Negligence in Interpretation of Pap Smears

Historical Perspective

In 1987, Van der Graaf, Y., et al., reported striking findings concerning screening errors in cervical cytoloty. In a screened population of 165,185 women, 555 women demonstrated "moderate dysplasia" or a higher lesion, three years after a negative screening. An examination of the slides previously read as negative showed that the adequate smears all were misread. Fully 1/3 represented "dysplasia" or a carcinoma in situ. According to Dr. Koss, in those cases contained in the literature where prior negative smears of patient with invasive cancer are examined, cancer cells are apparent on review.

In 1961, at a time when few American women were being screened, the incidence of cervical cancer was 33 per 100,000. By 1987, when the population of women screened at some time during their lives reached 80%, the incidence of squamous cell carcinoma of the cervix dropped to 8.3 per 100,000. The rate of cervical cancer, in countries where screening does not occur, continues at the same rate as that of industrialized countries before the initiation of large-scale screening programs. It is obvious that screening programs have greatly reduced the incidence of the disease. However, the continued occurrence of cervical cancer in the screened population suggests that inadequate screening occurs or that the screening process is inherently incapable of identifying a significant percentage of women with disease prior to the occurrence of invasive cervical cancer. It is this author's position that the occurrence of 8.3 cases per 100,00 is due to inadequacies in the screening process. That inadequacies exist is well borne out by the literature. It is these inadequacies which are the subject of this paper.

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