Screening detects disease, therefore screening must be good.
That simple mantra is, sadly, far from true, as the latest
errors in cervical-smear screening programmes become apparent.
Poor performance at the Kent and Canterbury Hospitals NHS Trust
in the UK is one of the worst examples in a series of setbacks
that have bedevilled such programmes since their inception in
the late 1980s. 91 000 cervical smears collected during 1990-95
and examined in Kent were rechecked: 333 women at high risk of
progressing to cervical cancer (which would have led to
immediate follow-up) had been told their smears were normal.
Eight have died of cervical cancer and 30 have undergone
hysterectomies. Unsurprisingly, many are seeking legal advice
with a view to compensation. Detection of abnormal cells on the
screening smear would have led to repeat testing, colposcopy,
biopsy, and treatment, when appropriate. Therein lies the
dilemma in any screening programme. The “correct answer” is that
some proportion of the results will be i