The Dean of the Faculty of Radiologists said:
The Faculty of Radiologists welcomes the release of the report on ‘Expert Reference Group report on the management of interval cancers in the BreastCheck screened population’. We hope that this can be the basis for maintaining public confidence in the Breast Screening Service that has always operated to the highest international standards.
BreastCheck commenced screening Irish Women for breast cancer in 2000. BreastCheck has invited over 2,733,000 women and performed over 2 million mammograms since 2000. The programme has detected 13,612 cancers and has contributed to the reduction in breast cancer mortality in this country by around 20% . This equates to approximately 110-130 lives saved per year. BreastCheck was established with stringent quality indicators and included a charter of women’s rights. BreastCheck has published a report every year with all key measurables and has met or exceeded almost all of the standards set out. BreastCheck has had three external international accreditations since its inception, the most recent by EUREF, the European Reference Organisation for Quality Assured Breast Screening and Diagnostic Services who awarded the programme reference standard accreditation, the highest possible standard valid till end of 2020.
When a woman enters the BreastCheck programme, she will be called for a mammogram every two years. Mammograms are difficult studies to read and there is a significant overlap between normal appearances and cancer. Mammography is not a perfect test but it represents the best available test for screening for breast cancer. Each woman’s mammogram is read by two consultant radiologists who are specially trained in screening mammography. There are 21 radiologists in the programme, each reading approximately 20,0000 mammograms per annum. Women with abnormal mammograms are recalled for further tests. Recalls are distressing for patients and must be kept to the minimum required for optimal detection of cancer.
A small number of women will develop breast cancer in between screening examinations, these are known as interval cancers. In all well-constructed breast screening programmes, there is an expected Interval cancer rate of around 2 per 1000. In Ireland this represents approximately 320-360 interval cancers per year. The Faculty of Radiologists recognises how upsetting it is for any woman to develop cancer while participating in a screening programme and understands that when confronted with an interval cancer diagnosis women will often have questions about their prior screening studies. BreastCheck has always facilitated patient requested reviews. This report now proposes doing these reviews in a more systematic manner.
While this is very much welcomed by the Faculty, we are anxious that if this process is not supported by adequate staffing resources and training then it may be counterproductive. The interval cancer rate is one of the most important statistics that we use to measure the quality of a screening programme and the Faculty of Radiologists strongly supports the collection and publication of this programmatic statistic as BreastCheck have done in the past.
This report comes at a critical juncture for the BreastCheck programme. New factors, in particular the rise in legal challenges, are presenting complex considerations for the programme. The costs of litigation to screening may potentially undermine the financial basis upon which screening is conducted. In turn, this dynamic may also present operational considerations, not least for the recruitment and retention of radiologists. These factors, alongside this report, mean that now is the time to move collectively in considering how best the BreastCheck programme responds and adapts so that we can continue to ensure that the women of Ireland can have a programme of the highest quality.
Dr Peter Kavanagh
Faculty of Radiologists, RCSI