Failure to diagnose cervical cancer: what went wrong?
Ms Helena, a 35-year-old secretary whose last smear three years ago was ‘normal’, presented for rescreening as scheduled. Her case record reveals a past history of recurrent vaginal discharge from trichomoniasis. She had one episode of post-coital spotting two months ago but did not take any action as it did not recur.
On speculum examination, the doctor noted the presence of a raised 1.5 cm irregular lesion on the anterior lip of a bulky cervix. The lesion had bled when the doctor was taking the smear. He had warned Helena that she might have spotting over the next few days. The smear was later reported as being unsatisfactory for evaluation due to the presence of blood and inflammatory cells.
At follow up a week later, the doctor reassured Helena that she has ‘only got inflammation’. He then scheduled an appointment for a repeat smear three months later.
However Helena continued to have irregular bleeding and spotting over the next one month. She was advised by friends to see a gynaecologist directly. A diagnosis of cervical cancer confirmed by biopsy was then made.
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Cancer screening. MOH Clinical Practice Guidelines. 1/2010.
Ministry of Health Singapore; 2010.