Observations From Pap Litigation Consultations

Abstract

Papanicolaou test litigation in the United States reflects widespread societal expectations that even occasional cervical screening should prevent nearly all cervical cancers in screened women. Scientific evidence clearly shows that these expectations are unfounded, especially for increasingly prevalent glandular cervical cancers and for more rapidly progressive cervical cancers in younger women. Reviews of Papanicolaou test slides involved in litigation repeatedly show 1 or more of 3 cytologic patterns: difficult-to-interpret abnormal glandular cell groups, difficult-to-interpret hyperchromatic crowded cell groups, and/or difficult-to-locate or -interpret abnormal immature metaplastic squamous cells. Multiple-slide blinded reviews, supported by professional organization guidelines, should be used to identify and differentiate culpable medical errors from factors primarily associated with the inherent limitations of human screening and interpretation. In the authors' opinion, remaining US cases of cervical cancer are most likely to be prevented or minimized by more widespread utilization of cotesting with US Food and Drug Administration-approved methods of liquid-based cytology and high-risk human papillomavirus DNA testing.