The “unfortunate experiment” that was not, and the indebtedness of women and children to Herbert (“Herb”) Green (1916–2001)

Abstract

All screening programs have the potential to result in harmful overdiagnosis and overtreatment. Sound evidence, policy, and standards are needed to keep this harm to a minimum. Screening for and “treating” cervical cytological abnormalities provides a sobering example. The term “carcinoma in situ” came into use from 1950 and implied—misleadingly—that an inevitable malignant process had been identified. Hysterectomy became widely used to “treat” it. New Zealand's Herbert Green was one of a minority of gynecologists around the world who recognized the possible dangers of harmful overtreatment. Green developed and monitored more conservative management approaches to avoid women being “subjected to hysterectomy”. By the mid-1980s, his approaches had been adopted not only within National Women's Hospital in Auckland, but more widely.In 1987, it was alleged in a magazine article that an “experimental” research program had been undertaken at National Women's Hospital to study the natural course of untreated cervical “carcinoma in situ”; that this had entailed withholding “conventional treatment” from some patients indefinitely; and that some patients had died as a result. A public furore resulted and led 2 weeks later to the creation of a judicial inquiry—the Cartwright Inquiry—which reported the following year.The findings of the Inquiry, which criticized Green's practice, have been both disputed and defended ever since, often by individuals with competing interests. In the recently published 2nd edition of their book Screening: Evidence and Practice, Angela Raffle, Anne Mackie, and Muir Gray have provided a fresh analysis. This concludes (see accompanying article) that the Cartwright Inquiry provides no trustworthy evidence of harm from the adoption of the conservative management introduced by Green and adopted by some of his colleagues at National Women's Hospital. It is now clear that the treatment and monitoring methods introduced by Herb Green have benefited numerous women through avoidance of major surgery and preservation of fertility.