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Smear test errors leave women with heightened fear of cancer: Celia Hall reports on the psychological pressures created as a result of the blunder in Scotland

THOUSANDS OF women in Scotland were left wondering if they had cancer last night when it was disclosed that cervical smear tests taken up to six years ago could have been misread.

The Scottish Office stressed that 90 per cent of the women involved would not have to be recalled or re- tested, once their slides had been re- read. But experts warned that the anxiety provoked by the blunder would be far greater than the worry most women experience when simply waiting for their result.

Dr Jane Wardle, clinical psychologist at the Imperial Cancer Research Fund's behavioural unit at the Institute of Psychiatry, said: 'Women in Scotland who are found to be positive are going to be quite upset and will need sensitive and careful handling. With screening, it is important for health professionals to remember, since we are dealing with a healthy population, that they must make themselves responsible for the anxiety they cause. They have an obligation to minimise it.'

The mistakes in the Greenock area came to light when a woman was diagnosed with cancer of the cervix, despite a smear test that suggested she was clear of disease. The Argyll and Clyde Health Board admitted 'serious discrepancies' and a doctor has retired. An inquiry has been launched and 20,000 cervical tests analysed in the five years up to 1992 are to be re-examined.

But this is not the first serious problem with the screening programme. In Liverpool in 1987, 45,000 tests were re-examined and 911 found to have been wrongly diagnosed after a similar series of errors in reading results three years previously. The doctor had retired by the time the problems came to light. Lily Hopkins, one of the women involved, who set up a support group, said four women had since died of 'cervical or related cancer'.

At the Christie hospital in Manchester in 1988, a batch of 3,000 smear tests passed as clear were re- analysed and 60 found to be suspect. In the Oxford area in 1985, a woman died after doctors failed to tell her a 1979 smear test had been positive. Mrs Hopkins said last night: 'There is a very different feeling when you are told they have made a mistake. If an abnormality is picked up you feel bad, but if they have made an error and then they tell you, you feel as if you have been terribly neglected.'

As a result of these errors safety measures were put in place. Today everyone involved in reading the tests is examined 'blind' on 10 smears at least once a year.

Only a small percentage of the women who are recalled for another test in Scotland will have 'abnormal cells' or cancer. Most will be recalled because the original test will not be readable.

Dr Elaine Farmery, chairman of the national co-ordinating network of the NHS Cervical Screening Programme, said the Scottish problems had come to light 'because of the External Quality Assessment Programme had worked'. She added: 'This was a very small isolated unit and the problem was found out. Women can be truly assured that the screening programme is good.'