Smear Test Scandal

jluv · 03-05-2018 08:00PM

iamwhoiam wrote: »

Thank you very much . I was confused if they knew her 2011 smear test was a false negative before her 2014 symptoms .

Sorry I'm only adding to your confusion!!! Checked back and it seems the 2011 was negative. In 2014 abnormalities were observed but she wasn't told till 2017. So I'm confused now too..as in 2014 she was diagnosed with cervical cancer..I was of no help at all

jluv · 03-05-2018 08:02PM

tretorn wrote: »

As I understand it though her test was re examined after she developed cervical cancer, this is normal in all cases where a woman develops cervical cancer after getting the all clear.

No one hid the fact that the cancer had been missed between 2011 and 2014, no one was aware it had been missed until she developed cancer of the cervix. I really dont believe any health board official would hide the fact that someones test was incorrect, they would immediately contact the person and do another smear test and then if a treatment plan was needed the patient would be looked after properly.

I could have a colonoscopy now and be told I am cancer free. I can continue on with my life but develop bowel cancer within six months.If someone was to review the colonoscopy results they may find there was cancer, this doesnt mean anyone is responsible for giving me cancer and I have to accept that humans make errors and some errors cost people their lives.

Is this not basically what happened here.

Yeah Tretorn,I got it wrong..apologies

iamwhoiam · 03-05-2018 08:03PM

jluv wrote: »

Sorry I'm only adding to your confusion!!! Checked back and it seems the 2011 was negative. In 2014 abnormalities were observed but she wasn't told till 2017. So I'm confused now too..as in 2014 she was diagnosed with cervical cancer..I was of no help at all

Oh . Now I am getting more confused . I will go see if I can figure it out

McCrack · 03-05-2018 08:09PM

tretorn wrote: »

As I understand it though her test was re examined after she developed cervical cancer, this is normal in all cases where a woman develops cervical cancer after getting the all clear.

No one hid the fact that the cancer had been missed between 2011 and 2014, no one was aware it had been missed until she developed cancer of the cervix. I really dont believe any health board official would hide the fact that someones test was incorrect, they would immediately contact the person and do another smear test and then if a treatment plan was needed the patient would be looked after properly.

I could have a colonoscopy now and be told I am cancer free. I can continue on with my life but develop bowel cancer within six months.If someone was to review the colonoscopy results they may find there was cancer, this doesnt mean anyone is responsible for giving me cancer and I have to accept that humans make errors and some errors cost people their lives.

Is this not basically what happened here.

Yes however if the 2011 smear was read correctly pre cancerous cells would have been identified and she would have had further diagnostic testing and commenced treatment with an excellent prognosis

Instead her treatment was delayed until the second smear in 2014 and sadly it seems her prognosis is terminal

iamwhoiam · 03-05-2018 08:11PM

http://www.thejournal.ie

jluv · 03-05-2018 08:18PM

IawIam...yeah I found a Journal account of the timeline too..
2011-clear
2014-audit of 2011 smear
2014-had second smear which showed possibilty of cervical cancer.
2016- Vickys doctor informed of false positive from 2011
2017-Vicky informed of false negative

iamwhoiam · 03-05-2018 08:25PM

jluv wrote: »

IawIam...yeah I found a Journal account of the timeline too..
2011-clear
2014-audit of 2011 smear
2014-had second smear which showed possibilty of cervical cancer.
2016- Vickys doctor informed of false positive from 2011
2017-Vicky informed of false negative

Correction just to be precise

2016 : Vickys doctor informed of false negative from 2011

And I presume her 2014 positive result led them to review the 2011 smear test result . It was reviewed due to her diagnosis in 2014 ?

jluv · 03-05-2018 08:36PM

iamwhoiam wrote: »

Correction just to be precise

2016 : Vickys doctor informed of false negative from 2011

And I presume her 2014 positive result led them to review the 2011 smear test result . It was reviewed due to her diagnosis in 2014 ?

Thank you..yes should have read false negative..
Now only from the Journal it reads more that the review of the 2011 smear and her having a second smear in 2014 which showed possible cancer were not connected.

iamwhoiam · 03-05-2018 08:45PM

jluv wrote: »

Thank you..yes should have read false negative..
Now only from the Journal it reads more that the review of the 2011 smear and her having a second smear in 2014 which showed possible cancer were not connected.

I think her diagnosis of cervical tumour ( she attended a doctor due to symptoms) led them to review her previous 2011 result . I don't think it was random but I could be wrong

Roger_007 · 03-05-2018 10:05PM

In the fallout from the current scandal, I presume that we can expect a flood of claims arising from errors in other mass screening programs such as Breast Check and the bowel screening program. Mass screening is never 100% effective and human error is inevitable.
The HSE are also storing up trouble for themselves in the way they are promoting the HPV vaccine - they are advertising it as protection from cervical cancer whereas, at best, it just reduces the risk.

laserlad2010 · 03-05-2018 10:17PM

McCrack wrote: »

Yes however if the 2011 smear was read correctly pre cancerous cells would have been identified and she would have had further diagnostic testing and commenced treatment with an excellent prognosis

Instead her treatment was delayed until the second smear in 2014 and sadly it seems her prognosis is terminal

What people fail to understand is that the false negative is expected. She was one of the people that screening misses, because screening is not perfect. It's not intended to be. In fact, absolutely no test anywhere is 100% accurate.

jluv · 03-05-2018 10:46PM

laserlad2010 wrote: »

What people fail to understand is that the false negative is expected. She was one of the people that screening misses, because screening is not perfect. It's not intended to be. In fact, absolutely no test anywhere is 100% accurate.

Understood..but if the review in 2014 saw inaccuracy,why was she not informed of this till 2017?

kirving · 03-05-2018 11:01PM

I can understand the false negative results, it's part and parcel of high volume testing. That's fine.

I don't understand how you can accept results as accurate when they statistically don't match with the prior testing by a third.

What I absolutely cannot get my head around though is that there is no obligation on the doctor to tell the patient about a diagnosis.

And the reaction from the NCCP, HSE and Government has been utterly appalling.

I work in a company that makes millions of parts every year, and every single one is tested literally dozens of times by computer. Mistakes happen. It's the REACTION to the mistakes which is important. When an error is found, you own up immediately to the customer, drop everything and don't stop working until it is fixed. Nothing less is acceptable in industry.

The HSE et al have as far as I can see, failed at every hurdle in the process to right the failures, and doubled down all the way to the high court to cover it up.

Absolutely disgraceful behaviour from people who are supposed to be working for us. This country owes a great deal to Vicky Phelan's bravery.

bekker · 03-05-2018 11:15PM

It appears from previous posts and reports in the media that there are generally held major misconceptions about the nature of screening programmes.

Why do so many women appear to believe that a screening test is a diagnostic test?

Why, if newspaper reports are accurate, does a least one GP believe that a previous negative smear result obviates the need for further diagnostic tests when other indicators of a potential cancer are present. Is this is the potentially a fatal misstep by a lone GP, or is an attitude more commonly held by GPs?

tretorn · 03-05-2018 11:16PM

Kevin Irving wrote: »

I can understand the false negative results, it's part and parcel of high volume testing. That's fine.

I don't understand how you can accept results as accurate when they statistically don't match with the prior testing by a third.

What I absolutely cannot get my head around though is that there is no obligation on the doctor to tell the patient about a diagnosis.

And the reaction from the NCCP, HSE and Government has been utterly appalling.

I work in a company that makes millions of parts every year, and every single one is tested literally dozens of times by computer. Mistakes happen. It's the REACTION to the mistakes which is important. When an error is found, you own up immediately to the customer, drop everything and don't stop working until it is fixed. Nothing less is acceptable in industry.

The HSE et al have as far as I can see, failed at every hurdle in the process to right the failures, and doubled down all the way to the high court to cover it up.

Absolutely disgraceful behaviour from people who are supposed to be working for us. This country owes a great deal to Vicky Phelan's bravery.

The Hse isnt at fault though, it was lab in the States who misread the test.

The media have terrified the whole country and really clarification is needed.

No one knew the test results were incorrect until Ms Phelan developed symtoms of cancer and went to the doctor. She had another smear and probably a more invasive examination and the cancer was found. It was at this point the 2011 test was rechecked and early signs of cancer were there.

No one knows why Ms Phelan wasnt informed but whether she was informed or not it would have made no difference to her treatment.

If the lab had tested her sample properly and found the cancer in 2011 she may have been cured. Cancer is a vicious horrible disease though so there is no way of knowing for sure whether treatment would have eradicated the cancer. There is no way of knowing either how the cancer Ms Phelan has will progress either, many people get very poor odds and live much longer in spite of it.

JP Liz V1 · 03-05-2018 11:24PM

Am I right in saying HSE's Tony O’Brien is "mates" with Leo Varadkar hence no action taken by Leo *coughs* wanna take a selfie or picture of me at even the opening of an envelope :rolleyes:

These poor women and well done Mrs. Phelan was speaking out

Pretzill · 03-05-2018 11:26PM

I can understand that screening is not foolproof. I can also see that mass screening can be revolutionary in keeping tabs on the health of the nation. But what I don't understand, what is plainly wrong is finding a problem and not reporting it (for whatever reason false negative/positive et Al) the fault lies in not mentioning it either to the patient or the gp and worse still, stating all is clear and there is no need to have a check for three may be even five years.

Enough time for the patient to believe nothing is wrong, enough time for a silent cancer to grow to terminal, no going back proportions.

Screening is there to check preventable, early curable cancer not to propagate it!

This is appalling an absolute disaster for many women and imo there should be accountability.

gctest50 · 03-05-2018 11:42PM

tretorn wrote: »

.........

The Hse isnt at fault though,

..

They couldn't be more at fault if they tried :

Who did Dr. Gibbons and the scientists voice their concerns to ?

The office cat ?

Dr Gibbons also said he and a group of "very well-qualified scientists" resigned after their concerns were allegedly dismissed.

Dr Gibbons said tests were outsourced to laboratories in the US and he expressed concern about the figures they received back.

"They were predicting fewer pre-cancer cases in a batch of similar population size to us.

"We were finding 1.8 cases per 100, they were finding 1.2.

"This was a third of a difference"

daithi1970 · 03-05-2018 11:50PM

laserlad2010 wrote: »

What people fail to understand is that the false negative is expected. She was one of the people that screening misses, because screening is not perfect. It's not intended to be. In fact, absolutely no test anywhere is 100% accurate.

On the other hand, if the screening was done according to the previous Irish/British guidelines, (i.e., 15 minutes per slide) would the abnormality have been detected? Certainly Vicky Phelan seems to think so.

kirving · 03-05-2018 11:53PM

tretorn wrote: »

The Hse isnt at fault though, it was lab in the States who misread the test.

No, the lab in the US was the Root Cause, but the HSE outsourced the test, supposedly validated it's accuracy, and rolled it out. The statistical error was known about, and ignored is seems.

We were finding 1.8 cases per 100, they were finding 1.2.

Link below.

As I said in the post, it's the reaction that's key here, and the HSE have made a dismal job of it. Not telling patients is unforgivable in my view, and serves only to protect the HSE from admitting their errors.

tretorn wrote: »

The media have terrified the whole country and really clarification is needed.

The HSE screwed up, and fought the patient all the way. The media are rightly piling on the pressure.

tretorn wrote: »

No one knew the test results were incorrect until Ms Phelan developed symtoms of cancer and went to the doctor. She had another smear and probably a more invasive examination and the cancer was found. It was at this point the 2011 test was rechecked and early signs of cancer were there.

It was known that based on a statistical average, 30% of cases were not being identified.

https://www.independent.ie/irish-news/health/doctor-predicted-cervical-smear-test-issues-10-years-ago-36858027.html

tretorn wrote: »

No one knows why Ms Phelan wasnt informed but whether she was informed or not it would have made no difference to her treatment.

I can hazard a guess. Noone wanted to admit to a mistake. It's a big statement to say it would have made no difference. Do her medical records state this?

tretorn wrote: »

If the lab had tested her sample properly and found the cancer in 2011 she may have been cured. Cancer is a vicious horrible disease though so there is no way of knowing for sure whether treatment would have eradicated the cancer. There is no way of knowing either how the cancer Ms Phelan has will progress either, many people get very poor odds and live much longer in spite of it.

It is a horrible disease, and there may be no way to know for sure, but that's not some type of get out jail free card.

If you're doing 150kph and a child runs out in front of you and you kill them, you'll be put in prison. They child almost certainly would have died had you been doing 120kph, but that doesn't matter. The outcome may be the same, but you'll be prosecuted for it.

daithi1970 · 04-05-2018 12:05AM

..one might wonder what Mary Harney would make of it, seeing as how she was one of the primary movers in the outsourcing of the Cytology service in the first place..

Ipso · 04-05-2018 12:12AM

Kevin Irving wrote: »

No, the lab in the US was the Root Cause, but the HSE outsourced the test, supposedly validated it's accuracy, and rolled it out. The statistical error was known about, and ignored is seems.

Link below.

As I said in the post, it's the reaction that's key here, and the HSE have made a dismal job of it. Not telling patients is unforgivable in my view, and serves only to protect the HSE from admitting their errors.

The HSE screwed up, and fought the patient all the way. The media are rightly piling on the pressure.

It was known that based on a statistical average, 30% of cases were not being identified.

https://www.independent.ie/irish-news/health/doctor-predicted-cervical-smear-test-issues-10-years-ago-36858027.html

I can hazard a guess. Noone wanted to admit to a mistake. It's a big statement to say it would have made no difference. Do her medical records state this?

It is a horrible disease, and there may be no way to know for sure, but that's not some type of get out jail free card.

If you're doing 150kph and a child runs out in front of you and you kill them, you'll be put in prison. They child almost certainly would have died had you been doing 120kph, but that doesn't matter. The outcome may be the same, but you'll be prosecuted for it.

As always in Ireland, no one is held accountable and someone who most likely got their well paying job via who they know will still walk away with a nice pension.

_Whimsical_ · 04-05-2018 12:21AM

Did anyone else see Prime Time tonight?

It featured a man from either the HSE or the Dept of health quoting the sensitivity of cytology testing in US labs as being between 65% and 70%, ie 35 - 30% of tests produce a false negative.

In the next breath he said that meant that less than 1 in a hundred women with a negative test were receiving an inaccurate result.

Anyone know how that math works out?

To me that would suggest as high as 3.5 women out of 10 are receiving an inaccurate result.
I'd be delighted to be wrong though!

iamwhoiam · 04-05-2018 09:58AM

Ipso wrote: »

As always in Ireland, no one is held accountable and someone who most likely got their well paying job via who they know will still walk away with a nice pension.

And that is the most agitating and upsetting part of all these scandals .NO one is held accountable for anything

jmayo · 04-05-2018 11:59AM

Squatter wrote: »

I wasn't referring specifically to "this woman" I was responding to the general point that marzic had made.

Fair enough.

tretorn wrote: »

The Hse isnt at fault though, it was lab in the States who misread the test.

The media have terrified the whole country and really clarification is needed.

Let me guess you work in HSE as admin or manager. :rolleyes:

As gctest quite rightly points out huge concerns were raised by qualified individuals about using the American lab(s) and they were summarily dismissed and the HSE ploughed ahead.

And then the HSE did not inform the patient of the failed test, dragged a terminally ill poor woman into court and then when they saw the writing on the wall they folded like a cheap suit.

So dont' try and pedal some shyte the HSE are not at fault.

And this is only one of many cases.

gctest50 wrote: »

They couldn't be more at fault if they tried :

Who did Dr. Gibbons and the scientists voice their concerns to ?

The office cat ?

Exactly the point.

Kevin Irving wrote: »

And the reaction from the NCCP, HSE and Government has been utterly appalling.

I work in a company that makes millions of parts every year, and every single one is tested literally dozens of times by computer. Mistakes happen. It's the REACTION to the mistakes which is important. When an error is found, you own up immediately to the customer, drop everything and don't stop working until it is fixed. Nothing less is acceptable in industry.

The HSE et al have as far as I can see, failed at every hurdle in the process to right the failures, and doubled down all the way to the high court to cover it up.

Absolutely disgraceful behaviour from people who are supposed to be working for us. This country owes a great deal to Vicky Phelan's bravery.

100% agree.

It almost looked like they adopted the Ford approach to this crisis when they found out something was wrong.
Lets bury it and if there are legal actions then we can try cover them up.

daithi1970 wrote: »

..one might wonder what Mary Harney would make of it, seeing as how she was one of the primary movers in the outsourcing of the Cytology service in the first place..

That fooker should have been strung up long ago, together with all the other ministers for health that have had something to do with the creation and propagation of the HSE.

Just remember come next election mehole martin was the guy in charge when the whole sorry mess was created and leo the great was in that department as well.

iamwhoiam wrote: »

And that is the most agitating and upsetting part of all these scandals .NO one is held accountable for anything

I have to say it is a good thing we are a mild mannered crowd because if this was done in some countries the individuals responsible could be facing someone going postal.

Amirani · 04-05-2018 12:11PM

JP Liz V1 wrote: »

Am I right in saying HSE's Tony O’Brien is "mates" with Leo Varadkar hence no action taken by Leo *coughs* wanna take a selfie or picture of me at even the opening of an envelope :rolleyes:

These poor women and well done Mrs. Phelan was speaking out

No, you're not right. They actually don't like each other by all accounts and had many run-ins while Varadkar was in the Department of Health by all accounts. There's no action being taken because the level of his responsibility is currently unclear and he's also leaving in a couple of months anyway.

Amirani · 04-05-2018 12:23PM

_Whimsical_ wrote: »

Did anyone else see Prime Time tonight?

It featured a man from either the HSE or the Dept of health quoting the sensitivity of cytology testing in US labs as being between 65% and 70%, ie 35 - 30% of tests produce a false negative.

In the next breath he said that meant that less than 1 in a hundred women with a negative test were receiving an inaccurate result.

Anyone know how that math works out?

To me that would suggest as high as 3.5 women out of 10 are receiving an inaccurate result.
I'd be delighted to be wrong though!

The sensitivity of the test refers to its ability to correctly identify the disease in patients who actually HAVE it. So a sensitivity of 70% would suggest that out of every 10 people who have the disease, 7 would be correctly identified and 3 would be false negatives.

However, the majority of women who are tested DON'T HAVE the disease. So it's not appropriate to apply the sensitivity to these people. Most women who get the test will correctly get a true negative (there will be some false positives).

Overall, the most likely result is a correct true negative.

daithi1970 · 04-05-2018 06:54PM

Amirani wrote: »

The sensitivity of the test refers to its ability to correctly identify the disease in patients who actually HAVE it. So a sensitivity of 70% would suggest that out of every 10 people who have the disease, 7 would be correctly identified and 3 would be false negatives.

However, the majority of women who are tested DON'T HAVE the disease. So it's not appropriate to apply the sensitivity to these people. Most women who get the test will correctly get a true negative (there will be some false positives).

Overall, the most likely result is a correct true negative.

most likely, they have confused sensitivity with specificity- the latter being the rate of correctly identified negatives. In the context of screening tests, specificity is more important than sensitivity...you have to be able to correctly
report negative results when negative is the correct answer.. ie if a test has a 95% specificity rate, 95 % of all negative results are regarded as being correct.

iamwhoiam · 07-05-2018 12:59PM

https://www.breakingnews.ie/ireland/vicky-phelans-daughter-amelia-meets-idol-ed-sheeran-after-cork-gig-841386.html

What a lovely moment for Vicky and her daughter . Every precious minute must be fabulous for Vicky

pitifulgod · 07-05-2018 01:04PM

tretorn wrote: »

The Hse isnt at fault though, it was lab in the States who misread the test.

The media have terrified the whole country and really clarification is needed.

No one knew the test results were incorrect until Ms Phelan developed symtoms of cancer and went to the doctor. She had another smear and probably a more invasive examination and the cancer was found. It was at this point the 2011 test was rechecked and early signs of cancer were there.

No one knows why Ms Phelan wasnt informed but whether she was informed or not it would have made no difference to her treatment.

If the lab had tested her sample properly and found the cancer in 2011 she may have been cured. Cancer is a vicious horrible disease though so there is no way of knowing for sure whether treatment would have eradicated the cancer. There is no way of knowing either how the cancer Ms Phelan has will progress either, many people get very poor odds and live much longer in spite of it.

The lab in the states wasn't an issue, the margin of error wouldn't cause an issue in the case of annual tests as they're conducted in US. The HSE were warned about the error rate.

Smear Test Scandal

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