Question

A 52 year old woman attends for a cervical smear test. Her doctor later contacts her and asks her to return because the smear was abnormal. The doctor recommends colposcopy, that is endoscopic examination of the cervix and vagina, but is unable to say whether the result of the smear showed pre-cancerous changes or not – in fact the concern may be technical. The woman is extremely concerned and not especially reassured that it may be a false alarm.

3a) What is the purpose of cancer screening in general?

3b) A proposal is put forward for a new screening programme. List as many criteria as possible that should be considered in deciding whether the new screening programme should be implemented.

3c) What controls and checks would you wish to see developed for the new screening programme?

3d) What medicolegal problems does a screening program raise?

Answer 1

Screening helps to detect cancers early even before they cause symptoms.E arly detection is important because when abnormal tissue or cancer is detected early,it is easy to treat than in advanced cases where metastasis occurs.

3b) various criteria considered for implementing a new screening program are -

the approach: screening programs uses one of the two approaches-a) Opportunistic: screening is done as a routine care when patient visits doctor.

b) population targeted for screening are actively identified and are then invited for the screening process.

the disease:oppurtunities for early effective intervention depend on the natural history of the disease.

the test:in this the performance of the screening test is evaluated by considering sensitivity,specificity,positive predictive value and negative predictive value.

. the cost:the cost effectiveness of the program is calculated.it includes the cost of test itself,cost of interpreting the test,cost of follow up tests,c post of program management and data processing,cost of treatment.

  the quality: Randomised controlled trails provide the evidence of effectiveness of the program.

The final appraisal of whether or not to introduce a screening program should ask whether sufficient level of quality can be achieved at least reasonable cost.

3c)the above criteria should be considered and goals should be set for a new screening program.contious monitoring ,feedback and interventions should be followed for the program to be effective.

3d) Testing and interpretation:this involves misreading or misinterpretation of the test results or pathology slides.

Assessment:this is most frequently associated with diagnostic issues.t he issues were failure or delay in performing a specific procedure or test when indicated or failing to refer the patient to a consultant

Managing follow up:it includes failure to follow up on test results , failure or delay in referring the patient to specialist, or arrange for further testing.