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1 in 4 women not getting proper care after abnormal Pap tests

One in four women who have an abnormal Pap test do not get any follow-up care, an Ontario study reveals.

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One in four women who have an abnormal Pap test - meaning they may have cervical cancer - do not get any follow-up care. And even those getting care are not getting it promptly, new research shows.

Dr. Rachel Kupets, a surgical oncologist at Sunnybrook Health Sciences Centre in Toronto, said having large numbers of women "falling through the cracks" is undermining screening programs. "We know we can save lives when we detect cancers but if there is a lack of adequate follow-up, then we're only fighting half of the battle," she said.

The research, published Wednesday in the medical journal Gynecologic Oncology, involved 43,792 women in Ontario who had a first-time, abnormal Pap smear between 2000 and 2005.

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A total of 1,195 women were diagnosed with cervical cancer and 559 with endometrial cancer.

A Pap test is a procedure in which cells are scraped from the cervix using a small paddle and then examined in a laboratory. If abnormalities are detected, a woman should undergo follow-up testing, such as a colposcopy, in which a lighted magnifying device is used to view the cervix.

Dr. Kupets and her team found there were significant delays between Pap testing and colposcopy - 13 to 24 weeks on average - and then it took another three to 26 weeks for a cancer diagnosis (or a clean bill of health).

Along the way, 26 per cent of the women got lost in the shuffle and had no follow-up testing.

The researchers found a variety of underlying problems, including: a lack of consistent language in pathology reports; an absence of clear guidelines for managing women with concerning results; long lag times for follow-up testing; and the fact that cervical screening programs are not integrated and connected to other levels of care.

"If we are going to put efforts into screening, we need to ensure there is a system in place to care for patients from the discovery of an abnormality through to diagnosis, treatment and recovery," Dr. Kupets said.

In 2011, an estimated 1,300 Canadian women will be diagnosed with cervical cancer and 350 will die as a result, according to the Canadian Cancer Society (CCS).

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Cervical cancer is caused principally by infection with human papillomavirus (HPV). There is now a vaccine to protect against HPV infection, but women are still urged to undergo Pap testing.

The CCS currently recommends that, once a women becomes sexually active, she should have a Pap smear every one to three years, depending on test results. However, that will likely change in coming months to reflect recent new scientific evidence.

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About the Author
Public health reporter

André Picard is a health reporter and columnist at The Globe and Mail, where he has been a staff writer since 1987. He is also the author of three bestselling books.André has received much acclaim for his writing. More

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