Taking Control of Your Pap Test
With increasing attention to cost effective medical practice, it is
important for women to keep a close eye on the quality of their Pap
tests. Every laboratory test will have a margin of error, no matter
how perfectly all the health providers perform their jobs. It is due to
the inherent limitations of the test. So, it is not always the lab's fault
when a test result is incorrect. What it is important to look out for
and guard against is an increase over this natural rate of error.
Types of Laboratory Errors
There are two basic types of errors in laboratory results. The first
type of error, is called a 'false positive'. That is when the test
reports disease when, in reality, there is none. This mistake may
cause some emotional distress and unnecessary follow-up testing.
In the case of the Pap test, this is relatively harmless. A false
positive does not result in the woman being told she has cancer
and has to have surgery. Rather, she is told she has some slight
irregularities in her test. She will need to have a repeat Pap done
sooner than routine, or an office procedure.
A 'false negative' result is what women fear. That is when the test
reports no disease when, in fact, there is a cervical cancer
growing. Cervical cancer is a very slow growing cancer and
extraordinarily easy to cure, in its early stages. A high rate of false
negatives will needlessly cost women their fertility, their bodily
integrity, and their very lives. It is estimated that up to 20-40% of
Pap tests may be falsely read as negative, when the natural level
of error is only 5%. There are many factors that contribute to
unnecessarily high false negative Pap test rates. Poor laboratory
readings are just one. Here's what they are and what you can do
Taking Control of Your Pap Test
Getting an adequately read Pap smear starts long before the sample gets to the lab.
If You Have a Choice, Choose a Woman-Friendly Health Benefits Provider
Compare the benefits of various insurers. Look for an insurer or managed care plan that:
Make sure your health provider is experienced in taking the pap test. If the sample is not taken correctly, no lab will be able to give you a good reading.
- Covers first routine mammogram by at least age 40
- Covers Birth Control
- Allows women to see an Obstetrician-Gynecologist without referral from another primary physician
- Has two days routine hospitalization for delivery and four days for cesarean
- Covers nurse-midwives
There are health care providers other than Obstetrician-gynecologists, who are likely to be experienced in taking the Pap test. These are, Family Practice doctors, nurse-practitioners, nurse mid-wives and primary care physicians, who have completed a course in Advanced Pelvic and Breast exam, like the one offered by AMWA.
It was the experience of one female physician to have her annual Pap test done by a pediatrician. Her HMO's policy was to assign the annual exams to the next available primary care doctor. She had to walk him through it because he'd forgotten the details of the procedure! Practice really does make perfect.
Ask your intended provider how frequently s/he does the exam and what extra training s/he has, if s/he is not an obstetrician/gynecologist.
Ask About The Techniques
Two of the most common reasons for a false negative test are the
failure to correctly take samples and the failure to immediately
apply chemical fixatives to the sample.
Taking a sample of cells from an area of the cervical os (the
opening to the uterus) called the squamocolumnar junction is
essential for the best results possible. Doing so correctly drops the
rate of false negatives dramatically. This area is best sampled with
a tiny brush-like swab. Ask your intended provider if s/he uses this
type of instrument before you make an appointment.
Also the chemical fixatives should be applied immediately to the
slide once samples are taken. If they sit around long enough for
them to air dry, the samples will become distorted.
Make sure your slide has been labeled to identify it as yours,
somehow, before you leave the exam room.
Ask your provider what s/he thinks of the lab your insurance wants
to use. Once you've got a good plan and a good doctor/provider
the easiest way to check on the quality of the lab where your
sample is being tested is to ask your doctor/provider. Your
provider will know whether or not there has been a history of an
unusually high number of inaccurate results. Ask your doctor where
s/he sends lab work when s/he has a choice. Ask if your provider
has faith in the particular lab in question. If you can afford it, it may
be worth it to pay for the cost of having the test read at a lab you
Check Out the Lab
HMOs often give laboratories large volumes of business in exchange for lower rates. In order to read this large volume of tests with a small payment; labs sometimes have their workers reading more tests, more quickly than they should. Mistakes can result. Federal law dictates standards for laboratories. This includes both qualifications for lab personnel and limits on how many Pap tests a full-time work can read. In theory, this is supposed to protect women. In reality, violations of these standards still occur and errors result.
Checking the labs yourself is a very time-consuming task and is best done as a project of a women's or health consumers group. The Clinical Laboratories Improvement Act is enforced by the Department of Health and Human Services. This is an agency of the federal government that inspects labs. With the help of your group you can check to see the following:
Go for Pap Tests Frequently
- Has the lab been cited for violations and if so are the citations related to Pap tests?
- See if the lab is approved for Medicare and Medicaid recipients.
- Has it been approved by the American College of Pathologists?
- Have your group check and see if there have been any lawsuits filed against the lab and why.
Go for a Pap test at least once a year. If you have special risks or circumstances, or previous questionable tests, your doctor may recommend more frequent testing. This is by far your best defense against all types of errors that can occur. Remember that every negative Pap test result you get back has a 5% chance of being a false negative simply due to the inherent limitations of the test. Cervical cancer takes about a decade to spread to life-threatening levels. If you go every year, even if you do have a false negative test, for any reason, there will be several other chances to catch the problem in plenty of time to cure it.