Smear tests: déjà vu

Editor—I refer to Goodman's review on cancer screening and misunderstanding by the media.¹ In an editorial on the rising risk of litigation in Pap smear interpretation, DeMay gives the following analogy: You are a firefighter. You arrive at a burning house and hear screaming. There are 10 people inside. You run in and save nine lives. Despite your best efforts, one person perishes. So, should you be cited for heroism—or indicted for homicide?²

The tabloids reporting the Leicester smear audit seem to have made up their minds in favour of the latter. They do not go on to explain exactly how the zero error standard can be achieved. Many of the improvements recommended after previous scandals were presumably in place in Leicester for at least part of the period covered by the audit. New technology has yet to prove itself in large trials. There are failures in all systems, and all we can do is attempt to reduce them but we are unlikely to eliminate them. As DeMay proceeds to say, not only are mistakes normal, they may even be necessary for the success of this screening test. Trying to eliminate these “mistakes” could make the test so costly as to be unaffordable.

The cancer czar should be congratulated for trying to defend the Leicester results, but I think that this is too little, too late. There have been numerous opportunities in the past to explain in simple terms to the public about the risks and benefits of screening.³,⁴ They are rarely exploited, hence yet another scandal.