Standards set for smear screening

By FRANCESCA MOLD health reporter

Safety standards for the cervical screening programme have been published - 10 years after the service began its aim of cutting cancer death rates.

The discovery of widespread under-reporting of cervical smears by former Gisborne pathologist Dr Michael Bottrill sparked health officials into formalising quality standards.

The problem with smear mis-reading in Gisborne continued unnoticed between at least 1991 and 1996, despite concerns being raised with doctors, disciplinary bodies and health bureaucrats.

Doctors, health advocates and women who testified at a ministerial inquiry condemned health officials for failing for more than a decade to provide a safe and effective programme.

The Health Funding Authority yesterday unveiled its interim operational policy and quality standards, sending more than 6000 copies to health promoters, smear takers, laboratories and other medical experts.

The detailed document sets a variety of standards that must be met by smear takers, laboratories and colposcopists (doctors who examine the cervix using a scope) before they can work with the national screening programme.

The standards will come into force for community laboratories this month.

The authority has also hired Otago University researchers to carry out independent monitoring of all parts of the programme.

Among the new standards is a requirement that pathologists reading smears must be fellows of the Royal College of Pathologists or have an equivalent qualification recognised by the Medical Council.

Laboratories reading smears on behalf of the programme must be accredited and read a minimum of 15,000 smears each year. The minimum smear requirement will be enforced from July.

Laboratories must have internal quality controls, including re-screening smears before the result is reported. They must also review negative smears of patients later diagnosed with high grade abnormalities or cancer.



Doctors who perform colposcopies must under the new rules perform at least 100 procedures a year and have a system to ensure that more than 95 per cent of women with a high-grade abnormality receive colposcopy within one month.

Women with a low-grade abnormality must receive colposcopy within six months and those with suspected cancer within a week.

Smear takers will be responsible for ensuring that a result is received for each smear taken.

They must make sure that women are recalled and that they receive appropriate follow-up care. Smear takers must keep their adequacy rate at 80 per cent.

Medlab managing director Brian Linehan said he supported the standards "on the whole."

He said they were a significant development but would also be a major imposition on many laboratories. He was particularly pleased with the compulsory accreditation, although it was more than 20 years after pathologists began advocating it.

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