The Challenge of Screening in Deprived Areas

A key public health requirement to encourage more women aged over 50 to present for breast and cervical cancer screening has been identified.  Gary Culliton of The Irish Medical Times interviews Dr Ann O’Doherty, BreastCheck’s Clinical Director.

A key public health requirement to encourage more women aged over 50 to present for breast and cervical cancer screening has been identified.  Gary Culliton of The Irish Medical Times interviews Dr Ann O’Doherty, BreastCheck’s Clinical Director.

There is a commitment in the Programme for Government to extend BreastCheck to women up to the age of 70, in 2014. This will require new money but there has been no announcement on this. This would be a huge leap, involving a 30 per cent increase in workload.

Currently, women are screened up to the age of 64 and BreastCheck is already under pressure in terms of resources.

“If we were given the go-ahead, we would do everything in our power to extend the programme,” said Dr Ann O’Doherty, Consultant Radiologist and Clinical Director, BreastCheck. “It would require significant investment.

“We should be getting to women within two years of them becoming known to the programme. We only achieve that with 61.4 per cent of those women. The other challenge is, we should be rescreening women within 27 months. We have fallen short somewhat because of a significant shortage of radiographers right across the country,” said Dr O’Doherty.

The programme has received an embargo derogation and it has been allowed to recruit. The target is to recruit 16 radiographers and eight of these have been recruited so far. “I wouldn’t like to give the impression that it’s all ‘happy days’ but we have been allowed to recruit and that is a big start. Hopefully if we manage to recruit enough radiographers, we will manage to catch up on that,” Dr O’Doherty said.

Women do not come for screening as readily as the programme would like. Yet those who come once for screening almost inevitably come back every two years.

Greater challenge

Getting people who are invited for the first time to come is a greater challenge and a major effort is underway in this regard. “There is a much better prognosis if we can pick it up early,” Dr O’Doherty said.

The focus is on the group most affected: women invited for the first time, aged between 50 and 52. This is also a bigger issue in areas of social deprivation.

The programme does a lot of work on the ground with practice nurses and GPs. “We desperately need to get women, when they are invited for the first time. If women come once, we are confident they will be happy with the service and will come back every two years,” Dr O’Doherty said. “If women do not come the very first time, they tend not to come later.”

A lot of research has been carried out on why women do not present and the fear factor is significant. “We need to ensure women know the outlook is so much better if breast cancer is detected early, when it is smaller and less likely to have nodes,” said Dr O’Doherty.

There are four BreastCheck centres in the country. One is on the St Vincent’s campus, one is on the Mater campus, one is in Cork and another is in Galway.

A significant amount of screening is done in static centres. The St Vincent’s BreastCheck centre, for example, is completely separate from the hospital and mobile vans go to locations such as Loughlinstown, Kildare, Wexford and Wicklow.

“We go to a safe environment such as the cancer support service in Portlaoise, because these are expensive pieces of kit. Sometimes these are hospitals. Women quite like going to mobiles. They are quick and efficient,” said Dr O’Doherty.

92 per cent are normal

After women have had a mammogram and these have been read, 92 per cent of women get a letter saying they are normal, within two weeks. If they are abnormal, women come back for assessment. Women who are called back for assessment have a 20 per cent chance of being diagnosed with breast cancer.

If there is something worrying at assessment, a biopsy is done the same day and the case is discussed at the multidisciplinary team meeting. If the patient has cancer, surgery is organised. Treatment is thereafter hospital-centred.

There is a charter which says that women with breast cancer have to be operated on within three weeks of being told they need surgery.

Meanwhile, CervicalCheck, the National Cervical Screening Programme, has reminded women aged 25-to-60 how important it is to have their smear test.

In particular, women aged 50 and over are encouraged to ensure they are up-to-date with their free smear test — a lower proportion of women in this age range attend for cervical screening.  Cervical cancer is a risk for these women and a free regular smear test is “a woman’s best protection against cervical cancer”, the programme said.

1.3m smear tests

In the first four years since the programme launched in September, 2008, almost 1.3 million smear tests were processed and more than 805,000 eligible women aged 25-to-60 have had at least one CervicalCheck smear test.

Women aged 25-to-60 should have a smear test every three-to-five years, depending on their age. CervicalCheck provides free smear tests and women have a choice of more than 4,600 male and female smear-takers nationwide.

GPs, practice nurses, family planning, women’s health and Well Woman Clinics all over Ireland are registered to provide free smear tests.

CervicalCheck writes to women who have already had a CervicalCheck smear test, informing them when the next smear test is due.

If a woman has not already had a free smear test, an invitation letter is not needed to register with CervicalCheck.  To arrange a smear test, an appointment is made with a registered smear-taker of the woman’s choice.

A smear test can pick up cell changes in the cervix.  If these cell changes are not found and treated, over time they can turn into cancer cells. A CervicalCheck smear test is a simple procedure that takes minutes, Dr Doherty added.

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