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Tragic cancer case a big worry for health officials

A woman surnamed Yeh, accompanied by Taipei City Councilor Lin Yi-hua, left, and her friends, holds a press conference yesterday to condemn the free pap smear tests provided by the government. PHOTO: SEAN CHAO, TAIPEI TIMES

A 47-year-old woman surnamed Yeh (葉) who followed provided health advice that cervical cancer could be detected in its early stages by having a regular pap smear test, and had had two screenings with normal results was diagnosed with advanced cervical cancer just two months later.

Sitting in a wheelchair and wearing a mask, Yeh, who has just finished a chemotherapy course after being diagnosed with cervical cancer in July, questioned the professionalism and effectiveness of the free pap-smear screenings the government provides.

"I was relieved after the results of the screenings came back negative. I just don't understand how I could have had advanced cervical cancer when the screenings showed that there was nothing wrong ... How can I trust the government again?" she said.

During a press conference held to tell Yeh's story, Taipei City Councilwoman Lin Yi-hua (林奕華) said that while both the central government and the city government provided free pap-smear services at all hospitals, clinics and mobile medical centers, this incident raised the question whether the quality of the health screening is good enough.

"We want to know how she could develop cancer in such a short time? Were there mistakes during the sampling process? Or was a wrong diagnosis made by the doctor?" she said.

Yeh completed a pap smear test at Da-an (大安) District Hospital last year, and did another at a mobile testing center provided by the Taipei Women and Children's Hospital this May. Both results showed no sign of cervical cancer.

According to the test in May, the result was "normal," although it noted there was "too much blood," and "another pap-smear in three months is recommended."

The hospital, however, only sent a card to inform her of the "normal" result, and it did not include the notes until Yeh's family asked the hospital to provide them after she found out she had cancer.

Taipei Municipal Hospital's obstetrics and gynecology doctor, Yu Jian-ren (余堅忍), said that because Yeh had previously had a Cesarean Section, it may have caused the contraction of her cervix and therefore the test sample would contain more necrosis cells, which would make it much harder to detect pathological changes. On the other hand, if the diagnosis noted that there was "too much blood" in the result -- a warning sign of cervical problems -- the doctor or the hospital should have informed the person about the potential danger.

"But pap-smear screening only has a sensitivity rate of about 87 percent, so there is always a possibility that the test failed to detect the cancer," he added.

The Taipei City Department of Health acknowledged that the medical institutions which provide the smears could provide a more detailed report, instead of a simple card. Whether the hospital or the doctor should be punished over the incident depends on further investigation, they said.

Lin suggested that the government should inform people about the margin of error for pap smears. To raise the effectiveness of cervical cancer screening, it would be much more effective to do a HPV test along with each pap smear, she said.
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