Nicole Ryan (Sinn Fein)
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I am here today to raise a matter that speaks to bodily autonomy, trauma-informed care and basic respect for women who have gone through far too much. I refer to the case of Sarah, a woman who underwent a radical hysterectomy in 2019. Her uterus, cervix, ovaries, Fallopian tubes and surrounding tissue were all removed. She has been medically confirmed not by one but by three different doctors as no longer requiring cervical screening. These include the surgeon who carried out her operation in London, her gynaecological oncologist here in Ireland and her own GP. Yet five years later, Sarah remains unable to opt out of the CervicalCheck register. She has asked repeatedly to be removed, at first providing medical grounds and documentation and later simply requesting to opt out. Despite this, the national screening service insists she undergoes yet another pelvic examination and a GP informed submission to confirm, once again, that she does not require screening. This is not only medically unnecessary but deeply traumatising. Sarah is someone who was failed by CervicalCheck in the past. She had three smears between 2016 and 2019, all of which were marked normal despite being symptomatic. Her pathology report following surgery revealed abnormal cell growth that had been entirely missed. She trusted the system once and it failed her. Now, instead of recognising the trauma that it caused, the system is forcing her to relive and all to be believed about her own body.

Why is a woman not allowed to make the decision for herself? Why is a signed declaration or existing medical evidence not enough? This policy is not rooted in patient care. It is rooted in paternalism. It reflects a broader culture of mistrust and a lack of agency for women in how their healthcare is managed. I ask for this policy to be reviewed urgently. Women who have undergone a total hysterectomy and have sufficient medical evidence must be able to opt out of the CervicalCheck register without further invasive procedures or bureaucratic barriers.

Emer Higgins (Dublin Mid West, Fine Gael)
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I thank the Senator for raising this really important issue. I am taking this on behalf of the Minister for Health and I have been provided with a script which I am sure will be provided to the Senator. I am quite concerned because the situation the Senator has outlined does not tally with some of what is in here. Let me read what is in here in relation the Senator's very specific question about opt-out procedures.

What the Department has advised is that the national screening service advises that any woman may remove herself from the cervical screening register if she wishes to discontinue her participation in screening and she is not required to provide a reason. This can be done by letter, email, phone or by completing the opt-out form. That sounds different from Sarah’s experience as outlined by the Senator. I am concerned by that because the official advice is it should be possible to opt out of this. To give a little bit of background to it, the Department has been quite clear that, if a woman has had a hysterectomy, in some instances cervical screening may still be advisable. It is not that in all instances, if someone has had a hysterectomy, they should be, ought to be or may wish to be removed, and that it does come down to clinical advice that has been provided. Therefore, the national screening service will often ask a woman to confirm with her gynaecologist at the time of her hysterectomy, in particular if it has had to do with cervical cancer, if she has any residual cervical tissue. Sometimes that needs to be monitored and that is often a reason women may wish to and may get medical advice to stay on the screening register. In Sarah's case, it sounds like she has had that medical advice and that appears to have been very clear. The advice from the Department is very clear, that this should be doable.

I am happy to raise this directly with the Minister on the Senator's behalf. If she wants to follow up with additional information, I am happy to take that too. The Senator will get a copy of the full and formal response, but that is the piece I think is most relevant, and diverges from the experience outlined by the Senator on the floor of the House today.

Nicole Ryan (Sinn Fein)
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I thank the Minister of State. I would love the Minister for Health to come to me directly on this issue. This case highlights that the person in question has had three different medical professionals saying she does not need to be there and can opt out because there is no need for it. It is causing her trauma. As the Minister of State said, regarding tissue perhaps being left over, etc., this person has none of that. Everything has been removed. It is very traumatising for her every time to have to prove she has actually undergone this traumatic experience. It is not good enough. I would really welcome a response from the Minister for Health on this issue.

Emer Higgins (Dublin Mid West, Fine Gael)
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Every year, 250 women in Ireland are diagnosed with cervical cancer and, sadly, around 90 lives are lost to this disease. It is something the Government takes very seriously. The Minister, Deputy Carroll MacNeill, is very passionate about it. Ireland is on track to eliminate cervical cancer in just 15 years, by 2040. That will be remarkable progress that will save lives. Cervical cancer, as we know, is among the few cancers that can be effectively prevented with vaccination and cervical screening. This is why it is so important that we continue to advise people to take part in these screenings, where it is appropriate for them.