have cancer.

All screening tests are associated with a small number of false-negative results and the Irish screening programmes are no exception. Despite operating to the highest possible standards, cancer screening programmes expect a certain number of such cases each year. There are published international rates for anticipated interval cancers and Irish screening programme performing in line with international best standards will have a similar false negative screening rate. We are concerned that if false negative screening tests are regarded as a breach of care, this position will potentially threaten the viability of the Irish cancer screening programmes altogether, to the great detriment of the Irish public.

This will also impact on the more vulnerable members of society who often present later for care with these conditions and those who cannot afford to pay for private screening.

The implication of this judgment will have a grievous impact on our ability to detect cancer and will result in poorer outcomes for many patients.

We urge the Government to respond to the Cross judgment in a manner that allows cancer screening to continue saving lives. We also urge all of our partners in healthcare to work together to restore and enhance public confidence in cancer screening.