'Urgent' new cervical cancer study required

By FRANCESCA MOLD

A prominent public health specialist has called for a new investigation into the medical history and diagnosis of Gisborne women caught up in the current cervical cancer scandal.

Professor David Skegg of Otago University has told a ministerial inquiry he believes a study of 40 cases of invasive cervical cancer in the Gisborne region, reported to the Cancer Registry since 1990, should be carried out as soon as possible.

The study would trace the cervical screening history of the women, to show whether their cancer had developed despite having a slide read as normal.

Professor Skegg said his colleague Dr Ann Richardson had applied to the Tairawhiti ethics committee for approval for the study and expected to receive a decision in the next few days.

The study could be carried out in time to be presented towards the end of the inquiry in July, he said.

Earlier in his evidence yesterday, Professor Skegg criticised the decision to have slides read by former Gisborne pathologist Dr Michael Bottrill retested by a Sydney laboratory last year.

He said it would have been of more scientific value to have sent a random selection of smear slides from Dr Bottrill and other pathologists to be tested at a number of New Zealand laboratories.

Professor Skegg also described a decision by the former Labour Government in 1989 to set up 14 computer sites for the programme instead of one national agency as ridiculous.

He said that decision had created major problems, delayed the implementation of an effective programme and wasted a lot of money.

It was also made in the face of strong, consistent advice from experts and consumer groups.

Professor Skegg said there had been a tendency for the Government to want to "devolve" responsibility for the screening project to area health boards rather than to the Department of Health.

There had also been inadequate investment in research and developing evaluation processes that was "perhaps typical of the health system and our society as a whole."

There had been repeated calls for better evaluation, with monitoring plans developed in 1997, but there had been too little action, he said.

"Better procedures for evaluation could have drawn attention to a major problem in Gisborne years ago, when remedial action could have been taken."

But while outlining his concerns, Professor Skegg also said it was vital that women did not lose faith in the effectiveness of a national screening programme.

Testing procedures could never be perfect and he warned that if pathologists became too afraid of making errors they might turn to "excessive" diagnosis.

This would mean women who did not have the disease might suffer unnecessary grief and resources would be wasted.

Professor Skegg said concerns had been expressed in the mid-1990s in Bristol, England, that the threat of litigation or being pilloried by the media had caused health professionals to live in fear.

That atmosphere had been engendered by inquiries such as the one being held in Gisborne.

However, he said, the fact that the hearing was being held did point to a failure of the screening programme.

Professor Skegg said steps should always be taken to protect women from "any incompetence or negligence on the part of health professionals," but that this should be detected through routine evaluation and monitoring of the programme rather than relying on ministerial inquiries.