'Far wider' cervical misreads possible

By FRANCESCA MOLD

Millions of cervical smear slides taken from women in the past 10 years would have to be rescreened if health authorities wanted to prove there had been no serious cases of laboratory under-reporting, says an Australian expert.

Dr Gabrielle Medley, director of the Victorian Cytology Service, yesterday gave evidence at a ministerial inquiry in Gisborne about her role as an advising pathologist in a Health Funding Authority review of 17 community laboratories.

The review, prompted after concerns were raised about Gisborne pathologist Dr Michael Bottrill, was commissioned in the hope that it would pick up indications of women at risk of under-reporting in other parts of the country.

Dr Medley yesterday admitted the HFA review, which in its conclusion states there are no concerns about the safety and wellbeing of women, could not exclude the possibility of systemic under-reporting at other laboratories.

"This review identified areas of concern that have been addressed. The laboratories appeared to be within acceptable practice levels at the time but I am unable to say there is no possibility of systemic issues leading to systemic under-reporting," she said.

The only way to do this would be to rescreen million of smears, which would be logistically impossible and a "huge waste of money," said Dr Medley.

The review, compiled by statistician Jim DuRose, revealed that six of the 17 laboratories had been investigated further after recommendations from Dr Medley and other pathologists who evaluated data collected during the study.

"Red flags" were raised about the practices of three laboratories, which were required to take action to check on past practices.

One laboratory has been asked to reread about 1700 smears it had originally called low-grade, some of which were later found to be high-grade.

The laboratory identified the concerns about undercalling itself in 1996 and the women involved are not believed to be at significant risk because they would have since had followup smears or treatment.

Women will be contacted if their smears are being reviewed.

"The red flags have been investigated and dealt with in the process of the advisory panel," said Dr Medley.

The review might not completely alleviate anxieties but it would have led to better practices in laboratories in the future.

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