Biomedical Engineering Reference
In-Depth Information
and Allergy Research (Vårdalstiftelsen), and from the Board of Research for
Health and Caring Sciences, the Board of Postgraduate Education, and the
Division of Nursing, all at Karolinska Institutet.
Notes
1 Papanicolaou had initial diffi culties in gaining acceptance of his method. Casper
and Clarke (1998) claim that the adoption and widespread use of the Pap smears
relied on a number of initiatives, alliances and power struggles whereby the Pap
smear was made 'the right tool for the job' of cancer screening.
2 In the USA the fi gure is over 50 million (Bristow and Montz 2000).
3 Cytology refers to the study of cells, their origin, structure, function and
pathology (Dorland and Anderson 1993). In a cytology laboratory context, the
Pap smear constitutes
one
form of cytology out of several others (e.g. sputum,
bladder washings and breast cytology).
4 The personnel involved in the daily work with the cytology samples are: the lab
auxiliaries, the cytodiagnosticians (biomedical technologists with an additional
six months training), and the lab physicians (physicians with additional training
in cytology and/or pathology). The lab auxiliaries perform most of the routine
preparatory work with the cytology samples prior to and after screening and
diagnosis. In Sweden, the cytodiagnosticans' main areas of responsibility are
'preparation' and 'screening' of all cytology samples. They are responsible
for 'reporting out'
normal
cervical cytology. They are also responsible for
discovering, marking (with the marking objective) and suggesting diagnosis of
potentially abnormal cells. Thus, if there are any potential abnormal cells on
the microscope slide, the cytodiagnosticians are the ones who detect them. The
number of abnormal cells on a slide varies and can, in some cases, be only a
handful. The lab physicians are responsible for the fi nal diagnosis of all abnormal/
pathological cells, which they perform either individually (the private lab, here
called 'City lab', used this system), or together with one of the cytodiagnosticians
by the multi-headed microscope (the public lab, here called 'Cyto lab', used
this system which they called 'demm'). The choice of laboratories was based on
some initially known variations: (i) private ownership and county council run
laboratories; (ii) the size of the laboratories; and (iii) the number of cervical
cytology samples handled. In addition, according to the Swedish National Board
of Health and Welfare (1998: 42), there are signifi cant differences between
cytology labs in Sweden, concerning, for example, the proportions of deviant
samples, the number of dysplasias found, and the proportions of samples that
cannot be assessed. According to the National Board of Health and Welfare
(ibid.), the large differences in proportions of deviant samples depend on
divergences in assessment criteria. The two chosen labs varied in regard to all
points. In this chapter, I focus on the cytodiagnosticians and to a lesser degree
on the lab physicians. The analysed data represents different persons and both
labs. An exception here is the fi eld notes on the joint diagnostic sessions (which
was only used at the public lab: 'Cyto lab').
5 See for example
The Report of the Cervical Cancer Inquiry
(1988), and Coney
(1988) on the longitudinal study on women with abnormal cervical smears,
the aim of which was to prove that carcinoma in situ is not (invariably) a pre-
malignant disease, performed at National Women's Hospital, Auckland, New
Zealand. A more recent example comes from the United Kingdom (Houston
et al
.
2001) where an external re-screening of 81,000 cervical smears was undertaken
in the mid-1990s and where 3,469 women had to undergo a re-check after being
