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.

Though there are a variety of diagnostic errors which occur due to negligence in the processing and interpretation of Pap smears some misinterpretations are unavoidable. Assume that a gynecologist properly obtains a Pap smear that is then properly applied to a slide and fixed. Though the patient, at the time is suffering from a pre-invasive lesion of the cervix, so few abnormal cells are present in the smear that they are unlikely to be located during a careful screening of the slide. The delay in diagnosis that results from this unrevealing smear is unavoidable and undoubtedly occurs. However, in the author's experience the patient presenting with advanced cervical cancer, following serial purportedly benign annual Pap smears has been the victim of professional carelessness. Review of slides, in such cases, reveals inadequate smears which were not reported, abnormal cells that were either identified but then ignored by the physician performing the Pap smear or were misinterpreted or not located by the cytopathologist or cytotechnologist examining the smear.

The devastation that results from a needlessly advanced case of cervical cancer, a disease, which most believe is largely preventable, is tragic. It is the obligation of the lawyer representing claimants in such cases to obtain through the legal system what compensation is there available. However, the legal process also can reveal the causes of a client's injuries and properly identify those persons responsible. Ideally, the process of litigation should inform those persons responsible of their errors and encourage them and others to act more responsibly in the future.

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.

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View Images:
Pap Smear Screening View - Low Power
Pap Smear - High power
Abnormal Pap Smear - Precancerous
High Magnification View Of Precancerous Change HGSIL