Top specialist admits smear rates too low

By FRANCESCA MOLD

A prominent pathologist who advised health authorities not to reread the cervical smear slides of thousands of Gisborne women has admitted the rate of abnormalities picked up by Dr Michael Bottrill was unacceptably low.

Dr Andrew Tie, vice-president of the New Zealand branch of the Royal College of Pathologists, yesterday told a ministerial inquiry he advised the Health Funding Authority last year not to rescreen 23,000 slides because there was insufficient statistical evidence to show there may have been widespread misreading.

Dr Tie's evidence was more subdued than his criticism of the HFA in a personal column in a college newsletter last year when he said the organisation had "gone for overkill" by commissioning the review.

In the newsletter, he said he was surprised by the number of people who "seem to have swallowed the media noise and jumped to the conclusion Dr Bottrill was incompetent."

However, under cross-examination yesterday, Dr Tie admitted the HFA investigation had identified a problem with Dr Bottrill's slide-reading.

His concession was echoed by another member of the college and laboratory adviser to the national cervical screening programme, Dr Clint Teague.

Dr Teague yesterday said he believed "unequivocally" that there had been under-reporting in Gisborne and that had significantly disadvantaged several women.

In March last year, Dr Teague appeared as a witness for Dr Bottrill at a High Court trial involving a woman who developed invasive cancer after having slides misread. He had earlier appeared as a witness for the woman at a medical disciplinary hearing.

A lawyer for the women affected, Stuart Grieve, QC, suggested that if the pathologist's preliminary advice to the HFA had been accepted in April 1999, none of the information about Dr Bottrill's reporting rates would have come to light.

Dr Tie replied by saying at the time a complete reread did not seem the best way to investigate, and other strategies could have also revealed the same information the HFA now had.

Dr Teague told the inquiry he was profoundly distressed by the findings of the HFA review.

Dr Teague said if recommendations he had made for improving quality assurance were fully implemented, the chances of the Gisborne crisis recurring would be minimised.

At yesterday's hearing, Mr Grieve also revealed a new HFA report yet to be presented to the inquiry would show the incidence of cervical cancer in Tairawhiti between 1990-95 was 30 per 100,000. This compared to Australia's rates of nine per 100,000.

Dr Tie agreed the Tairawhiti rate was extremely high for an area with a significant proportion of women on the screening register.

He also agreed, in response to questions, that if there was a high incidence of cancer in Tairawhiti, there should also be a corresponding rate of high-grade abnormalities.

Mr Grieve said the new report showed Dr Bottrill's laboratory read 0.53 per cent of all smears as high grade, compared to the national average of 1 per cent. In terms of low-grade abnormalities, Dr Bottrill read 0.25 per cent, compared to the national average of 6.57 per cent.

After Dr Bottrill retired in March 1996, the reporting rates showed high grades shooting up to 1.71 per cent and low grades to 8.83 per cent.