“The Person Reading Your Sample May Miss The Abnormality”

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From a 12-page information leaflet about cervical screening on the HSE website

This morning.

In the The Times Ireland edition.

Journalist Catherine Sanz reports that the HSE have created new information booklets to accompany smear test invitations sent out to women.

Ms Sanz reports the booklets “will contain disclaimers and illustrated explanations of why abnormalities can be missed”.

Ms Sanz reports:

The new leaflets say: “Abnormalities may be missed because the person reading your sample may miss the abnormality. This happens occasionally no matter how experienced the reader is.” They also warn that abnormalities can be missed because “they do not look much different from normal cells” and “there may be very few abnormal cells in the sample”. The leaflet adds that, because cervical cancer takes many years to develop, any abnormal cells missed in one test can be detected in the next one.

Smear test can’t rule out cervical cancer, women told (The Times Ireland edition)

Information leaflet: About your free cervical screening (HSE)

Yesterday: “We’re An Easy Target, We’re Easy To Let Down”

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28 thoughts on ““The Person Reading Your Sample May Miss The Abnormality”

  1. Harry M

    Mind boggling that this was never communicated in the first place. Screening isn’t preventative medicine and does not state you are cancer free, nor could it. It’s risk reduction only

    1. Cian

      Smear tests, when done to international best practice, aren’t even particularly accurate. It is a great pity this wasn’t communicated before now either.

      1. millie st murderlark

        So WHY am I putting myself to such tremendous discomfort for a procedure which isn’t even that accurate?

        That’s enormously frustrating.

        1. username in use

          Because screening greatly reduces the number of people who die from cancer? The same reason you wear a seatbelt in a car, even though it’s not guaranteed to save your life.

        2. harry

          risk reduction through detection of early warning signs, and it has been massively successful (don’t know the stats but have spoken to the Irish cancer society)

        3. Cian

          80% of Irish women are going to Cervical Check (260,000 each year). 65,000 don’t attend.

          More women from the 65,000 who don’t attend will die of cervical cancer than from the 260,000 who do.

        4. Andyourpointiswhatexactly?

          As my doctor always says to me, “This won’t hurt, Andyourp. It’s like flinging a sausage up Patrick Street!”.

        5. Cian

          One other thing that is often overlooked is that there are also “false positives” – where a woman is told the results are positive for cancer – but she is, in fact, clear.

          This causes huge stress and the women may receive treatment that is unnecessary.

          If you test more frequently (annually) then you will reduce your false positives (a small number) but increase your false negatives (a large number). In the USA they tested annually for a while – but changed that to every 3 years when they realised that if you tested annually (from 25-60) there was an even chance that every woman would get at least one false-negative in her life!!.

          1. millie st murderlark

            It’s just for someone who takes their sexual health seriously and has been getting regular smears since the age of eighteen, it’s very frustrating to read that they’ve not even really that accurate after all.

            So what’s the point of having them if they aren’t fit for purpose? Is there not a more comprehensive or accurate test they can do?

            And I say this as someone who had uterine tumours removed because they were discovered at a smear test at the age of twenty, so I’m very well aware of the benefits of them.

          2. Orla

            So you know the benefits of having them? What do you mean by “not that accurate”? There’s data behind the accuracy. I don’t understand your complaint unless you were misinformed as to the accuracy by whoever carried out your smears.

          3. Cian

            There is a more accurate test available – the HPV test – however this still isn’t 100% accurate (Smear catches 15/20; HBV is 17/20).

            Cervical Check is going to be one of the first national screening services to use this test when it is rolled out (provisionally) next year. It was supposed to be done this autumn, but it was delayed for some reason.

            https://www.thejournal.ie/hpv-test-ireland-4245263-Sep2018/

  2. GiggidyGoo

    If abnormal cells ‘do not look much different’ and ‘there may be very few abnormal cells’, would that not indicate the need for further investigation? After all, if abnormal cells are present at all then the test isn’t clear?

    1. Andyourpointiswhatexactly?

      Isn’t the implication that they don’t see the abnormal cells, though? Therefore there wouldn’t be any further investigation as they’ve been missed as they look like regular cells.

    2. Cian

      I think what this means (and I’m making up the numbers):
      A. a slide may contain 1000 individual cells[1].
      B. in a clear slide all 1000 will be ‘normal’.
      C. the difference between a ‘normal’ cell and an ‘abnormal’ cell is small.
      D. on a positive slide, only some (5? 30? 50?) of the 1000 cells are ‘abnormal’ – the remainder are ‘normal’.
      if you look at 900 of the cells on a positive slide – it is possible that you happen to only see ‘normal’ cells. And then you say it is clear, and move on.

      Or imagine you are looking at photographs of people attending a match. There are ~1000 people in each picture. You need to spot the photographs where there are people with, say, moustaches (but full beards are ok). Faces with moustaches ‘do not look much different’ to those without. Moustaches aren’t that popular. Looking at the photo you will notice that some people’s faces are obscured – on others shadows look like moustaches (and vice-versa).

      [1] All cells are slightly difference sizes and shapes. On a slide some cells will be jumbled on top of each other (so you can’t see some/all of them clearly). Other areas on the slide may be empty. Some slides will have more cells than others. Other slides will have more clearly visible cells.

      1. Fact Checker

        You have displayed more statistical understanding than every single Irish journalist and politician – congratulations!

    1. Cian

      Then you get more false positives.
      If there are 100,000 women going for testing. 2000 have cancer. 98,000 don’t.
      25% of the women get a false negative [they have cancer, but it is missed] that is 500 women.
      5% of the women get a false positive [they don’t have cancer, but are told they do] that is 4,900 women.

      If you test every year what happens is:
      There are still 100,000 women going for testing – more frequently. 2000 still have cancer. 98,000 don’t.
      25%/3 of the women get a false negative [they have cancer, but it is missed] that is 167 women (we caught 333 earlier!) .
      5%*3 of the women get a false positive [they don’t have cancer, but are told they do] that is 14,700 women (an extra 9,800). These women will (unnecessarily) go on for more invasive testing and treatment.

      The benefit is
      * 333 women getting correct results!

      The costs are:
      * 200,000 additional tests (both the monitory costs for doctors & labs, but also 200,000 women ‘inconvenienced’).
      * 9,800 additional women getting anxiety & stress that the may have cancer!
      * 9,800 additional repeat tests + treatments + any complications from these
      * less faith in testing because of all the false-positive (which would lead to fewer people participating… leading to more deaths)

  3. Nally

    So what is the point of taxpayers money being spent if nothing is held account
    Let’s just abolish everything and save our money

  4. Nally

    i Wish we were as casual regarding someone slipping in a business premises when not watching what they did and save on personal injury claims

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