Smears may be futile, say experts

By MONIQUE DEVEREUX, Health Reporter

Medical experts are questioning the reliability and safety of the national cervical screening programme because work has still not begun on a key recommendation of the Gisborne cancer inquiry.

The recommendation was for an urgent review of all cases of invasive cervical cancer to see whether pathologists were under-reporting in areas other than Gisborne.

At a public meeting in Gisborne yesterday to report progress on fulfilling the inquiry's recommendations, British pathologist Dr Euphemia McGoogan told health officials it was "not acceptable" that the review was not yet done.

Dr McGoogan, a world expert in cervical screening, said although she understood the reasons behind the delay, it was a serious concern for the safety of women that the information was still not available.

"Without it how can you reassure women that the cervical screening programme is safe?"

She also criticised the lack of availability of the official Gisborne inquiry report and the lack of staff within the National Screening Unit, which monitors the cervical screening programme.

The audit was one of 46 recommendations to come out of the inquiry. It was deemed urgent at the time of the report - 18 months ago - because without it the extent of under-reporting of cervical smears around the country would not be known.

But in April Health Minister Annette King said the audit would not be completed for another 18 months.

The problem lies in collecting the information because the law prevents experts using medical records without informed consent from the women concerned.

The cabinet has approved some changes, but new legislation has not been passed. That means the safety of the screening programme cannot be guaranteed, says the Auckland barrister who acted for the inquiry panel last year.

Royden Hindle said last night: "At the end of the day you don't have the information to ensure the programme works properly. If you can't do that, you should not have a programme."

Mr Hindle said it was pointless spending thousands of dollars without knowing if the system worked.

The Government had the options of discarding the requirement for informed consent, making all medical records accessible for the purpose of the audit through tough legislation, or putting the screening programme on hold until the audit was completed.

"At present there is no one who can absolutely guarantee the screening programme is working properly and is a safe system," said Mr Hindle.

"Why put more people at risk unnecessarily?"

Mrs King and Director-General of Health Karen Poutasi welcomed Dr McGoogan's comments, saying her independent review was a vital part of ensuring the inquiry's recommendations were followed through.

Mrs King detailed progress on the 46 recommendations so far - 37 are underway and eight have been completed.

Several people at the meeting - some visibly upset - asked questions, most wanting reassurance that procedures were in place to ensure the Gisborne scandal would not happen again.

Not all were convinced. "I have no faith any more," said one woman. "You're asking us to trust you and trust this system, but I can't. I have no faith left."

Mrs King said she could not change the mistakes of the past but she could take control to ensure they did not happen again, and she wanted to continue moving forward.