Prior to 1940, cancer of the uterine cervix was the leading cause of death from malignancies in women. Fortunately, there has been a dramatic reduction in the mortality from cancer of the cervix. Today, cervical cancer ranks sixth in cancer mortality. Most of this decline can be attributed to the early detection and treatment of lesions of the uterine cervix.
It is now well accepted that in virtually all cases intraepithelial neoplastic changes precede invasive cervical cancer. Intraepithelial neoplasms are pre-cancerous lesions and over the years have been variously called dysplasia, CIN, squamous intraepithelial lesions and carcinoma in situ (CIS). Fortunately, these pre-cancerous lesions can be evaluated by cervical cytology, often referred to as PAP smears. PAP smears are the best screening test available to detect pre-cancerous lesions. That is why the standards of care in gynecology dictate that PAP smears be performed on a yearly basis. The PAP test or PAP smear checks for changes in the cells of the cervix. There is no age limit for the PAP test. All sexually active women, no matter what age, should have an annual PAP test. Even if not sexually active, every woman 18 years and over should have a yearly PAP test. If the PAP test detects abnormal cells, close monitoring by a gynecologist is required.
Pre-cancerous cervical lesions are graded. Low-grade lesions often regress on their own. Mild pre-cancerous lesions also can regress spontaneously or they can remain stable for many years. Nevertheless, they should be followed very closely. Although severe lesions can regress on their own, this is uncommon. Another kind of abnormal PAP test is known as atypical squamous cells of undetermined significance (ASCUS). If your PAP test reveals any pre-cancerous lesions or ASCUS, it is extraordinarily important that it be monitored frequently and when necessary treated. When pre-cancerous lesions are destroyed before they become cancerous, invasive cervical cancer can be avoided.
There are many treatments for pre-cancerous and cancerous lesions of the cervix. Colposcopy is useful for not only identifying lesions but for treating pre-cancerous lesions as well. Cryosurgery, CO2 laser oblations, loop electrosurgery and cold knife conization may also be used to treat pre-cancerous lesions.
Cervical cancer malpractice claim frequently arise from errors interpreting PAP smears and from errors interpreting biopsies of the cervix. In addition, many cases arise as the result of gynecologists failing to properly follow and treat pre-cancerous and cancerous lesions. There is no question that when pre-cancerous lesions are discovered they can be treated and cures can be effected. Unfortunately, errors are made interpreting PAP smears. Either pre-cancerous lesions are totally missed by the cytotechnologist and pathologist or they are under-diagnosed. When this occurs a woman is essentially deprived of treatment of these pre-cancerous lesions. In addition, when biopsies are taken of the cervix, pre-cancerous and cancerous lesions can be negligently overlooked, again depriving a woman of cures for cervical cancer. Because of present day technology, it is virtually inexcusable for a woman who has had yearly PAP smears to ultimately end up with invasive cervical cancer. It is also inexcusable for pre-cancerous lesions and cancerous lesions to be overlooked on pathologic examination of biopsies. It is further inexcusable for a gynecologist to fail to properly monitor and treat pre-cancerous and cancerous lesions.