Dr. Tony Holohan:

I wish to make a general point and not to take issue with many of the specifics Deputy Coppinger has raised or, indeed, the legitimacy of questions about laboratories and contracts being raised.

I have been doing some calculations and I can give some general figures for the purpose of illustration. What I am trying to address here is a sense that we have evidence of a substantial failure of the cytology service that people here depend on for the reliability of the tests. We have to try to reassure people about that because they are genuinely worried and concerned.

We carry out approximately 250,000 smears per year. The abnormal rate that is reported, between high grades and low grades, is approximately 8,000. I will call that 10,000 for the purpose of simplicity. That is 240,000 negative test results per year. We know we have approximately 300 incident cases of cervical cancer in this country per year.

We believe the test performs at the rate of about 70% sensitivity. That means it misses about 30% of cancers that are present at the time of testing. For simplicity, we will say that works out to be somewhere in the region of 100 false negatives. That gives a false negative rate of substantially less than 1%, therefore, when the accuracy figure of 99% set out in the figures is quoted, it is based on statistics like that. That is a back of the envelope calculation. What I am trying to illustrate is that the general assertion - I do not suggest Deputy Coppinger is making this particular assertion - is that there is some evidence here of a substantial failure in the cytology service being used to give people reassurance. We simply do not have evidence of that. There have been substantial failures. There has been clear admission in regard to them, particularly in terms of unacceptable failures of communication to patients, but that cannot be equated with a statement or review. I have to make that point about the cytology service and the evidence we have in terms of performance. The point has been made by the director general that the differential performance, about which again there is a legitimate question, can be provided by way of response to the committee. That may well help to satisfy some of the questions that have been asked.