Patricia Fitzpatrick

Identifying barriers and facilitators to participation in cancer screening among Irish Travellers, a minority ethnic group in Ireland, using a codesigned approach

Introduction This study sought to determine participation by eligible Irish Travellers, a minority ethnic group, in the cancer screening programmes in Ireland (bowel, breast and cervical screening) and to determine barriers/facilitators to screening. Methodology This study was co-designed with the National Cancer Control Programme (NCCP) and Pavee Point Traveller and Roma Centre, Ireland. A survey questionnaire, adapted from the NCCP's 2022 National Survey on Cancer Awareness, was disseminated to Travellers via Traveller Community Health Workers (TCHWs). Results A total of 574 survey questionnaires were distributed across 12 different Primary Health Care Traveller Projects in the Republic of Ireland and 483 (84%) were returned completed; 148 (30.6%) were from men and 306 (63.1%) from women (6.3%, missing data). High proportions had ever attended breast (72.6%) and cervical (65.4%) screening. Bowel screening uptake was low in both men (12.5%) and women (19.2%). Low proportions recalled receiving an invitation to programmes. The faecal immunochemical test test used in the BowelScreen programme prompted embarrassment as a barrier in eligible men (62.5%); embarrassment was lower in women for bowel (38.5%), breast (32.9%) and cervical (30.4%) screening. Fear was the second highest barrier. The main facilitators of screening attendance were talking to TCHW and an invitation respectively, particularly in women eligible for bowel (50%; 53.8%), breast (49.3%; 50.7%) and cervical screening (47.6%; 48.2%), but lower in men (25%; 37.5%); 25% cited the family doctor as facilitator. Conclusion Travellers face barriers accessing mainstream health services; easy access to screening must be ensured . The TCHW is a key facilitator. There is a need for universal ethnic identifiers to facilitate routine monitoring of participation and outcomes for Travellers in screening.

Interval cancer audit and disclosure in cervical screening programmes: An international survey

Background Legal cases involving the National Cervical Screening Programme in Ireland following non-disclosure of an interval cervical cancer audit prompted this first international comparative survey of interval cervical cancer audit. Methods A survey of 22 international population-based cervical screening programmes was conducted, to determine if they undertook audit of invasive cervical cancers. Those countries/regions that perform reviews were asked (i) how the audit was undertaken, including how the reviews were performed and how they controlled for retrospective bias, (ii) how women are informed of the audit process and how their consent is obtained, and (iii) how audit results were disclosed to patients. Results Seventeen countries/regions invited completed the survey (77%); 65% (11/17) have an audit process for interval cervical cancers. Five perform individual patient reviews; three perform programme-wide review, with calculation of interval cancer detection rates; one routinely performs programme-wide review with calculation of interval cancer detection rates and offers individual reviews, and one routinely performs local hospital-level reviews. In the remaining country/region, hospital laboratories audit cancers, with a national audit process for all cervical cancers. Varying methodologies for retrospective cytology review were employed; four include control samples, with a ratio varying from 1:1 to 1:2. Three conduct a blinded review. Most countries/regions do not discuss interval cancer audit with participants and 3/11 (27.3%) inform women when a cervical cancer audit takes place. Disclosure is limited and variable. Conclusion The responses suggest that there is no consistent approach to audit of interval cervical cancers or to disclosure of audit results.

Interval cancer audit and disclosure in breast screening programmes: An international survey

Objective and Setting Accurate monitoring of interval cancers is important both for quality improvement and education and is a key parameter of breast screening quality assurance. Issues in relation to communication regarding interval cervical cancer in the Irish cervical screening programme were found, prompting interval cancer process review in all cancer screening programmes. An international survey to examine international consensus on interval breast cancer audit processes was conducted to inform Irish processes. Methods A survey of 24 international population-based breast screening programmes was done to determine which undertook audit of interval breast cancer; if yes, they were asked (1) how they undertake audit, (2) if they obtain individual consent for audit and inform women of audit results, and (3) if disclosure of audit results occurs. Results Response was 71% (17/24). Of these, 71% (12/17) have a programmatic audit process to calculate the interval cancer rate (ICR). Of these, ten also carry out radiological reviews, three using a blinded review. Two inform patients that audit is taking place; two provide choice to be in the audit; nine state that routine screening consent covers audit. For two of the five that have an open disclosure policy for medical incidents, this policy applies to screening interval cancers. One other country/region has an open disclosure policy for category 3 interval cancers only. Five have legal protection for interval cancers arising in the screened population. Conclusion While consistency in providing aggregate programmatic audits exists, there is no consistent approach to individual interval cancer reviews or results disclosure.

The effect of HPV vaccination on the rate of high-grade cytology in 25-year-old women attending cervical screening in Ireland

Abstract Introduction Women vaccinated through the initial catch-up HPV vaccination programme (2011/12 to 2013/14) first became eligible for cervical screening in 2019 at age 25. This study aims to examine the changes in detection of HG cytology outcomes in 25-year-olds screened from 2010 to 2022 compared to population data on HPV vaccination in this group. Methods This was an ecological-type study. Cytology results from the CervicalCheck database from 2010 to 2022 (High Grade, Low Grade, and No Abnormality Detected) were plotted against data from the National Immunisation Office on the uptake of HPV vaccinations in females from 2010 to 2022. Results Vaccination rates in the catch-up programme were lower (44–70%) than for routine HPV immunisation at age 12/13 in 2010/11 (81%). The rate of high-grade cytology in 25-year-olds in 2015–2018 was 3.7% of all cytology tests taken in this age group. For the corresponding period from 2019 to 2022 (when vaccinated women were attending screening), the average percentage of HG cytology in 25-year-olds was 1.5%, representing a significant reduction in HG cytology proportions (p < 0.001). Conclusion This study provides early evidence of the potential impact of HPV vaccination on cervical disease in the Republic of Ireland. Despite lower vaccination uptake in the initial catch-up group, we are seeing early signs of the positive protective effect of HPV vaccination in women at the time of their first cervical screening test. Plans to incorporate individual-level HPV vaccination status for women on the cervical screening register will allow more detailed assessment of the impact of HPV vaccination.

Lack of consensus in calculation of interval cancer rates for cervical cancer screening

AbstractIntroductionIn 2018, nondisclosure of results of retrospective audits of cytology in interval cancers precipitated a crisis in the Irish national cervical screening programme. In response, an Expert Reference Group was convened which recommended a collaborative approach to the development of a new key performance indicator, the interval cancer rate. The Expert Reference Group also recommended that the Irish programme should collaborate with international colleagues to reach consensus on (i) the definition of an interval cervical cancer, (ii) the methodology to calculate the interval cancer rate, and (iii) benchmarking with other international programs. This study was undertaken to determine if a consensus regarding the definition of an interval cervical cancer and the calculation of an interval cancer rate exists.Material and MethodsA web‐based questionnaire was sent to 18 population‐based cervical screening programs. Inclusion criteria involved (1) a national or regional population‐based cervical screening prograe; (2) a country or region with a population ≥population of Ireland; (3) programs located in Europe, Australia, or Canada; (4) programs that had responded to a previously published international survey on the disclosure of retrospective cytology reviews in cervical cancer cases.ResultsThe response rate was nine out of 18. Of nine respondents, six had an agreed definition of interval cervical cancer, and four of these calculated an interval cancer rate. Three programs neither calculated interval cancer rates nor had any guidelines related to this. Of the six with an agreed definition, all respondents defined the numerator as invasive cancers in the screening age group, with four including microinvasive disease. Respondents included cancers diagnosed 3–5 years after the last screening test had been taken. Three respondents also included cancers diagnosed in women up to 3.5 years after they exited the screening program. Countries use different denominators, including (i) per women years, (ii) per number of screens, and (iii) per total cancers in screened population.ConclusionsThere is variation in the parameters used in interval cancer rate calculation. To allow benchmarking of cervical screening program performance, there is a need for consensus on a standardized method of interval cancer definition and interval cancer rate calculation.