Can regulatory proficiency testing by the cytobureaucracy decrease both false negatives and cervical cancer deaths?

Cervical Cytologic Smear False Negative Fraction

“…This parallels the experience reported by Krieger and Naryshkin and others who claim that although FNFs may fall below 5%, they are unlikely to remain below this level: a 5-10% FNF may represent a "floor." [1][2][3][4][7][8][9]15,[18][19][20][21]24,32 A main cause of false negative smears not addressed in this or many other studies is the absence of abnormal cells on the smears themselves due to sampling problems. In this study we dealt only with false negatives due to either the misinterpretation of or failure to detect abnormal cells on the smears.…”

Toward Implementation of a Regional Quality Assurance Program in Cytopathology

“…[17][18][19][20] Data have shown that some cities in North America actually fell behind others in preventing cervical cancer deaths since the introduction of gynecologic cytology quality assurance programs. 17 However, use of the cervical cancer death rate as an indicator of the value of proficiency testing is far from being perfect, as the figure is significantly affected by a number of factors, such as education, sexual attitudes and shift in population. 21 Most interpretive false negatives that occur in routine practice are due to overlooking relatively small numbers of abnormal cells as a result of momentary inattention due to fatigue or obscuring factors rather than of unfamiliarity with diagnostic criteria.…”

“…One consumer group filed a lawsuit in the United States claiming that the format of one of the proposed cytology quality assurance programs was too loose in allowing too much time for slide screening. 17 However, if the time allocated is too short, it may become an additional stress factor for some participants and therefore contribute to errors, especially in more difficult cases. 25 …”

Accuracy of Liquid-Based Pap Tests

“…11,[22][23][24]38 The major factors contributing to the false negative CP are inadequate sampling of the transformation zone of the cervix, failure to detect abnormal cells and failure to correctly interpret the significance of abnormal cells. 1,7,13,16,20,27,39 Detection and interpretation failures are frequently due to cervical cells being clumped or overlaid with other cervical cells or inflammatory cells.…”