Bar News - September 22, 2006
Medical Malpractice Law - Cervical Cancer Cases from a Plaintiff’s Perspective
By: Randolph J. Reis and Kevin M. Leach
Since development of the Pap smear by Dr. Papanicolaou in the 1940s, cervical cytology screening has become the mainstay for early detection of cervical cancer. It has led to a dramatic reduction in deaths from cervical cancer.
Cervical cancer is among the most common cancers found in women in the United States. Approximately, 14,000 women will be diagnosed with invasive cervical cancer this year alone, according to research from the Cancer Resource Center of the American Cancer Society. Of these, almost 4,000 will die from this disease. This is especially tragic because if cervical cancer is detected early, the survival rate is nearly 100 percent.
Despite the excellent chances of survival by early detection, too many women have their cervical cancer diagnosis delayed when general practitioners and gynecologists fail to perform appropriate screening tests, when cytotechnologists and cytopathologists misread Pap smear slides, and physicians fail to take the necessary steps when cervical cancer is suspected.
Attorneys investigating these tragic circumstances should keep in mind the common failures associated with misdiagnosed cancer cases. These include: failing to order regular Pap smears, misreading Pap smear slides, failing to recognize common symptoms of cervical cancer, failing to follow up on test results, and failing to order a colposcopy. If such oversights can be corrected, many more women will have an excellent chance of being 100 percent cured of their cervical cancers and the unnecessary and tragic loss of life will be avoided.
Standard of Care
Proper medical care calls for the physician to test women for precancerous developments even in the absence of any symptoms. The intended outcome of cervical cancer screening is different from that of screening for other types of cancer. The primary goal is not to find cancer, but to find precancerous lesions.
For effective screening of cervical cancer, women should have regular cervical smears (Pap smear) and pelvic exams. Cervical smears consist of a scraping of a woman’s cervix from which pathology slides are prepared. These slides are then screened by cytotechnologists or cytopathologists for abnormalities.
To assist in the proper diagnosis, the Bethesda System was created in 1988 by the National Cancer Institute to standardize the terminology and reporting of cervical cytology. That system has been widely followed internationally. It defines terms and criteria for a satisfactory specimen, a normal slide, and various types and degrees of abnormalities on cytology slides.
If a slide being screened shows atypical squamous cells (thin, flat cells of the surface of the skin and cervix) of either unknown significance or of a high grade, the standard of care requires that a cytotechnologist direct that slide to a cytopathologist for additional review. Obviously, the correct interpretation of Pap smear slides is of critical importance in the screening process.
“Cancer of the cervix has long latency between dysplasia and invasive carcinoma, providing an opportunity for detection by routine screening,” according to Harrison’s Principals of Internal Medicine (2005). If abnormalities are detected when the disease is at a precancerous state, or when the tumor is small and there is little or no vascular involvement, it is highly curable. However, if a misinterpretation of a Pap slide leads to a delay in diagnosis and treatment, the predictable development and spread of cervical cancer will likely lead to its becoming incurable.
Discovery Key in Litigation
The attorney investigating the case should keep in mind that discovery can play an important role in the litigation of cervical cancer cases. Internal controls, reviews, protocol, history of false negative readings, employee qualifications, employee reviews, and regulatory history should be sought to help determine why an error may have been made at a facility reviewing Pap smear slides. However, the most critical evidence in a cervical cancer case is likely to be the slide itself. The slide(s) should be obtained and reviewed by a competent, objective, cytopathologist and cytotechnologist. Those reviewers will look for the proper classification of the slide(s) and any abnormalities under the Bethesda System. Among the abnormalities included in the screening process are such changes as a high n/c ratio (the size of the nuclei in relation to the cytoplasm of the cells), the color or shading of the nuclei, the borders of the nuclei, and evidence of inflammation without any sign of infection.
If a Pap smear slide was not obtained when it should have been, or if one was obtained but was misinterpreted, medical negligence may have occurred. Whether any such negligence proximately caused a precancerous or early cervical cancer to progress to an incurable stage will need to be addressed by a gynecologic oncologist. Since this is such a highly curable disease, it is a genuine tragedy for so many women to lose their lives to it each year.
Attorneys Randolph J. Reis and Kevin M. Leach, of Reis & Leach in Manchester, specialize in the practice areas of medical malpractice and personal injury cases. To contact them with your comments, e-mail firstname.lastname@example.org and email@example.com.