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The BBC's Giles Latcham
"Nation-wide cancers are still being missed"
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Brad Timms, of the Cancer Research Campaign
"The public should not lose faith in the screening programme"
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Dr Rashmi Shukla, Leicestershire Health Authority
"We cannot prevent every single case of cervical cancer"
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Professor McPherson, School of Tropical Medicine and
Professor Holland, Public Health at London School of Economics
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Thursday, 3 May, 2001, 12:06 GMT 13:06 UK
Women died after smear errors
Cervical smear
Cervical smears do save lives
Inaccurate smear tests for cervical cancer have led to the deaths of 14 women and unnecessary suffering for many more, a major audit has revealed.

The study, carried out in Leicester, of women who went on to develop cervical cancer showed that in a third of these cases smear tests produced inaccurate results.

Another 64 women, also given the all-clear, required more radical treatment - such as a hysterectomy - than might otherwise have been needed if their smears had been analysed accurately.

The government's cancer czar Professor Mike Richards has insisted that the findings do not show that the screening programme is deeply flawed.

He said no system could ever be 100% accurate, and urged women to continue to attend for regular smears.

However, he admitted that the findings may be replicated by other audits around the country.

I must emphasise that the cervical cancer screening programme in Leicester is not failing

Professor Mike Richards, National Cancer Director
Experts reviewed the cases of 403 women diagnosed with cervical cancer between 1993 and 2000 at Leicester Royal Infirmary.

They found that 324 of the women had undergone at least one smear test prior to their diagnosis.

Of those, discrepancies were found in the smear tests of 122 women. In 84 cases women were given the all-clear wrongly, and in another 38 cases the degree of abnormality was under-estimated.

Human error

Professor Richards said: "I would like to offer my condolences to the relatives of the 14 people who have died and I much regret that 64 patients have had to undergo more radical treatment than would otherwise have been necessary.

"However, I must emphasise that the cervical cancer screening programme in Leicester is not failing. Without screening more patients would have died and a lot more would have required more radical treatment.

"The screening programme is a major success, but it cannot pick up every case.

Professor MIke Richards
Professor Mike Richards said the screening programme saved lives
"No smear test will ever be 100% accurate, but clearly we have got to strive to get as close to that level as is humanly possible."

Professor Richards said that the cancers that had not been picked up were difficult to detect. He said that each smear test contained thousands of cells, and in some cases only one or two were abnormal.

An external pathologist is to re-examine the 122 smear tests found to be inaccurate.

The women who have been affected will be offered a consultation with a cancer expert, and a firm of solicitors has been asked to handle any legal complaints.

In future, women who develop cervical cancer will be offered details of their smears as routine.

Saves lives

It is estimated that the NHS Cervical Screening Programme saves around 1,300 lives a year, and prevents the disease from taking hold in another 3,900 cases. Between 1992 and 1997, deaths from cervical cancer have fallen by 25%.

Professor Richards said women should go for smear tests at regular three to five year intervals.

Leicester Royal Infirmary
The smears were carried out at Leicester Royal Infirmary
He said that if women had regular tests the chances of more than one "false-negative" result were extremely small.

Professor Richards also stressed that quality standards for smear tests had been improved since many of the women in the study were examined.

In 1995 it was ruled that a second screener should always check every slide. Three-quarters of the women who suffered as a result of inaccurate tests were tested before this date.

Julietta Patnick, national co-ordinator of the NHS Cancer Screening Programmes, said research had shown that five yearly tests detected 84% of cervical cancers. She said the extra number of lives that would be saved by switching to annual tests would be minimal.

She said: "Cervical screening can prevent 80 to 90% of cancrs in women who attend for regular smear tests, but it is not 100% accurate.

"We want women to come for cervical screening fully informed about not only about the benefits, but also the limitations."

Technological advances

It is hoped that advances in smear technology will reduce the number of inaccurate results in future.

A technique called liquid-based cytology in which smear cells are added to a solution before a microscope slide is made up produces clearer images for analysis.

Results of a trial of this technique will be presented to the National Institute for Clinical Excellence (NICE) next year.

Dr Peter Sasieni, cervical cancer screening expert at Imperial Cancer Research Fund, said: "It is easy to identify women who have been let down by screening, but it is almost impossible to say who would not be alive today if screening didn't exist.

"It is only by reviewing smear tests from women who have developed cancer and comparing them with smears from healthy women, that we can learn from our mistakes and improve the quality of screening."

In total 73,000 smear cases are processed in Leicester every year.

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See also:

03 May 01 | Health
Smear test errors: The history
03 May 01 | Health
Screening: What should we expect?
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