Did outsourcing of cancer testing sentence a woman with cervical cancer to death?

james toney

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I see you are one of those people who get taken in by the " single victim narrative ",
Dont worry there are a lot of you about!

You are wrong, why worry about a person that gloats about dead and dying women from the cervical cancer scandal.

Also...and just importantly, who quoted the "single victim narrative" about Cervical Cancer...was it in a legal case, media, or just from you?
 


redmonite

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You are wrong, why worry about a person that gloats about dead and dying women from the cervical cancer scandal.

Also...and just importantly, who quoted the "single victim narrative" about Cervical Cancer...was it in a legal case, media, or just from you?
I don't gloat over dying women, unlike a lot of people l despise our media when they use womens grief and pain to gain readers or viewers. What is wrong with discussing facts. If you are afraid of facts all you are doing is spinning.
I made three factual statements the blew apart the media misinformation about Cervical Check, if l have erred in fact please point it out.
 

james toney

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I don't gloat over dying women, unlike a lot of people l despise our media when they use womens grief and pain to gain readers or viewers. What is wrong with discussing facts. If you are afraid of facts all you are doing is spinning.
I made three factual statements the blew apart the media misinformation about Cervical Check, if l have erred in fact please point it out.
Calm down, you have already proved how nasty you are with #2,151 gloating over women's deaths.

Why have you not answered the question... who quoted the "single victim narrative" about the Cervical Cancer scandal...was it in a legal case, media, or just something you made up?
 

Ardillaun

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From what I've heard in the media about cervical screening, this would not alone result in more false positives, but would make 'negatives' virtually extinct. In other words, a huge proportion of subjects would have to be told 'well, we think your results is probably normal, but we can't be absolutely sure, so we can't give you the all-clear. Come back next month/year/ whatever and hopefully it'll be surer and clearer then'.
One would probably see more of the ASCUS and LSIL diagnoses - the milder abnormalities. Pathologists work hard to minimize ASCUS numbers which put patients in a grey, uncertain zone. This is the system used:


With the benefit of hindsight, Ireland might have introduced HPV screening earlier. It’s a bit odd that the US cytology labs involved didn’t suggest that Ireland follow their example with computer-based screening and HPV testing in addition to manual slide screening.

CPL is one of two U.S., and two Irish laboratories, that have provided Pap smear testing for the Irish cervical screening program since 2008. These screens have been performed through manual examinations of individual slides, without the benefit of computer-based imaging and a separate HPV test, which together comprise the clinical standard in the U.S. and many other countries for cervical cancer screening.
 
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Ardillaun

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At least we’re probably not going to hear the misleading term ‘absolute confidence’ being bandied about too much in the future when referring to cervical screening. The judges deliver a mild rebuke here to their colleague:

While the High Court’s use of the words” absolute confidence” to describe the proper approach “may have created more confusion than clarity”, it is clear all the relevant witnesses in this case had agreed a screener should not give a clear result in respect of a slide “unless they had no doubt but that the sample is adequate and did not contain any suspicious material”.
Both Cross and the Supreme Court failed to digest a really basic point; expert pathologists reviewing a particular slide involved in a lawsuit for as long as they like to find abnormal cells are not in the same position as cytotechnologists giving, say, ten minutes to each one. Unless the slides are given as unknowns to cytotechs in a routine batch to be reviewed in routine time only, performance below what the judges call here ‘the standard of approach‘ cannot be proved. It may have happened but a fair test is required to show that. There’s a reason multiple people are included along with the suspect in an identification lineup. Lastly, I don’t know if the fact that false-negatives are unavoidable in any cervical screening program, e.g. because abnormal cells weren’t sampled in the smear or because they were missed on screening, was acknowledged anywhere in the judgement. It should have been.
 
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Noble Guardian

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At least we’re probably not going to hear the misleading term ‘absolute confidence’ being bandied about too much in the future when referring to cervical screening. The judges deliver a mild rebuke here to their colleague:



Both Cross and the Supreme Court failed to digest a really basic point; expert pathologists reviewing a particular slide involved in a lawsuit for as long as they like to find abnormal cells are not in the same position as cytotechnologists giving, say, ten minutes to each one. Unless the slides are given as unknowns to cytotechs in a routine batch to be reviewed in routine time only, performance below what the judges call here ‘the standard of approach‘ cannot be proved. It may have happened but a fair test is required to show that. There’s a reason multiple people are included along with the suspect in an identification lineup. Lastly, I don’t know if the fact that false-negatives are unavoidable in any cervical screening program, e.g. because abnormal cells weren’t sampled in the smear or because they were missed on screening, was acknowledged anywhere in the judgement. It should have been.
in fact, as part of their defence quest had conducted a number of blinded reviews on the original slide in situations similar to what have been existed for the original reviewer. in those blind reviews a majority of the reviewers concurred with the original reading of the slide, suggesting that the the abnormalities that were seen were not as obvious as they were under a more detailed l medicoegal review.
However both justice cross and the supreme court discounted this blind review, which I thought was very unfortunate.
 

redmonite

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Calm down, you have already proved how nasty you are with #2,151 gloating over women's deaths.

Why have you not answered the question... who quoted the "single victim narrative" about the Cervical Cancer scandal...was it in a legal case, media, or just something you made up?
Ok James as you dont want to deal in facts, so be it. The " single victim narrative " is a devise the media use when the facts dont support a story. You should look out for it.
 

Ardillaun

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in fact, as part of their defence quest had conducted a number of blinded reviews on the original slide in situations similar to what have been existed for the original reviewer. in those blind reviews a majority of the reviewers concurred with the original reading of the slide, suggesting that the the abnormalities that were seen were not as obvious as they were under a more detailed l medicoegal review.
However both justice cross and the supreme court discounted this blind review, which I thought was very unfortunate.
I should have mentioned that. Cross didn’t seem to understand the crucial significance of the difference between a blinded cytology review and a review of the slides by an expert pathologist witness. It’s all the difference in the world. This point seems so obvious to me. If you want to assess whether a cytotechnologist failed to meet the required standard, you try and recreate the conditions which that cytotech was in when they read the slide, i.e. multiple cytotechnologists looking at the slide for the same time and with no knowledge of the patient outcome. Otherwise bias is inevitably there and the expert has to figure out what they would have thought if they didn’t know how the case turned out and, in addition, they were a cytotechnologist. Ideally, review should be blind, time controlled and conducted by multiple reviewers (separately, of course) who are peers of the original professional.
 
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redmonite

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I should have mentioned that. Cross didn’t seem to understand the crucial significance of the difference between a blinded cytology review and a review of the slides by an expert pathologist witness. It’s all the difference in the world. This point seems so obvious to me. If you want to assess whether a cytotechnologist failed to meet the required standard, you try and recreate the conditions which that cytotech was in when they read the slide, i.e. multiple cytotechnologists looking at the slide for the same time and with no knowledge of the patient outcome. Otherwise bias is inevitably there and the expert has to figure out what they would have thought if they didn’t know how the case turned out and, in addition, they were a cytotechnologist. Ideally, review should be blind, time controlled and conducted by multiple reviewers who are peers of the original professional.
I would of thought the fairest way of reviewing a slide would be to slip it into a group of slides going for routine reading, as you say to ask a reviewer " are there abnormal cells in this slide " is a completely different question to " there are abnormal cells in this slide, find them"
 

Ardillaun

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I would of thought the fairest way of reviewing a slide would be to slip it into a group of slides going for routine reading, as you say to ask a reviewer " are there abnormal cells in this slide " is a completely different question to " there are abnormal cells in this slide, find them"
Exactly. There’s the world of a difference there.
 

davidcameron

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I should have mentioned that. Cross didn’t seem to understand the crucial significance of the difference between a blinded cytology review and a review of the slides by an expert pathologist witness. It’s all the difference in the world. This point seems so obvious to me. If you want to assess whether a cytotechnologist failed to meet the required standard, you try and recreate the conditions which that cytotech was in when they read the slide, i.e. multiple cytotechnologists looking at the slide for the same time and with no knowledge of the patient outcome. Otherwise bias is inevitably there and the expert has to figure out what they would have thought if they didn’t know how the case turned out and, in addition, they were a cytotechnologist. Ideally, review should be blind, time controlled and conducted by multiple reviewers (separately, of course) who are peers of the original professional.
So is CervicalCheck's existence in danger?
 

Ardillaun

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So is CervicalCheck's existence in danger?
I doubt it. The good news about cervical cancer is that it will become a much rarer disease in the coming decades thanks to immunization. HPV testing of the specimen and additional computer-aided screening of slides should also cut the number of cancer cases missed.
 

Massey

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The big concern with the Cross judgement was the spill over to other screening programs , especially breast screening- I believe the supreme court decision has protected the other screening programs.

Why it upheld the Cross judgement with regards to cervical screening- really beggers belief.
 

Noble Guardian

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I believe the supreme court decision has protected the other screening programs
How? The principle of absolute certainty remains.
 

redmonite

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How? The principle of absolute certainty remains.
I think the screening programmes are safe, but only because it would be politically impossible to end them, the problem is however the cost, if we continue to pay out millions to people whom screening missed, then the money will be diverted from some other part of the health service. This will cost lives, but as we wont have names or pictures that won't matter.
 

davidcameron

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I think the screening programmes are safe, but only because it would be politically impossible to end them, the problem is however the cost, if we continue to pay out millions to people whom screening missed, then the money will be diverted from some other part of the health service. This will cost lives, but as we wont have names or pictures that won't matter.
Why do Dr Ciara Kelly and other physicians not consider that? There's nothing to prevent relatives of patients who would die because of the diversion of resources from speaking out.
 

Ardillaun

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How? The principle of absolute certainty remains.
Yes. Unfortunately, the judges of the Supreme Court seem to continue to support the principle behind ‘absolute confidence’, i.e. their ‘no doubt’ criterion. This issue should have been approached from the standard of care end - what is a reasonable standard for the profession? Even ‘no reasonable doubt’ would have been better, given that it is considered stringent enough for convictions in the criminal justice system. I’m not sure they really understand the human element in image interpretation and the inevitability of some degree of imprecision in every lab test. We’ll just have to see how this peculiar approach plays out with other screening programs. The conflict between the perfect and the good has been addressed by many authors. As Shakespeare put it, ‘Striving to better, oft we mar what's well’.
 
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redmonite

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Why do Dr Ciara Kelly and other physicians not consider that? There's nothing to prevent relatives of patients who would die because of the diversion of resources from speaking out.
Because you dont have a picture and a name , emotion trumps fact in our brave new world.
 


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