Obstetrician says he warned about smear test outsourcing 10 years ago

Sam Coulter-Smith calls for urgent review of outsourcing of Irish tests to US companies

Sam Coulter-Smith.  Photograph: Eric Luke

Sam Coulter-Smith. Photograph: Eric Luke


A former master of the Rotunda Hospital has called for an urgent review into the outsourcing of smear tests to the US in the wake of the cervical cancer screening controversy.

Sam Coulter-Smith said he warned the government a decade ago against testing being moved to private companies overseas, because he was worried that resulting problems would mean cancer cases being missed.

The leading obstetrician and gynaecologist said screening systems vary from country to country with different medical terminology used. The time differences and the distance between medical staff and analysts also concern him and other doctors.

“There is an issue of Americans using completely different nomenclature – they use different wording to describe smears and abnormalities,” he said.

“There were always going to be issues in relation to translating between the two services.

“Also there is a need for multidisciplinary team meetings to discuss various degrees of abnormality. If you are trying to organise those multidisciplinary team meetings across multiple time zones, via video link, that creates its own technical difficulties as well as the language.

“When you put all of that mix together it is not altogether surprising that there were issues in relation to quality assurance.”


In 2008, the National Cancer Screening Service first awarded the contract to analyse 300,000 Irish smear tests a year to US firm Quest Diagnostics.

Two years later, Clinical Pathology Laboratories, based in Austin, Texas, won a bid to provide laboratory services for CervicalCheck, the national cervical cancer screening service.

Terminally-ill Vicky Phelan (43), from Limerick, settled her High Court action against Clinical Pathology Laboratories for €2.5 million earlier this week, with no admission of liability.

It emerged from a 2014 audit of smear tests that she had wrongly received the all-clear for a test she underwent in 2011, but she was not told about it until last September. She was diagnosed with cervical cancer in 2014

In 2008, medics had fought to keep smear testing in Ireland. At the time, consultant pathologists warned that up to 1,000 cases of cervical cancer a year could be missed if the analysis was outsourced to the US.

“Our cytology system in the Rotunda Hospital, which was well developed, fully accredited and world class, with very good quality assurance systems in place and numerous people analysing smears – two looks rather than one – the quality assurance was at a much higher level than the US,” said Dr Coulter-Smith.

While he said he would not pre-judge the outcome of an overall review into CervicalCheck ordered by Minister for Health Simon Harris, he insisted it must look at whether screening services should be moved back to Ireland.

“I think that would be preferable to what we have now,” he said.

Screening is not an exact science and different people disagree on abnormalities, said Dr Coulter-Smith, adding: “If you have everybody speaking the same language for a start, that is helpful.”

But while testing in Ireland would, he said, “reduce the likelihood” of cases such as Ms Phelan’s and others, he cautioned that it may be too late to resurrect a good cervical screening service in the country.

“A lot of the people who worked in the cytology service have moved on to other things, we had to retrain people and allow them to move to other laboratory services,” he said.

“In the Rotunda, the cytology services are dramatically watered down. I suspect a lot of places wouldn’t have the ability to take that service back.”