'Obvious abnormality' in rescreened slides

By FRANCESCA MOLD

A number of cervical smears from Gisborne women contained a rare kind of tumour that occurs when the disease has gone undiagnosed for a long time, says an Australian pathology expert.

Dr Annabelle Farnsworth, a highly qualified cytopathologist who led the mass rescreening of 23,000 slides originally read by Dr Michael Bottrill, told a ministerial inquiry that she was astounded by the obviousness of the abnormalities she found in the smears.

The high rate and kinds of abnormalities she saw were extremely unusual in a population of women involved in a screening programme.

Some of the cells on the slides were like those normally seen in classic cytology textbooks written in the 1950s and 1960s and contained "keratinisation" - a cellular appearance rarely seen in Dr Farnsworth's Sydney laboratory.

"It was quite striking for me. We were all very interested in the appearances ... we didn't expect any of it.

"It was absolutely overwhelming," she said. "From what I saw we were looking at women who had these tumours for a long time."

Dr Farnsworth said she had assumed her staff would find the Gisborne slides difficult to read, but instead they found most of the high-grade abnormalities "extremely obvious."

The inquiry heard that of the 23,000 slides, Dr Bottrill had reported 123 high-grade or cancerous - 0.54 per cent of the total. The laboratory re-reading the smears found 544 high-grade and 29 cancerous - about 2.49 per cent.

"You saw it at five times the rate Dr Bottrill did?" asked Stuart Grieve, QC, lawyer for the women affected.

"That's correct," said Dr Farnsworth.

However, the results of the Sydney re-read and the ability to compare the findings with Dr Bottrill's reporting were questioned earlier in the inquiry by Scottish pathologist Dr Euphemia McGoogan. She had concerns that the results might be biased because the Sydney laboratory knew there might be errors and would take more care checking the slides.

Dr McGoogan was also worried that the time lapse between the taking of the smears and the re-reading could mean different technology or processes were used to analyse the slides, skewing the results.

In response to questions about Dr McGoogan's concerns, Dr Farnsworth agreed that some might apply, but said her staff simply "saw the appearances we saw."

She also said the high incidence of cervical cancer in the Tairawhiti Healthcare district - 30 per 100,000 - was quite striking, and compared it to Third World countries such as Vietnam, where 27 in every 100,000 women develop cervical cancer.

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