Warning over reliance on US cancer tests
Doctors are being forced to make judgment calls on cervical smear tests analysed in the US putting thousands of women at risk, a leading health lobby warned today.
The Dublin Well Women’s Centre criticised the health service for sending tests to private labs in Chicago and Texas as it tries to reduce waiting times for results.
It claimed methods of analysis differ in the US and Irish doctors were being forced to interpret test results without proper guidance, leading to the threat of mis-diagnosis.
Well Woman issued the warning following the release of its 2006 Annual Report, which contains an analysis of 37,000 smear tests taken at three Dublin clinics from 2002 to mid-2006.
The report revealed the majority of abnormal results came from medical-card holders and those on low-incomes.
“While we welcome the fact that waiting times for smear results have fallen in recent months, the vastly different method used in reporting those results is an issue of concern for us,” Well Woman’s chief executive Alison Begas said.
“Effectively, US laboratories speak a different language and our doctors are being forced to translate from one system to another, without enough guidance. This compromises doctors and patients, and could result in a potential abnormal result slipping through the net.”
Until recently women’s smear tests were sent for analysis to the Royal College of Surgeons Ireland.
But Well Women said the Health Service Executive (HSE) began sending tests to private labs in the US to shorten the length of time patients had to wait for results.
“With the impending roll-out of the national cervical screening programme, it is unsustainable to outsource tests without an extensive training programme of our doctors in the US-reading method,” Ms Begas said.
“This method is based on a presumption that women have annual smears, whereas in Ireland, women are only routinely tested every three years. Such discrepancies would also need to be considered if outsourcing was sustained.
“Ultimately, a proper infrastructure of accredited laboratories needs to be developed in Ireland to ensure that the national cervical programme is credible and clear cut, for both women and doctors.”
More than 80% of those tested in the four-year study, aged between 25 and 40, were given the all-clear.
Of those with abnormal test results, the majority were medical card holders and from low-income backgrounds.
The report revealed the Well Woman’s Coolock Clinic had higher referral rates than its clinics at Liffey Street and Pembroke Road.
When further analysed, it found the highest referral rate for hospital tests was among medical card patients.
“Approximately half of the women attending Coolock have a medical card. When figures are broken down, it became apparent that those on the general medical service have a significantly higher rate of referral than private patients, even those from the same geographical location,” said Ms Begas.
“There may be a number of factors affecting this outcome.
“The Human Papilloma Virus (HPV), which causes cervical cell abnormalities, is more prevalent in women who are smokers. It is also more prevalent across groups who experience sexual intercourse at an early age.
“From our experience at Well Woman, both of these are factors across low income groups.
“Poorer immunity, resulting from poor diet, is also a contributing factor to low resistance to HPV.
“Better access to sexual health education would be a starting point in addressing the higher prevalence of HPV among low income groups,” she said.
