Some 35,000 cervical smear tests were recently outsourced to the US when it emerged that there were waiting times of up to six months for results from Irish labs.

The backlog is now cleared, and the Health Service Executive (HSE) says all routine smears will remain in Ireland unless another backlog develops, but that outsourcing will recommence if a four-week turnaround is not met.

However, Dr Shirley McQuade, medical director of the Dublin Well Woman clinic, said there was "margin for error" when doctors were reading smear test results from US labs due to a different grading system that was "like another language."

"We carry out about 9,000 cervical smear tests a year and the Royal College of Surgeons (RCSI) at Beaumont did them for us before the outsourcing, " she said.

"After sending us the test results, they also send us a recall reminder letter when the woman needs to be tested again. The US labs do not issue a reminder letter. This means there is a potential for glitches and doctors could miss if a woman needs to be tested again soon if she has abnormal cells."

The Well Woman clinics have had to adapt their computer system to cope with the thousands of test results they have received from the US and introduce their own "recall and reminder" system. "Even things like date of birth being the wrong way around because it's an American system have caused us problems, " said McQuade. "Because we are a big clinic, we were able to adapt. But for GPs working by themselves, it is more difficult and people could slip through the net."

Dr Martine Millett Johnston, medical director of the Kilkenny clinic, agreed:

"It's a different reporting system and it has led to confusion and cases where people should have been recalled sooner."

Dr Jim Stacey of the Association of General Practitioners recently received correspondence to his practice explaining the terminology used in the outsourced test results from the Irish Cervical Screening Programme. "It's a letter explaining how to read the American test results. It's muddling to say the least, " he said.

"We could do without a change in terminology. It leaves it open for the possibility of errors. There is no doubt there will be an increasing number of errors." So far, routine smears Stacey has sent for analysis have all been handled at Irish labs and he is hopeful this situation does not change.

Stacey and McQuade both believe the outsourcing should never have taken place. "The laboratory facilities are here in Ireland, it's a staffing problem with cytologists that needs to be addressed, " said McQuade. "We were able to call up the RCSI if we had a query about a test result because of the relationship we'd built up.

But with the outsourcing, the quality of service has been diminished."

The Irish College of General Practitioners said it was aware of the "different reporting classification used in the US" but "individual GPs reported no major difficulties with this." However, it also called for the HSE to deal with any future backlog in Ireland by expanding services rather than outsourcing.

Quest Diagnostics in the US was the company selected to clear the backlog and was chosen because it was accredited and had the capacity to sort out the problem on an "immediate basis, " said a HSE spokesman.

A national cervical screening programme providing screening every three years for women aged 25 to 44 years, and every five years for women aged 45 to 60, is to be rolled out early next year. "It is anticipated that the expansion of the screening programme here could cut current mortality rates from cervical cancer by up to 80%, " said Sheila Caulfield of the National Cancer Screening Service.