Cervical Cancer Cases
The Pap Smear Case

A noted cytopathologist, Leopold Koss, has said that the use of the Pap smear should virtually eliminate the chances of a woman developing invasive cancer. Nevertheless, this year approximately 7,000 women will die of the disease-a disease that is largely preventable.

Presented with a potential client or claim where a woman has suffered invasive cancer, a presumptive claim exists. Presumably, a potential claim would never be presented to a lawyer if there had not been a physician supervising treatment for some period of time prior to the diagnosis of invasive cervical cancer being made.

Whether followed by a gynecologist or a family doctor, every woman is entitled to regular gynecologic examinations and Pap smears. Though there is some controversy as to how often Pap smears should be performed in sexually active women, all agree that annual Pap smears are required until a series of normal Pap smears suggests a lengthier interval before re-testing is justified.

Some family doctors obtain Pap smears themselves; others refer patients to gynecologists for that purpose. In an HMO environment, the referral to a gynecologist represents a cost, direct or otherwise, to the referring doctor's practice.

If a primary care physician or gynecologist fails to recommend and obtain regular Pap smear evaluations with the required frequency (never less than one every 2 to 3 years and more often if risk factors are present), a claim may be made out on that basis alone.

More commonly, Pap smears are obtained with sufficient regularity but are improperly interpreted and reported upon by the cytology laboratory. The primary care giver ordering the smear may receive an appropriate report but fail to take appropriate action on the basis of the information provided.

The evaluation of a Pap smear case, therefore, requires that one obtain the slides for at least five years prior to the diagnosis of cancer having been made. Laboratories are only required by law to retain slides for five years. Once obtained, such slides must be reviewed by a highly competent cytopathologist. The cytopathologist who reviews the slides should be an expert who, if the slides provide a basis for a claim, is willing to testify. Never place or direct others to place Pap smear slides in the mail. They cannot be replaced.

It is naturally important to obtain from the primary care physician a full copy of the office records which will include the Pap smear requisitions submitted to the laboratory. The laboratory's Pap smear reports should be requested from the laboratory or Hospital separately. This is important because often there are handwritten recommendations or notes on one copy of the report, which do not appear on the other. In addition, the requisition sent may contain different information, historical otherwise, from that contained in the report the laboratory issues.

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