According to the HSE, all screening for Breast and Cervical Cancers was suspended because of the Coronavirus on March 30th. That’s five weeks ago.
In Ireland, there are approximately 3,100 new cases of Breast cancer every single year. Using simple maths, therefore, you would expect there to be something like 62 new cases of Breast Cancer (assuming testing goes on for about 50 weeks of the year normally) detected every single week. Or 310 over a 5 week period.
Just because you suspend testing, of course, doesn’t mean that there are no new cases of Breast Cancer. What it means is that new cases become more difficult to detect, and in many cases are not detected at all.
And with Breast Cancer, early detection is essential:
Early detection of breast cancer is important as it is associated with an increased number of available treatment options, increased survival, and improved quality of life. While there is no definitive method of preventing breast cancer, early detection provides the best chance of effective treatment. However, while early detection of breast cancer can help improve outcomes, there are also risks involved with any screening program. These include the chance that a false positive or false negative diagnosis can be made. When undergoing any screening test, the risks and benefits of that test should be considered.
Screening mammography is the best early detection method for reducing the number of deaths associated with breast cancer (as outlined by current evidence). Mammography is generally not undertaken in patients under 40 years of age (as age is the largest risk factor for breast cancer), however women older than 40 should have mammograms every two years.
When doctors talk about the risk of people dying from other conditions due to the shutdown, this is exactly the kind of thing that they mean. We cannot say for certain, but it is a very reasonable assumption that there are something like 300 women in Ireland with Breast Cancer who will not find out that they have it until much later than they ordinarily would have. It’s unlikely that will mean that all of those women will die, but it’s also not a stretch to think that some of them, ultimately, will.
And it’s a similar story with the cervical screening.
Shutting down the screening services five weeks ago isn’t something we should be angry about. The desire to protect health workers, and keep the number of people in hospital and medical facilities down, was perfectly understandable and correct. Indeed, outpatient services across the whole spectrum were suspended for that reason. It’s not a case of Government negligence or bad policy.
But it is, surely, time to re-start those services as soon as possible. And to integrate them into the case being made to the public for a limited re-opening of the economy and a limited return to something approximating normal life.
The problem the Government has, of course, is differentiating between essential and non-essential services in the public mind. For example, it’s absolutely vital that people are able to access outpatient services like breast screening in hospitals. It’s probably less essential that people are allowed go to the beach. But convincing the public of that is another matter.
The problem is psychological – if you announce any easing of restrictions at all, people will assume that the worst is over and it’s okay to resume everyday, normal, activities. It’s a bit like how a football team leading 3-0 with ten minutes to go will sometimes go to sleep and end up winning 3-2, or not winning at all. Complacency setting in is a major danger.
It’s very important that we re-open essential services like Breastcheck.
But it’s also very important that the rest of us remember this:
I don't know who to credit for this but it's floating around and it's very good. pic.twitter.com/RhWLfMmclX
— John McGuirk (@john_mcguirk) May 10, 2020