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The impact of the CervicalCheck controversy on provision of colposcopy services in Ireland: a cohort study
  • Maria Cheung,
  • M. Fitzpatrick
Maria Cheung
National Maternity Hospital

Corresponding Author:[email protected]

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M. Fitzpatrick
National Maternity Hospital
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Abstract

Objective: In 2018, an inquiry into the Irish cervical cancer screening programme attracted widespread media coverage, resulting in anxiety about the quality of the screening programme. We investigated whether the controversy led to an increase in referrals based on clinical suspicion and the impact on waiting times for abnormal cytology. Design: A retrospective cross-sectional analysis was performed. Setting: Department of Colposcopy, National Maternity Hospital, Dublin, Ireland. Population or Sample: All colposcopy referrals before (March 2016 - 2018) and after (March 2018 - 2020) the media coverage. Methods: Chi-squared (χ2) and independent one-tailed t-tests were used to perform between-group analyses. Main Outcome Measures: Suspicious-appearing cervix referrals, colposcopic impression and histological diagnosis of these referrals, waiting time for abnormal cytology referrals. Results: Post-controversy, suspicious cervix referrals increased (10.1% to 14.2%; p=0.037x10-27), as did colposcopic impression of CIN (p=0.000000016). While an increase in CIN1 histology (18.5% to 30.3%) was diagnosed, a decrease in high-risk CIN2 (10% to 8.6%), CIN3 (6.2% to 2.9%), AIS (1.2% to 0.3%) and invasive cancer (2.8% to 1.2%; p=0.0058 x 10-9) were diagnosed. Across all grades of cytological abnormality, significantly fewer patients were reviewed in the recommended waiting time post-controversy. Half of delayed abnormal cytology referrals had high-grade changes. Conclusions: Heightened anxiety and increased surveillance does not necessarily lead to better clinical outcomes for patients but can result in unnecessary distress for low-risk patients and delays to diagnosis for high-risk patients with concerning abnormalities. Funding: None Keywords: cervical cancer screening, CervicalCheck, scandal, controversy, media, colposcopy.