Most women assume that if their Pap test comes back abnormal, the health system will protect them. But a new study finds that more than one quarter of women with abnormal results never gets followup care.

It's a worrying finding, since an abnormal test result suggests that cells on the cervix are changing and cancer may be beginning to grow. If the cells are cancerous and they are left untreated, the cancer can spread, resulting in a hysterectomy, or even death.

For the study -- the first of its kind in Canada -- researchers at Sunnybrook Health Sciences Centre's Odette Cancer Centre in Toronto looked at 43,792 women who had a first-time, abnormal result following a scheduled Pap test.

The women were followed for a period of up to two years to determine how their cases were managed.

The researchers were stunned to find that 26 per cent of the patients never went for a follow-up test, called a colposcopy, to determine whether the abnormal cells spotted by their Pap smear were cancerous.

The study's lead investigator, Dr. Rachel Kupets, a surgical oncologist with Sunnybrook's gynecology cancer care team, says she was troubled by the findings.

"I was quite surprised by the high level of loss to follow-up," she told CTV News.

"These women were not getting colposcopy services, they were not getting hysterectomies, or any procedures to eradicate their precancerous changes."

The study wasn't able to determine where things broke down: whether their doctors were not getting the results; whether they were not referring the patients for further tests; or whether the women were not showing up for the follow-up tests.

Kupets says there needs to be a review of the system to see how it can be improved so that affected women get the further care they need.

Treating precancerous cervical lesions is crucial, since the cells sometimes progress into cancer. For some, that progression is slow and takes years. But for others, it's a different story.

Shelley Withyma knows how fast cervical cancer can take root. Just over a year ago, her Pap test came in normal. Then, 12 months later, things had changed for the worse.

"Within that year I went from have a normal Pap smear to having cancer," she told CTV. "It was a really big shock."

She quickly underwent surgery to remove the cancer. But this study found many women may not be so lucky.

The researchers found that those women who did get a referral for a colposcopy waited up to six months for referral. The average time to diagnosis of cervical cancer was between 3 to 26 weeks.

Kupets says that kind of wait time is unacceptable, given that as many as three per cent of Pap tests reveal full-blown cervical cancer.

"There is a risk that women may develop cervical cancer over such long periods of time and women with cervical cancer can progress into more serious cancers," she says.

Kupets says she launched the study because she wanted to know why there were still so many women coming into her clinic being diagnosed with advanced cervical cancer, even with the wide availability of the Pap test.

"It is very frustrating to see that we have a test to prevent cervical cancer, and despite all the technology, women still develop a preventable disease," she says.

The study, published in the June issue of the journal, Gynecologic Oncology, includes a number of recommendations to improve the care for patients with abnormal results. They include:

  • developing consistent language for pathology reports, so that doctors don't misunderstand abnormal results
  • establishing guidelines for managing women with concerning results
  • expediting appointments for more investigative tests
  • adopting screening programs that are connected to other levels of care

"We have to do a better job, as physicians, as the community," says Kupets. "It takes many components to make a successful outcome in health."

With a report from CTV medical specialist Avis Favaro and producer Elizabeth St. Philip