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Cervical cancer scandal is likely to be worse than we are being told

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WHENEVER there appears to be an emerging scandal in NHS Scotland it will inevitably be fulminant. Such is the secrecy that clouds everything the SNP touches public relations silence is no exception. Rather like pulling couch grass, it is more revealing how far it has spread than how unsightly it first appears.

I say couch grass but I could easily use cancer as an example, spreading insidiously throughout the body until a lump, a bump or a pain becomes the tip of a lethal iceberg. We have been here so many times, such as the baby ashes scandal or the lying of NHS Lothian fifty times about waiting lists falling, when in fact they were rising.

Such deceit simply has to be factored in, rather like nuclear safety in Japan or Russia, any safety issue in NHS Scotland will be lied about until every possible lie has been disproven. So, with the latest emerging scandal of bodged cervical cancer screening, we are about to start another round of pulling at the couch grass.

A propos of nothing, the women’s health minister has informed the Scottish Parliament something serious has happened that first emerged in December 2020. That means that after six months the issue cannot be covered up any longer. Maybe the family of the woman reported to have died from cervical cancer post partial hysterectomy is about to litigate, maybe the scandal is about to mushroom. Before we speculate further, let us look at the background to this worrying event.

Cervical cancer is a lethal disease. It starts deep in the body, in the cervix and spreads quickly to lumps of tissue called lymph nodes. There are many around the cervix because the blood supply of the female pelvis is rich, so the flow of cells from any tumour is high. This early spread to nodes and the nature of the cancer cells means this is a very difficult disease to treat once established.

This is why screening is acceptable and routine even though it is uncomfortable. The reason this discomfort and NHS cost is tolerated is the considerable gain in life and chance of cure from early detection. Screening picks up both early signs of cancer, so called CIN and also stray cancer cells. This is crucial because,

“Any delay in cervical cancer screening increases the risk of a woman dying or shortening her life. That delay may be clinical or political”

This is why even 6 months delay of missed screenings from December to now is devastating and utterly unacceptable. I can see how this played out. A clinical audit picked up in one health board that the screening programme had missed women who had had a partial (subtotal) hysterectomy and had done so since 1997.

This is incredible. All women of 25-64 are invited for cervical screening unless excluded. The recent transgender campaigning makes this needlessly complex because now they are are classified as persons with a cervix. Here is one obvious issue for the future, how do you define someone as having a cervix? You either check EVERY hysterectomy record and cross it against those who identify with women, or you simply invite patients who were born female.

Luckily this is a very recent phenomenom. More important is that women will have been taken off recall lists because people assumed those with a subtotal hysterectomy did not need a cervical smear. This is catastrophic and like so many things, once records are entered incorrectly, it is often only adverse events that identifies this.

The very fact a systemic error happened in one health board must have raised the question,

“Why has this happened here and nowhere else?”

The health secretary cites a wish to avoid undue alarm at raising the issue earlier but what qualification allows Marie Todd to make this call? The alarm is not undue if the findings of a report are indeed alarming. That’s justified alarm!

We must know the clinical and legal advice sought and received in choosing not to alert the public or at least general practice to this systemic failing. 

Something else emerges. Are we to believe that no other deaths from cervical cancer occured in women with subtotal hysterectomies?

This must now be audited immediately by auditing all cervical cancer deaths against the records of subtotal hysterectomies. 

It’s intriguing that this was never flagged up at a managed clinical network for women’s cancers. I find this the most alarming part really. We know that natural curiosity is not a strong suit of nationalists but it should have been for clinicians.

There was nothing stopping changes being made to the screening programme the moment the December report came in. If that was not done across Scotland that is unforgiveable because it adds to the number of women at risk and in fear. It would have been the first and most obvious remedial action.

Returning to the couch grass issue, I am aware of concerns raising privately about screening accuracy in Ireland and in England. It would be an ideal time not only to deal with this immediate failing but to suggest, perhaps, there is more couch grass waiting to pulled.

Where screenings have returned normal tests in those who went on to develop cancer the minimum is these results now receive a second look to see if they really were normal (sadly this happens) or if in fact diagnoses were missed. 

This is where surgery and politics are so different. With any point failure in the cancer management track the politician will try and fix the bolt and the surgeon will order the whole track inspected because bolts rarely fail in isolation if well maintained. We call such “broken bolts” herald signs in surgery.

It is likely I believe this failure in one part of the screening programme is a ‘herald sign’ and demands scrupulous, clinical audit without any attempt by politicians to delay it, which would be as absurd as trying to bury a live wire in the rain. What you can’t see only surprises you more when it shocks you.

Anyone serious about women’s health must assume this failure to act quickly is not only grossly negligent but also the tip of an iceberg until proven otherwise.

Who is the most experienced health secretary in Holyrood?

Over to you Nicola. This is leadership, away and crack on with it. It demands such special and immediate attention while Covid-19 rages on. Couch grass grows when it isn’t pulled.

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