Gisborne inquiry prompts calls for stand-alone screening unit

By FRANCESCA MOLD

A stand-alone cervical screening unit which could become part of a national cancer control agency is likely to be set up as the result of a ministerial inquiry.

The Gisborne inquiry into mass under-reporting of cervical smears ended yesterday after a marathon 12 weeks of evidence from women caught up in the health scandal, medical experts and health officials.

The panel must now prepare its report, which will include criticisms and recommendations, by December 20.

It is predicted that the move to a stand-alone screening unit will be among the plethora of recommendations made by the inquiry team.

In the past two weeks, inquiry chair Ailsa Duffy, QC, has questioned representatives of all parties on whether they would support the screening programme being moved from the Ministry of Health into a stand-alone cancer prevention agency.

Her suggestion has received widespread backing from women affected, public health experts, researchers and women's health groups.

In its evidence, the Cancer Society recommended that a national prevention agency be set up with responsibility for the cervical and breast screening programmes, their databases and the Cancer Register.



The call for a new agency follows a Cancer Control workshop last year during which 110 participants agreed that a coordinated approach to cancer prevention was needed.

Medical experts say a new agency is desperately needed if New Zealand's high cancer death rate is to be addressed.

Lawyers representing affected women have stressed the need to move the screening programme away from the ministry because of "grave reservations" about its performance. It is thought the ministry should have input but not be in direct control because of its failure to monitor or evaluate the success and safety of the programme in its 10-year history.

Ms Duffy also consistently expressed interest in the idea of changing the programme's policy so that women enrolling are informed that researchers may use their medical records without obtaining their consent.

A big failing of the programme has been its inability to do in-depth audits of cervical cancer cases to determine whether there have been mistakes made in diagnosis and treatment.

Under existing health legislation, researchers are unable to obtain information identifying women from the screening register without consent. If this obstacle was removed, records could be more easily accessed by researchers monitoring the programme's safety and success. Women who objected to the use of the information without their consent could opt off the register.

Ms Duffy has indicated the report will not focus on blame. But it was possible adverse comment would be made, along with recommendations.

She has carefully questioned the ministry about its failure to evaluate and monitor the national screening programme since its inception.

It has also faced questions about why it failed to implement advice from expert groups set up by the ministry and the length of time it took to make laboratory accreditation compulsory.

In its final submissions, the ministry and Health Funding Authority have asked the panel to take an unemotional, analytical, objective, constructive and balanced approach to its findings.

It said the extensive criticism levelled at the early stages of the programme and failure to detect the Gisborne situation earlier needed to be balanced against its success in reducing cervical cancer rates.

"It is easy to be critical ... with hindsight, but we need to keep in mind that no medical professionals, including pathologists ... rang alarm bells."

The ministry claimed it had chosen not to challenge some evidence given to the inquiry because it would have taken too long and may have damaged relationships with some experts still involved with the programme.


Fighting for a cause

Herald Online feature: Gisborne Cancer Inquiry

Official website of the Inquiry