Comment On Screening Service Review
Comment On The Release Of The Report Of The Independent Review Of The Breast Screening Service In Otago Southland
Otago District Health Board Committed To Implementing Recommendations
The Otago District Health Board is proud of the record of the Otago-Southland breast screening programme in achieving a high coverage of the eligible population, and a high detection rate of early breast cancer. This achievement is fundamental to ensuring the ultimate objective of the programme, to reduce deaths from breast cancer.
The Otago District Health Board is fully committed to implementing the recommendations of the Review, to ensure that the women of Otago and Southland continue to receive a service which is effective in detecting breast cancer, and which meets international standards of breast screening practice in every respect. We believe considerable progress has been made toward implementing many of the recommendations in the report and the Otago District Health Board will be working closely with the Ministry to address the remainder.
The implementation of the initial recommendations of the External Review Team
BSHC was able to recommence screening in August 2000 having met an initial set of recommendations of the review team covering additional safety measures relating to data management systems. In chapter 3.8 of the report "the External Review Team endorsed the changes made by BSHC to their quality assurance systems since June 2000."
The effect on women
Otago District Health Board accepts the need for improvements in the leadership and data management processes of the Otago-Southland breast screening programme (BreastScreen HealthCare). The Otago District Health Board sincerely regrets that two women had a delay in the diagnosis of their breast cancer, and a number of other women experienced anxiety and distress.
The two women with delayed diagnosis have received a formal apology. Both women have undergone treatment according to international best practice and continue with care and support from their general practitioners and Dunedin hospital.
Strengthening the leadership of the programme
Dr Sally Chartres, a radiologist with the required expertise in screening mammography and the quality management of breast screening accepted appointment as Clinical Director of the programme in October 2000. Dr Chartres will be accountable to BreastScreen Aotearoa, through the Chief Executive of the District Health Board. According to the report "this change in leadership provides the opportunity for BSHC to be revitalized and, more than any other stage, it is paramount that such revitalization occurs."
Improving the service
As part of a full assessment of all steps in the screening process, the systems of data management have been strengthened to meet the required standards. This has been supplemented by additional training and support. BreastScreen HealthCare is also committed to minimising reporting and assessment delays, while maintaining high quality services.
The Otago District Health Board has also approved a new purpose-built facility for the breast screening service in the Fraser Building (previously the Physiotherapy building), adjacent to Dunedin Hospital. This new first class facility is expected to be completed during 2001.
Review of files
BreastScreen HealthCare initiated a review of the files of all women screened from 1 July, 1997 until the suspension of screening in June, 2000. A total of 14,641 files were reviewed; 64 errors were identified, 25 women were recalled for assessment of whom 2 were found to have cancer and 6 were offered re-screening (none found to have cancer). Five women whose files could not be located were offered re-screening and all had normal results.
"It is to BSHC's credit that all women whose files were reviewed were informed of this. This must have helped allay the anxieties of women in the region," the report says.
The file review was extended to include women who had been enrolled in the screening programme but had left between 1991 and 1 July 1997. 6278 files out of a total of 6290 additional files have been checked. The remaining 12 women, whose files were not located on site, have been contacted and offered a mammogram. Of the 6278, 2 women have been contacted for further follow-up. The files of the remaining 6276 women did not require any further follow-up.
Evaluation of the Pilot Programme in the 1990s
In order to assess the feasibility of a national breastscreening programme, the two pilot programmes were evaluated routinely. The outcome of these evaluations provided input into the development of the national programme, which was launched in December 1998.
The report released today outlines concerns expressed by the Breast Screening Aotearoa Independent Monitoring Group (BSAIMG) about the high rates of recall to assessment for women in the Otago-Southland programme. These issues are being addressed, and in the most recent monitoring report BreastScreen HealthCare has shown improvement against targets. It is expected that this trend will continue in future reports.
Commitment to breastscreening
The Otago District Health Board sincerely apologises for the distress caused to women affected by the systems errors in breastscreening. The Board is committed to providing a breast screening service for Otago and Southland which fully meets the national quality standards for BreastScreen Aotearoa. As a result of the changes that have been made women can be confident of the safety of the programme and its continued effectiveness in reducing deaths from breast cancer.