Europe South Asia Asia Pacific Americas Middle East Africa BBC Homepage World Service Education
BBC Homepgaelow graphics version | feedback | help
BBC News Online
 You are in: Health
Front Page 
UK Politics 
Medical notes 
Background Briefings 
Talking Point 

Professor Richard Lilford, NHS Research Unit
"The cervical screening programme will never pick up all cases of cancer"
 real 28k

Friday, 19 November, 1999, 22:37 GMT
Smear equipment `misses cancers'
Experts say some cervical smear equipment should be replaced

Signs of cervical cancer are being missed because a commonly used device is ineffective, according to experts.

A team of obstetricians and gynaecologists say the failure of the broad-tipped Ayre's spatula to pick up all types of cells may mean more women are being recalled for further smears and some abnormalities are being missed.

Women could be having to be recalled in larger numbers and some abnormalities may be missed
Professor Henry Kitchener
The spatula is less effective than other available spatulas and brush devices, say the specialists at St Mary's Hospital, Manchester, St James's Hospital, Leeds, and the University of Birmingham.

A range of different cells, including those from inside the cervical canal, is needed to provide an accurate diagnosis but they found the Ayre's spatula was the least efficient device at collecting cells from inside the opening of the cervix.

If the smear is contaminated with blood or does not include the right types of cells, the cytologist cannot say for certain whether the sample is normal or abnormal.

The woman may therefore have to be recalled for a further test, causing unnecessary distress and expense to the health service.

Abnormalities missed

One of the report's authors, Professor Henry Kitchener, said: "Women could be having to be recalled in larger numbers and some abnormalities may be missed."

The report in the medical journal The Lancet says the Ayre's spatula is the least effective device for cervical sampling and should be replaced by extended-tip spatulas.

A spokeswoman for the National Screening Programme said: "We recommend in our guidelines that people use the extended-tip spatula based on evidence that it is better for harvesting cells."

But the British Society of Coloproscopy and Cervical Pathology said the best device to use depended on the individual woman and factors such as whether she had previously given birth or had undergone treatment.

Smear test accuracy questioned
The society's secretary, Patrick Walker, says the Aylesbury spatula, which has a modified head, was now usually preferred to the Ayre's version.

Mr Walker, a consultant gynaecologist, said: "The spatula of choice is that which will give you the greatest number of satisfactory smears for the greatest number of women.

"The Aylesbury is probably the best and increasingly it is in most common usage."

'Don't worry'

He said brush-like devices, which were highlighted in The Lancet study as being most effective in combination with an extended-tip spatula, were sometimes the most appropriate device.

A spokesman for the Imperial Cancer Research Fund said women should not worry too much about the problem.

She said: "As the revised guidelines on spatula use were issued two years ago, we would imagine that few, if any, of the unsuitable spatulas are still being used."

The Court of Appeal this week upheld the right to compensation of three women whose wombs were removed after smear tests carried out at Kent and Canterbury Hospital failed to detect cervical cancer.

E-mail this story to a friend

Links to more Health stories

Search BBC News Online

Advanced search options
Launch console

See also:
16 Nov 99 |  Health
Cancer compensation claim upheld
29 Jan 99 |  Health
Clampdown on screening failures
24 Feb 99 |  Health
Women lose confidence in smears

Internet links:

The BBC is not responsible for the content of external internet sites
Links to other Health stories are at the foot of the page.