Dr. Nóirín Russell:

I thank the committee for the invitation to attend this meeting. The Covid-19 pandemic has challenged healthcare systems throughout the world in a way that was inconceivable this time last year. In March, when we knew very little about Covid, screening services internationally played their part by pausing their programmes in order to prevent infection based on best public health advice. Since then, we have assessed the risks of delivering screening in a Covid environment and have put in place measures to reduce these risks.

In restarting cervical screening, we are focused on managing capacity across the whole screening pathway so that people get their results and any follow-up assessment in a timely manner. CervicalCheck resumed screening on 6 July by prioritising inviting the longest waiters to reduce the risk of the people delayed. By the end of December 2020, we will have issued a first invite letter to everyone due screening in 2020. We issued more than 270,000 invites in 2020 and screened more than 117,000 people in primary care.

While the global demand for Covid-19 testing has put pressure on laboratory supplies internationally, our laboratory is continuing to meet our capacity needs. For women, this translates into approximately 80% of result letters being issued within six weeks of the test. We continue to appeal for people to book their test when invited.

We have been asked how the pressures of the global pandemic will affect the people we care for in screening. These concerns are also our concerns. While we continue to work to minimise the impact of Covid-19 on screening, evidence shows that because of the typically slow progression of cervical cancer - over five to 15 years - the beneficial outcomes do not reduce if screening is delayed for six months.

The purpose of screening is to improve population outcomes for the condition being screened for. In CervicalCheck, that is decreasing the incidence of and mortality from cervical cancer. We do this by assessing risk in individuals and referring those with a higher than normal risk for further assessment in colposcopy. All screening programmes involve finding a balance between their benefits and potential harm. Our rigorous quality assurance systems ensure the programme meets the highest international standards and keeps risks as low as is possible.

Our new primary HPV screening programme will lead to a temporary increase in referrals to colposcopy in year two. We have investment in place to grow our colposcopy provision. However, we must also work with the HSE national women and infants programme to ensure capacity is created in the gynaecology service for women with symptoms who may previously but erroneously have been sent to colposcopy for quicker access to gynaecology services.

We are concerned when we hear people from all walks of life confuse screening services with diagnostic services, and we welcome the opportunity to talk to the committee about this today.

In March of this year, the HPV test was introduced as the primary cervical screening method. It brought CervicalCheck in line with international best practice in cervical screening. With HPV screening we are testing for a different risk factor in the development of cervical cancer: the presence of the human papillomavirus, that is, HPV.

We know that HPV screening is better at predicting which women are at risk of developing cancer but it will not detect everyone. No screening programme will pick up all potential cancer cases; none is designed to do so. When a potential case of cancer is not detected in screening, this does not mean that the screening test has failed. It illustrates the boundaries of the test. Furthermore, when these women go on to get cancer and their cytology slides are reviewed retrospectively, there is a four in ten chance that abnormalities will be seen that were not seen at the time of screening. This is called retrospective bias. It is important that as a society we acknowledge this uncomfortable truth.

The National Cancer Screening Laboratory, NCSL, build will begin in January 2021. In time, it will become the principal provider of cervical screening laboratory services. For now, a high-quality laboratory service continues to be delivered by Quest Laboratories in the US.

We are grateful that GPs and practice nurses are continuing to fulfil their important role as key sample takers for CervicalCheck. We thank our colposcopy colleagues who, during the pause in screening, continued to work hard to reduce the waiting list that had resulted from the issues affecting CervicalCheck in 2018. Our colposcopy turnaround times are continuing on target.

In October, the National Screening Service, NSS, welcomed the publication of the expert reference groups’ interval cancer reports. These reports were commissioned as part of the Scally review in 2018 and their publication marks the completion of 113 of the 116 Scally report actions. The reports acknowledged that Ireland’s cancer screening programmes operate to the highest international standards. They emphasise, however, that every year there will be people who develop interval cancers. This is a difficult diagnosis for people to receive. We are now working to implement those recommendations in full. We plan to consult widely with patients and their doctors about the future process. Finally, we are grateful to the many patient representatives who voluntarily give up their time to support our screening programmes this year at an especially difficult time. We remain committed to having patients at the centre of our screening programmes.