Ministry accused of cancer inaction

An international expert has criticised the Ministry of Health for not thoroughly investigating the medical history of every woman diagnosed with cervical cancer since the Gisborne inquiry.

In her final review of the inquiry, Scottish pathologist Euphemia McGoogan says she finds it "incomprehensible" that the histories were not immediately investigated.

The aim of checking the case histories of women newly diagnosed with cervical cancer is to find out whether the disease was missed previously, and if other women were also likely to have been misdiagnosed.

Dozens of women developed cervical cancer and some died after under-reporting of cervical smears during the 1990s by former Gisborne pathologist Dr Michael Bottrill.

After a 12-week inquiry into the Gisborne scandal and shortcomings in the national cervical screening programme, which did not pick up Dr Bottrill's mistakes, guidelines were set to fix the problems.

The ministry appointed Dr McGoogan as the watchdog to ensure that recommendations from the inquiry's report were implemented.

In response to the criticism, Health Minister Annette King said last night that she would ask the ministry to consider ensuring the histories of all new cases were investigated.

In her report, Dr McGoogan also criticises the delay of an audit of the national screening programme, which will not be completed for 18 months.

The Gisborne inquiry recommended in 2001 that it be available within six months.

But even when it is completed, the audit will not be able to say if the programme failed in other parts of the country and other women developed cancer because their smears were misread.

Over the past two years, Dr McGoogan has criticised the ministry's ability to carry out the inquiry's requirements.

In her final report, issued today, she said much work had been done, and the programme was maturing.

But she did not believe the ministry had "a good understanding of the principles of a public health screening programme".

"The benefits to the whole population, the limitations of the screening test and the limited ability of a single cervical smear to protect individual women are generally poorly understood."

She did not believe New Zealand had a fully effective screening programme, and highlighted other concerns, including a lack of adequate training for medical experts who take the smears.

Dr McGoogan repeated her recommendation that the ministry create a population register to ensure all eligible women were in the screening programme.

But she was most critical of the delay of the audit and its inability to say where else there might be problems similar to Gisborne.

"I regret that there is still no explicit evidence that the [screening programme] at that time was safe and effective.

"I cannot accept that New Zealand women will not be given this reassurance."

Annette King said last night that she recognised there were many areas to improve, but a good deal of progress had been made in the past three years.

An audit of each new cervical cancer case - to find if the cancer might have been previously missed in smear-reading and if that could mean other women were at risk - was something she would put to the ministry to consider.

The screening programme is now being independently reviewed by the University of Otago and its findings are made public every three months.

Mrs King said she believed the screening programme was safe, despite Dr McGoogan's concerns.

The McGoogan report

Key proposals:

* Fully investigate new cervical cancer cases.

* Consider offering women two smear tests 12 months apart.

* Take great care with the re-read of slides from the Cancer Audit, particularly with respect to slides considered equivocal or atypical.

* Find ways to compare reporting rates from different laboratories.

* Set up a scheme for staff to monitor continuing competence.

* Make the transfer of information between smear takers, laboratories and colposcopy clinics and the Screening Register easier.

* Keep the National Screening Unit, its clinical leadership, management structure and location within the Ministry of Health under critical review.