Smearing the Pap Smear; the Pap Test Misses Some Cervical Cancer through Labs' Errors
Bogdanich, Walt, The Saturday Evening Post
SMEARING THE PAP SMEAR Conclusion: Pap slides are often kept only as long as the law requires. In states without laboratory laws--which is nearly half of them--a lab needn't keep slides at all unless it operates in interstate commerce or is Medicare certified. In the latter case, it must keep them two years.
Patricia Ashton, a cytotech and consultant to a major national laboratory, says that her lab's lawyers instruct workers to =get rid of slides as soon as possible" to limit liability. "I don't think it's medically ethical," she says.
Even if a suspect slide exists, retrieving it can be a problem. A now-defunct Boston laboratory called Elm Medical Labor, after having failed to detect a woman's cervical cancer, covered up the error by substituting a negative Pap slide for a positive one in her file, according to evidence presented by the Massachusetts attorney general in a state court. A jury last year found the lab had violated state consumer-protection laws; the case is on appeal.
Dwight Golann, who handled the state's case, also presented evidence that slides were improperly prepared at the lab; that one screener spent just seconds on each specimen; that slides were examined at home; and that the lab had failed to find the abnormal cells on 10 of the first 12 positive slides checked by investigators in a rescreening.
The dimensions of some abuses have been stunning. A Mansfield, Ohio, lab was discovered in the late 1970s to have sent out nearly 6,000 erroneous Pap-test reports. A worldwide alert located many, but not all, of the women affected. And this past September, health authorities in Britain issued an international alert for 911 women who had Pap smears misdiagnosed by a leading pathologist there.
Bab lab work is currently a paramount concern for Planned Parenthood Federation of America, which last year took 1.4 million Pap smears through affiliated offices and clinics. Early last year, Planned Parenthood warned affiliates of "a rapid rise in the number and cost of claims" due to laboratory errors, specifically Pap smears.
A few years ago, it tried to catch a lab it suspected of misreading Pap slides. Twice it sent the lab, which it won't name, slides from women known to have cervical cancer or its precursors, and twice the lab failed to report abnormalities. When Planned Parenthood tried to retrieve the specimens, one set was said to be lost and the other came back smashed. It was as if "they beat them up with a hammer," recalls Louise Tyrer, a physician who is vice president for medical affairs.
As complaints about lab work pour in, Planned Parenthood has begun trying to identify problem Pap labs. One lab that has come to its attention is International Cancer Screening Laboratories in San Antonio, Texas. Among the largest in the nation, ICSL processes about a half-million slides annually from 49 states. In 1985, it was banned from operating in New York after failing the state's proficiency test in cancer screening.
ICSL, operting out of a modern building on the outskirts of San Antonio, employs 42 screeners full- or part-time. It pays the part-timers 50^ a slide and gives salaried employees 45^ for each slide they screen after meeting the daily quota.
One screener is recorded as having analyzed 4,710 slides in June. That is a rate more than four times what the American Society of Cytology considers the maximum safe workload. Even if he worked all 30 days in June, the screener would have to have done 157 slides a day.
At such rates, "I wouldn't expect a cytotech to screen effectively or reliably," says George H. Anderson, a physician at the Cancer Control Agency of Vancouver, British Columbia, which has a highly regarded Pap-screening program. Says Dr. Robert Hutter of the American Cancer Society: "If such things are happening, then I would says that's terrible. …