Quality and liability issues with the Papanicolaou smear: the role of professional organizations in reform initiatives.

The professional societies of cytotechnologists, cytopathologists, and general pathologists have recognized growing problems that attend medicolegal issues in gynecologic cytology practice. Current trends imply two factors may soon adversely affect society's effort to stop deaths due to cervical cancer. First, the cost of gynecologic cytology services may rise sharply owing to extraordinary increases in the cost of malpractice coverage and the expenses entailed in growing quality assurance programs. Second, many practitioners and institutions may seek to avoid gynecologic cytology practice altogether as the malpractice burden increasingly becomes intolerable. The result of these trends would be increased numbers of deaths from largely preventable cervical carcinomas. After outlining these and related issues, this article seeks to provide some educational and medicolegal suggestions for concerted action by our societies. The goal remains unaltered from the time when Papanicolaou tests were new; we have the most effective cancer prevention screening tool ever devised and must make it widely available to all who may benefit from it.