Smear tests golden rule not followed

By FRANCESCA MOLD

The head of the country's cervical screening programme has expressed concern at suggestions that a number of Gisborne women with symptoms of cancer may not have been sent by their doctors for immediate further tests.

In response to questions at a ministerial inquiry yesterday, programme manager Dr Julia Peters agreed she was concerned that standards of care which demanded women with visible abnormalities should be sent for follow-up investigation were not followed by health professionals in several cases.

Counsel assisting the inquiry, Hanne Janes, told the hearing it was usually a golden rule that signs which may indicate cancer should take precedence over any "normal" result from a cervical smear slide.

She asked Dr Peters if she was concerned that "clearly in quite a few of the cases, this was a standard not adhered to at a clinical level."

"Yes, to be honest it was," replied Dr Peters.

A number of the women who have given evidence at the Gisborne inquiry have spoken of suffering from pelvic pain, discharges and bleeding from the vagina and other symptoms which indicated something was seriously wrong.

Yet in some cases, where women had received a normal smear result, doctors tended to treat the symptoms rather than embarking on further tests to find if cancer was the cause.

Ms Janes asked Dr Peters how the Health Funding Authority could reinforce standards of care in the minds of health professionals involved in the programme.

Dr Peters said the standard had been repeated in a number of documents and it was a priority for the HFA to ensure the message was "out there loud and clear."

She said new educational information was also being prepared for women and smear takers.

The inquiry also heard yesterday how recommendations had been made to the screening programme since it began in 1991 that annual audits of the cases of women who had developed invasive cervical cancer be carried out.

But legal restrictions in Section 74a of the Health Act, which prevent researchers from accessing information from the cervical screening register which may identify women, have meant such audits have not gone ahead.

Researchers giving evidence at the hearing have criticised the legislation, describing it as ridiculous.

Public health specialist Professor David Skegg had wanted to do an audit of the cases of about 40 Gisborne women who had developed invasive cancer in the past 10 years.

He had hoped the results could be presented to the inquiry to help the panel determine whether there was under-reporting of cervical smear slides in Gisborne.

But an ethics committee demanded that Professor Skegg obtain written consent from each woman or her legal representative before he access the information.

Such a restriction means the project is unlikely to go ahead.

It has also stymied similar proposals to evaluate the overall success of the screening programme by using an audit of invasive cancer cases planned more than two years ago by epidemiologist Dr Brian Cox.

In response to questions about whether changes should be made to legislation to allow the audit without requiring written consent, Dr Peters said she believed it was important for the protection of women at a "population level."

However, she had concerns about how women would react to their personal information being made available, saying it was vital that confidence in the confidentiality of the programme be protected.
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