THERE has been considerable progress in the diagnosis, treatment and prevention of breast cancer in Scotland. Publicity campaigns have encouraged women to look out for the symptoms and increased the number of those coming forward. We are much better informed about the disease than we were. And, most encouragingly of all, the number of women dying has fallen.
But the system designed to spot and treat breast cancer is still some way from where it should be. Survival rates have improved, but Scottish women are still more likely to die within a year of discovering they have the disease than women in mainland Europe. There is also some inconsistency in the treatment of the disease, with women in one part of the country receiving a particular drug or therapy while women elsewhere are denied it.
And now another problem has emerged that means more than 1,600 women who missed out on screening for as many as nine years have still not been checked. The problem first came to light when a women contacted a screening centre in August last year to report she had not been called for a check-up for more than three years. An investigation was then launched by the watchdog Healthcare Improvement Scotland (HIS) which discovered that, from 2002, thousands of women had not attended a screening appointment for between three and nine years.
The cause of the problem was a fault in the IT system which is used to generate the letters inviting women for screenings. Women who move in or out of a particular practice should automatically appear on the system but the IT fault meant that the letters were not sent out. Even more worryingly, HIS says the risk of such a problem occurring was recognised but nothing was done about it until the patient came forward last year.
Serious though it is, the problem should be put in some perspective – breast screening typically picks up nine cases for every 1,000 women tested, which means that the number of cases which may have gone undetected is very small. But the aim of the breast screening system must be to catch cases as early as possible and any number of women falling through, however small, must be seen as a failure.
The NHS National Services Division (NSD), which runs the screening programme, also has some lessons to learn. Why was nothing apparently done about a known risk? NSD must also ensure a system is in place to identify any future risks and deal with them promptly so women are not missed again. It must also do as the HIS has suggested and review whether more can be done to ensure those women who have still not been screened can be seen as soon as possible.
The good news is that the majority of women in Scotland are receiving their invitation to be screened on time and, if they are aged between 50 and 70, are being seen every three years. But women must be reassured the gap in the system that the HIS review has identified has been closed and the risk of anything similar happening again has been minimised as much as possible. The improvement in the diagnosis, treatment and prevention of breast cancer is welcome, but it appears there is still some progress to be made.
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