A Pap smear is a simple test that should be done at the time of your routine pelvic examination. When the doctor is doing the internal examination of the female organs, he should also perform the Pap test, which involves taking a scraping of cells from your cervix and placing the cells on a slide for later microscopic examination. Pap tests can find infections and identify abnormal cells even before they become cancerous. Timely treatment can prevent cervical cancers from developing, or allow for treatment in the early stages, which prevents the spread of the cancer.
The current standard for performing Pap smears is:
If you are at a high risk for developing cervical cancer, you should have a yearly Pap test, no matter how old you are. Conditions that place you in the high risk category include:
Other possible risk factors:
1. Pap smears are not performed:
If your gynecologic needs are managed by a specialist, a gynecologist, they tend to obtain studies like Pap smears routinely, as per recommended safe standards. However, many health insurance plans do not permit the use of specialists, like gynecologists for routine care. This is where many balls get dropped. Providers who are not familiar with standards for all the health maintenance examinations required for the variety of patients they see, may fail to perform a Pap smear out of his lack of knowledge that it is his duty to do so.
Some offices routinely over-schedule patients, or are working short-staffed, or the patients scheduled have unusually complicated needs and problems, so the physicians may take shortcuts in their examinations. Skipping a pelvic examination is a real time-saver, but may be a shortcut that poses serious hazards to patients.
2. Pap tests are done improperly:
Obtaining a proper Pap smear requires that clinician have special skills and follow guidelines to collect an adequate sample. The sample must contain particular samples of cells from the cervix, and the sample should not be contaminated with blood or infection. If a sample does not contain the required components (ectocervical and endocervical) and/or has other cells contaminating the slide, then the pathologist must note that the specimen is not adequate, and communicate this back to the person who sent him the sample. In this event, in order to have a useful sample, the Pap smear must be obtained a second time.
3. Abnormal laboratory reports are miscommunicated or misfiled:
When an inadequate sample is taken, or if a serious abnormality is found, the pathologist or technician examining the sample must convey the finding to the provider who ordered the study, who must communicate the need to recall the patient to the scheduler, who must reach the patient and communicate a need to return to the physician's office to have the Pap smear repeated. There are many steps in this process where errors may occur.
All of the facilities involved must have procedures in place to assure that the patient receives the message and returns for appropriate follow-up testing. Failures on the part of the diagnostic laboratory where the Pap smear slide was examined, and/or your provider's office have resulted in failures to recall patients for necessary follow-up.
4. Pap tests are misread by laboratories:
While reading your slide might be the most important thing in your
life, your slide is probably one of hundreds more like it in the day of a
cytotechnologist, the person who is largely responsible for the interpretation of the
slide. Only if the tech perceives something awry does s/he call in the
pathologist for closer scrutiny.
Quality control at these laboratories, such as their hiring qualified technologists and pathologists, in making certain that they only review so many slides, and for a short enough period of time so as to not lose concentration, is directly related to the number of errors made.
Procedures for reporting abnormalities and verifying that the provider gets notified is equally important to verify that red-flagged specimens get appropriate follow-up. Yes, mistakes happen, but fewer mistakes happen when facilities hire adequate numbers of well-trained professionals, and when they have policies and procedure in place. Further, it is not just a business, it could be your life or your health. Laboratories have a duty to care for your specimens as if your life depended on it.
The most common allegations of negligence in cervical cancer cases include your physician or medical provider's failures:
Failing to follow established cervical cancer screening guidelines;
Failing to take a good history to discover if you have signs and symptoms suspicious for cervical cancer;
Failing to perform pelvic examinations with routine health maintenance examinations;
Failing to perform appropriate testing for reports of bleeding between periods, unusual vaginal discharge; painful sexual intercourse; pelvic pain.
Failing to perform additional testing, like colposcopy (using a scope to directly visualize the cervix) or biopsies, as indicated;
Failing to perform timely and appropriate interventions to treat abnormalities;
Failing to schedule high-risk patient follow-up at appropriate intervals;
Failing to educate patients and support them to avoid complacency;
Failing to recognize warning signs in high risk patients;
Failing to prescribe additional diagnostic testing, for equivocal or suspicious test results;
Failing to order a follow up Pap in 6 months, if indicated by prior suspicious findings.
Problems that result from failures within the laboratory that examined and reported on the findings on the Pap smear include:
Failing to properly examine the slide, hence missing noteworthy findings;
Failing to report inadequate sampling or abnormalities, so that proper follow-up can be provided;
Mix up slides which
leads to reporting another patient's findings to you.
Diagnostic delays can lead to significant injuries and a worsened prognosis that may have been avoided had the abnormality been diagnosed and properly treated in a timely manner. What could have been treated with a local excision of abnormal tissue may require a hysterectomy, radiation and chemotherapy if the diagnosis was delayed. A late diagnosis may deprive you of a chance for a cure. Delayed diagnosis and treatment of cervical changes can be life-changing and even deadly.
If you fear that substandard medical care or outright errors resulted in a delay in detecting your cancer, or caused complications in your cancer care that hurt your chance of recovering, I will look at your case free of charge, and tell you if you may have been the victim of medical malpractice. If your case is outside our jurisdiction, we can help you to find skilled and ethical counsel in your area.
Mark R. Bower, Esq
Law Offices of Mark R. Bower, PC