This Friday in Seville, the Minister of Health, Presidency and Emergencies, Antonio Sanz, chaired the newly formed commission to monitor the “problems detected in the Breast Cancer Screening Plan”, a body created expressly to confront the crisis of late diagnoses that has shaken the Andalusian Government of Juan Manuel Moreno. And in it an updated number of women affected by this problem has been given: there are 2,317 compared to the less than 2,000 that were initially announced.
During the meeting, it was reported that 2,317 women were identified with radiological findings that raised doubts – of which around 90% are from the Virgen del Rocío hospital in Seville – and that they had exceeded the period recommended by clinical guidelines for the follow-up of these findings. Of these 2,317, there are 1,778 who have already had the test indicated by the radiologist, while the rest have an appointment before November 30 to have it done.
At the meeting of experts, from which the Association of Women with Breast Cancer of Seville (Amama) that uncovered the scandal, two senior officials from the Andalusian Health Service (SAS) have participated, one from the radiological area and another from the IT department, who have been tasked with refuting the complaints of alleged manipulation of mammograms on the ClicSalud and Diraya digital platforms, where users can see their clinical history.
This complaint, registered by Amama on Tuesday before the Seville Prosecutor's Office, has motivated the opening of an investigation just 48 hours later, and despite the categorical denial of President Moreno, who on Thursday in Parliament disgraced the entire opposition as a whole that they were destroying the credibility of the health system with the sole objective of overthrowing his Government seven months before the elections.
The two senior SAS officials have highlighted this denial, explaining how both the analysis and publication of the tests in the system, as well as their maintenance on the digital platform, work internally. However, they have left unanswered why the cases of women who have publicly denounced that their mammograms, before the outbreak of the screening crisis, appeared with signs of “findings” signed by two radiologists then temporarily disappeared – coinciding with the collapse of the computer service – and finally reappeared, but without the marks indicating the lesion or the signatures of the responsible radiologists.
“Technically you can't delete anything”
The coordinator of the SAS breast units – at the time, head of service at the Virgen de la Victoria University Hospital in Málaga –, Maribel Acebal, explained this Friday that “technically nothing can be deleted” in those images hosted on the server. “From the clinical and professional point of view of the radiologists who are in the hospitals every morning, we cannot do that. We will have to ask those responsible for the computer systems (of the SAS) if it is possible or not possible.”
Acebal, who is also a radiologist, has also stressed that the system creates “traceability”, that is, that “anyone who has entered a medical record, now with current computer systems, can see it. The system is key and transparent, and there is no hand anywhere.”
At his side, the head of Digital Infrastructure of the SAS, Luis Santiago Sánchez, has also appeared before the media (the Ministry of Health has only cited the graphics), who has elaborated that “it is not possible to make changes” to the patients' files “due to data protection.” “Only when the citizen requests it,” he said. Sánchez has admitted that the system “collapsed” this week due to the “call effect” that caused Amama's complaint to the Prosecutor's Office, ensuring that there were changed medical records or that they had disappeared.
The ClicSalud application usually receives between two and 15 queries per hour, but this week it multiplied to 400 or 500 accesses per hour. “We are engineers, we prepare the system for the demand we have normally, not in an avalanche,” he said, after announcing that the server's capacity will now be expanded to prevent it from crashing again. Regarding Amama's complaint, Sánchez stated that women do not have the capacity to understand the changes they have found in their medical records. “The system sometimes presents errors, and non-technicians misinterpret the errors, there are many ways of looking at things,” he said.
“Guarantees and quality criteria”
The person in charge of the SAS digital platform has defended the system, recalling that “every time a test is generated, it has to be available because a judge can request it,” or because in the middle of a surgery, the doctor may need to consult a CT scan.
The breast cancer early detection system performs voluntary mammograms on women aged 49 to 71, around 485,000 per year. Two projections are made of each breast, so that a complete study has four images or x-rays. From there, each specialist can decide to do “complementary projections” and draw marks on the mammogram where they see a lesion, Acebal explained.
When asked about the case of “Anabel's breast”, which Congresswoman Inmaculada Nieto denounced in Parliament on Thursday, the coordinator of the SAS breast unit assured that “because of a specific case I could not call into question the population screening program for breast cancer”, she said, defending that the “guarantees and quality criteria of the system are exquisite”.