Health: Cervical cancer laboratories deal with too few smears

One in five cervical cancer screening laboratories deals with too few smears to ensure accuracy. Jeremy Laurance reveals that Government guidelines on the minimum size of labs are being ignored, putting women at risk.
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Women whose cervical smears are processed in small laboratories are at greater risk of having the early signs of cancer missed because the screeners who check their smears have too little experience.

Official figures show that 33 out of the 181 laboratories in England are still screening fewer than 15,000 smears a year, 18 months after the health department announced this was the minimum number necessary to ensure screeners had sufficient expertise to detect abnormalities.

Last week Warwickshire health authoritiy announced it was re-examining the smears of 18,000 women after checks showed some that were abnormal had been missed. The mistakes have been blamed on the inexperience of the screeners at the laboratory at St Cross Hospital, Rugby which was processing fewer than 7,000 smears a year. The errors are the latest in a series of scandals that have rocked the cervical cancer screening programme. Earlier this month Frank Dobson, Secretary of State for Health, announced a national review of the breast and cervical screening programmes following disasters at the Exeter breast screening centre and at the Kent and Canterbury hospital cervical screening laboratory.

The 15,000 minimum number of smears for each laboratory was set in guidelines issued in March 1996 by Sir Kenneth Calman, the Chief Medical Officer. This re-iterated advice originally issued by the medical royal colleges, backed by a Government circular, in 1988. Health authorities were expected to exercise their financial muscle in the NHS internal market to achieve change.

Despite these instructions, the lab at the St Cross Hospital, Rugby, is the only one processing fewer than 15,000 smears a year that has since closed. Of the 34 small labs operating at March 1996, 33 are still in operation today.

Julietta Patnick, co-ordinator of the national service, said: "The St Cross lab was too small. They just weren't spotting the abnormalities."

She said proposals to shut smaller labs and transfer their work to larger ones had run into oppositon from groups who wanted to keep the work done locally. But no matter how good the screeners a small lab did not see a sufficient number of abnormal smears. "With small labs there is always a question about their casemix and their viability in terms of staffing and training."

The national review announced by Mr Dobson requires all health authorities and trusts to draw up an action programme by next February to ensure all screening programmes meet national standards. Ms Patnick said that despite the problems the screening service was saving lives and it was essential women did not lose faith in it. "We can't excuse what has gone on but the mortality and incidence are dropping like stones. The programme is working well but it could be better."

Cases of invasive cancer have fallen from 16 to 11.2 per 100,000 since 1979, exceeding the target of 12.8 to be achieved by 2000 set under the Health of the Nation strategy. The death rate has declined from 7 to 4.1 per 100,000 since 1979.