Cervical Cancer Cases
The Negligent Interpretation of Pap Smears

Published by the American Society of Cytopathology in their Journal, Pathology Patterns Reviews.

Cervical cancer continues to kill approximately 4900 women annually. This is a particularly alarming statistic to the 15,700 women who are annually diagnosed with new cases of cervical cancer.

Each year many women diagnosed with cervical cancer, or their significant survivors consult lawyers to determine whether the stage of the cervical cancer at the time of diagnosis and the related morbidity and mortality could and should have been avoided. According to Dr. Scott, examining pathology claims at one insurance carrier corresponding to the period of July 1, 1993 to August 10, 1995, 17% of the claims involved Pap smear interpretations as the central issue. The dollar value of the claims was estimated to represent 25% of all new pathology claims during the measured interval. Though an examination of the claims for any interval of any given insurance carrier is not necessarily reflective of national or regional trends, there is no question that it is the common experience of knowledgeable physicians and lawyers that Pap smear cases represent significant liability exposure for health care providers.

The number of claims made involving Pap smears represents, at best, a very small percentage of the total number of false-negative cases which have, in fact, resulted in needless delays in diagnosis and treatment and resultant excess morbidity. This is obvious when one considers that the false-negative rate of a single Pap smear is widely quoted to be 20%. . Some maintain that more recent data actually indicate the sensitivity of a single Pap smear in women undergoing routine screening may be closer to 50%.

Koss has asserted that invasive cancer is rarely preceded by truly negative serial Pap smears when available for the 2 to 3 years prior to the diagnosis of invasive cancer being made. My experience is consistent with that of Dr. Koss.

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.

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