CERVICAL CANCER STUDY: THE LEGACY OF NATIONAL WOMEN’S UNFORTUNATE EXPERIMENT
A New Zealand study reported in the Lancet Oncology in April 2008 revealed that between 31–50% of women with untreated CIN3, a precancerous disease of the cervix, will develop cervical or vaginal cancer over 30 years.
The study’s results are based on an independent analysis by a team of medical experts at Otago University of a clinical study of the natural history of CIN3 carried out by Dr Herbert Green at National Women’s Hospital during the 1960s and 1970s. The team led by Dr Margaret McCredie analysed the data compiled by Dr Green and confirmed that there is a high risk of cervical cancer in women not treated after finding precursor lesions, and a very low risk in women who received conventional treatment.
Dr Green’s clinical study was the subject of the judicial inquiry in 1987 now known as the Cartwright Inquiry. The Inquiry found that the study was unethical because treatment was withheld without consent, monitoring of outcomes was inadequate, and the study was not ended when clinicians raised their concerns. One of Judge Silvia Cartwright’s recommendations was that the material should be made available for research.
The records of 1229 women were analysed and it was found that among the 143 women who received only a diagnostic punch or wedge biopsy, 31% developed cervical cancer after 30 years. In the subset of 92 women who had persistent disease within 24 months of the original diagnostic biopsy, 50% developed cervical cancer after 30 years. These estimates took into account later treatments for many of the women.
Among the 593 women who received conventional treatment – usually by a cone biopsy or a hysterectomy – and treatment for recurrent abnormalities, the risk of invasive cancer was about 1% over the same period.
This latest study extends the earlier analysis by Dr Bill McIndoe and colleagues which was published in 1984. Professor Ron Jones, who instigated the current study and was involved in the earlier analysis, said “The present study has employed different methods of analysis and the follow-up has been extended to 30 years. However the findings are very similar to those reported by our group 24 years ago. Whereas in the original study we assessed the risk of cancer as 25 times greater in women with in-adequately treated CIN3, compared to treated women, the present estimates are even higher.”
An article that appeared in the NZ Herald referred to Dr Green’s study as one of the most vilified pieces of research in New Zealand. It has now given the world its most valid estimates yet of the risk of the precursor lesions known as carcinoma in situ or CIN 3 developing into cervical cancer.
As the publication of this paper occurred just before the 20th anniversary of the release of the Cartwright Report on 5 August 1988, it's appearance was very timely.
THE CONFERENCE AND THE PHOTOGRAPH
Just over 20 years ago a photograph was taken at a conference that has haunted those involved ever since. The photograph of the four women who spoke at the conference was one of dozens of photographs that were taken that day but this photograph has assumed a significance that is out of all proportion to the reality of how and why it came to be taken. It has come to be seen as evidence of a feminist conspiracy, and as part of a victory celebration organised by a group of feminists whose anti-doctor stance and activities ruined the reputation of a hospital and almost succeeded in bringing down the medical establishment in New Zealand. The truth is of course far more prosaic and far less exciting.
The conference was organised by the Auckland Women’s Health Council to mark the first anniversary of the release of the Cartwright Report and it took place on Saturday 5 August 1989 at the Freeman’s Bay Community Centre. Going under the title “A Day of Reckoning: the Cartwright Report - one year on,” the conference aimed to assess how much progress had been made on implementing the recommendations contained in the Report.
The conference was opened by Dame Cath Tizard, then mayor of Auckland. The speakers were Clare Matheson, Sandra Coney and Phillida Bunkle.
Dame Silvia Cartwright had also been invited to attend as the newly formed Auckland Women’s Health Council wished to thank her and convey to her what her report meant to members of the Council. While the importance of the judge’s work had already been acknowledged and rewarded at a government level when she was made Dame Commander of the Order of the British Empire earlier that year, members of the AWHC and many other women who had been deeply affected by what had been revealed during the Inquiry simply wanted to acknowledge the judge at this event.
The conference felt more like a working bee than a victory celebration to those involved in organising it. The afternoon was spent in workshops discussing the issues that arose out of the Inquiry and were of importance to consumers. Papers had been prepared for the workshops and recommendations from the workshops were presented at the Plenary Session held at the end of the day.
There were many photographs taken throughout day. Clare Matheson, one of the four women in the now famous photograph, (the other three being Sandra Coney and Phillida Bunkle and Dame Silvia Cartwright) describes how this particular photograph came to be taken and her part in it:
“Silvia Cartwright did not want to be drawn in and refused to be part of it. It was at my behest that she finally agreed to do so. It is a request that I have regretted ever since. So much hay has been made of what was a simple act of generosity on Dame Silvia’s part.”
The truth about the photograph is that a gracious woman reluctantly agreed to have her photo taken during the conference with the three women involved in the original Metro article. The photo, taken a year after the release of the Report and two years after the government set up the Inquiry, has subsequently been interpreted as meaning something it was not.
August 5th Ceremony 2009
8.30am Wednesday 5th August 2009
Claude Road, Epsom, Auckland
On August 5th 2009 the Auckland Women’s Health Council held its 20th annual ceremony at the Statue of Peace on the site of the former National Women’s Hospital.
The Herstory of the Annual Ceremony
On August 5th 1988 Judge Silvia Cartwright’s report on the Inquiry into the treatment of cervical cancer at National Women’s Hospital was publicly released.
On August 5th the following year the Auckland Women’s Health Council organised a conference to discuss progress on implementing the recommendations contained in the Cartwright Report. The events of the day included a visit to the Statue of Peace sited in front of the hospital where women gathered to remember those women who had been part of “the unfortunate experiment” at the hospital during the 1960s and 1970s, and who died or were damaged as a result of not receiving the treatment they needed.
The visit was the first of what is now an annual ceremony held in front of the statue on August 5th each year as we gather to bring flowers in memory of the women who died and those who suffered.
On 18 September 1993, Women’s Health Action unveiled a plaque and planted a pohutukawa tree in memory of Dr Bill McIndoe, cytologist and colposcopist at the hospital from 1963-83, and Dr Malcolm McLean, who was a pathologist at the hospital from 1961–88. The ceremony was attended by family, friends and colleagues of the two doctors, members of women’s health groups, the manager of National Women’s Hospital, and people who had been involved in the Cervical Cancer Inquiry who attended to acknowledge the efforts of both men to get action within the hospital over the cervical cancer experiments.
The tree and plaque are beside a path in the hospital grounds near what used to be the colposcopy clinic where Dr McIndoe worked and overlooked by Dr McLean’s pathology laboratory.
Since 1993 the annual ceremony at the statue of peace is always followed by a walk to the back of the building to lay flowers around the plaque beneath the now large pohutukawa tree which is always in flower in August while we pause to acknowledge the work of both men and the price they paid for what they did.