The gynecologist's perspective of liability and quality issues with the Papanicolaou smear

Cytologic screening for precancerous lesions and cancer of the cervix and subsequent treatments of these lesions have been effective in reducing the incidence and mortality of cervical cancer. Gynecologists in the United States have used the concept of an "annual Pap smear exam" to encourage and provide health maintenance medical care for women. Inadvertently, women have been given the perception that Pap smears are highly accurate. Cervical cytology consists of specimen collection and interpretation of the cellular material, with potential errors in either component. The Bethesda System, the most recent classification, was not pretested prior to introduction. Consequently, management guidelines are continuing to evolve. A screening test should only assign a probability of disease in an individual. Ten percent of malpractice lawsuits against pathologists involve misread Papanicolaou smears. Quality improvements have been and should continue to be effective. The liability issue needs to be addressed through public education.