Cervical Cancer: Missed Pap and HPV Results in Oregon

Cervical cancer screening is built around finding precancerous changes — what the consensus guidelines call cancer precursors — while they can still be treated.¹ That is what makes a mishandled result costly: the opportunity the screening was designed to create is the thing that gets lost.

A delayed cervical cancer diagnosis can turn on more than whether one slide was read correctly. It can turn on a result that came back abnormal and went nowhere, or on screening that stopped years ago and was never restarted.

Two guidelines, and right now they differ

For cervical cancer screening today, "the guidelines" are not a single settled thing. Which guidance applied at the time of the care is worth establishing first.

The U.S. Preventive Services Task Force recommendation that is currently final dates from August 2018. For ages 21 to 29 it gives a grade A recommendation to screen every three years with cervical cytology alone. For ages 30 to 65 it gives a grade A recommendation to screen every three years with cytology alone, every five years with high-risk HPV testing alone, or every five years with both together. It recommends against screening before 21, and against screening after 65 in people with adequate prior screening and no high risk.² The Task Force has an update in progress, but a draft is not a recommendation, and the 2018 statement is the one that currently stands.

The American Cancer Society revised its guideline on December 4, 2025. It recommends starting screening at age 25 and continuing until at least age 65. Its preferred option is primary HPV testing on a sample collected by a health care provider, every five years. It lists other testing options as well: self-collected HPV testing every three years, or co-testing every five years. A Pap test alone every three years is offered for the case where none of the other approaches is an option. Self-collection is limited to tests and collection devices approved by the U.S. Food and Drug Administration, available through a health care provider.³

So a 22-year-old who has never been screened sits outside what the American Cancer Society now recommends and inside what the Task Force still recommends. That is not a puzzle about which body is right. It is the reason the year the care was given, and which guidance the clinician was working from, are among the first things worth establishing.

What the Oregon statute actually measures

A screening guideline and the legal duty are two different things, and it is worth being precise about what Oregon law says.

Under ORS 677.095(1), a physician licensed to practice medicine or podiatry by the Oregon Medical Board has "the duty to use that degree of care, skill and diligence that is used by ordinarily careful physicians in the same or similar circumstances in the community of the physician or a similar community."⁴ Subsection (2) states the same kind of duty for a physician associate licensed by the board, measured against ordinarily careful physician associates.⁴

Read that measure closely. It is stated in terms of what ordinarily careful practitioners do, in the same or similar circumstances, in that community or a similar one. The statute is the yardstick, and it is written in terms of practice rather than in terms of any particular organization's published schedule. Where two respected bodies currently recommend different starting ages and intervals, the statutory question does not change: it is still what ordinarily careful physicians, or ordinarily careful physician associates, do in the same or similar circumstances.

The abnormal result that goes nowhere

The screening interval is not the only thing that can go wrong. What happened after a result came back abnormal is a separate question.

The consensus guidance for managing abnormal results is the risk-based framework published by the American Society for Colposcopy and Cervical Pathology in 2020. It shifted from algorithms based primarily on the test result to management organized primarily around a patient's estimated risk of high-grade precancer — CIN 3 or worse. Rarer abnormalities are still handled by result-specific recommendations within the same document.¹

That framework was built to be added to rather than rewritten, and it has been. The same committee published updates "through September 2023," and among the items those updates address is "management of patients for whom colposcopy was recommended but not completed" — the situation where the recommended next step was identified and did not happen.⁵ In 2025 the Enduring Consensus Cervical Cancer Screening and Management Guidelines Committee issued recommendations for applying extended HPV genotyping results to a positive test.⁶ The same committee issued recommendations for HPV testing on self-collected vaginal specimens.⁷ The genotyping recommendations were built on the clinical action thresholds from the 2019 framework, and they state that where high-grade cytology or histology is present, or the patient is being followed after treatment of CIN2 or worse, management using the 2019 guidelines is recommended.⁶

Which of these applied to a given patient depends on when the care happened. That is the same point as the screening schedules: the question is what the guidance was at the time, not what it is now.

Situations that raise this question include these. An abnormal cytology or a positive HPV result is filed to the chart and never communicated. A colposcopy is recommended, the referral is never made, and no one follows up when the appointment does not appear. A result arrives after the patient has changed addresses or clinics and nothing chases it. A patient is told results are normal when the report says otherwise.

In each of these the question is not diagnostic skill. It is whether a system that generated a finding also acted on it. Whether a delay changed the stage at which treatment began, and what that difference meant for the patient, is a medical question that takes expert review of the records.

Oregon's deadlines

Timing works differently in a delayed-diagnosis case, and the reason sits inside one word of the statute.

ORS 12.110(4) provides that an action for injuries "arising from any medical, surgical or dental treatment, omission or operation shall be commenced within two years from the date when the injury is first discovered or in the exercise of reasonable care should have been discovered."⁸

That word — "injury" — does not mean what it sounds like. Under Gaston v. Parsons, 318 Or 247, 864 P2d 1319 (1994), "injury" as used in ORS 12.110(4) consists of harm, causation and tortious conduct.⁹ The two-year period does not begin until the patient knows, or in the exercise of reasonable care should know, facts that would make a reasonable person aware of a substantial possibility that all three exist. The court put the standard between two extremes it rejected: actual knowledge of each element is not required, and a mere suspicion is not enough.¹⁰

That distinction does real work in a case like this one. A patient can know she has advanced cervical cancer, and know that an earlier result was abnormal, and still have no reason to be aware of a substantial possibility that the handling of that result was tortious. Gaston itself held that a patient's knowledge that an informed-consent right had been violated did not mean that patient knew, or with reasonable care should have known, of a cause of action for negligence in performing the surgery.⁹ Describing the deadline as two years from when a patient learned she was sick states the rule incompletely, and states it short.

The same subsection sets an outer limit. It provides that "notwithstanding the provisions of ORS 12.160, every such action shall be commenced within five years from the date of the treatment, omission or operation upon which the action is based …", with a narrow exception. Where there has been no action commenced within five years because of fraud, deceit or misleading representation, the statute allows suit "within two years from the date such fraud, deceit or misleading representation is discovered or in the exercise of reasonable care should have been discovered."⁸

Note what that outer limit runs from: the date of the treatment or omission, not the date of discovery. A misread slide or an unreturned result can therefore sit undiscovered while that five-year period runs.

The "notwithstanding the provisions of ORS 12.160" language matters too. ORS 12.160 otherwise suspends the limitation period for a person who is younger than 18 when the cause of action accrues, and for a person who at that time "has a disabling mental condition that bars the person from comprehending rights that the person is otherwise bound to know."⁸ ORS 12.110(4) sets its five-year limit notwithstanding that section. Because the statute keys to when the injury was discovered or reasonably should have been, the dates on the individual reports carry real weight.

Getting a case reviewed

A delayed cervical cancer diagnosis may or may not be a claim. It depends on what the records show was found, what was recommended, what was communicated, and whether the delay changed the stage at which treatment began. Those are questions for a review of the actual records by qualified experts, not questions a website can answer.

If you are concerned that an abnormal Pap or HPV result was not followed up, an Oregon attorney can review the reports and the timeline with you.

This article is educational

This article describes Oregon law in general terms. It is not legal advice and does not create an attorney-client relationship.

Time limits matter. Most Oregon personal-injury and auto-accident claims must be filed within two years of the injury or accident. Medical malpractice claims must be filed within two years of when you knew or reasonably should have known of the negligence, with an outer limit of five years from the act itself (with a fraud exception). Wrongful death claims must be filed within three years of the date of death. Claims against public bodies (cities, counties, state agencies, public hospitals) require a notice of claim within 180 days. Missing these deadlines typically ends a case.

If you think you may have a claim, call Huegli Law at 971-317-6436 for a free case review. Todd Huegli is licensed in Oregon and consults on cases in Oregon only.

Footnotes

1. Perkins RB, Guido RS, Castle PE, et al. 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. J Low Genit Tract Dis. 2020;24(2):102–131. https://doi.org/10.1097/LGT.0000000000000525 ↩ ↩²

2. Cervical Cancer: Screening — final recommendation statement (2018). U.S. Preventive Services Task Force. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/cervical-cancer-screening ↩

3. The American Cancer Society Guideline for Cervical Cancer Screening. American Cancer Society. https://www.cancer.org/cancer/types/cervical-cancer/detection-diagnosis-staging/cervical-cancer-screening-guidelines.html ↩

4. ORS 677.095 (Duty of care). Oregon State Legislature. https://www.oregonlegislature.gov/bills_laws/ors/ors677.html ↩ ↩²

5. Perkins RB, Guido RS, Castle PE, et al. 2019 ASCCP Risk-Based Management Consensus Guidelines: Updates Through 2023. J Low Genit Tract Dis. 2024;28(1):3–6. https://doi.org/10.1097/LGT.0000000000000788 ↩

6. Massad LS, Clarke MA, Perkins RB, et al. Applying Results of Extended Genotyping to Management of Positive Cervicovaginal Human Papillomavirus Test Results: Enduring Guidelines. J Low Genit Tract Dis. 2025;29(2):134–143. https://doi.org/10.1097/LGT.0000000000000865 ↩ ↩²

7. Wentzensen N, Massad LS, Clarke MA, et al. Self-Collected Vaginal Specimens for HPV Testing: Recommendations From the Enduring Consensus Cervical Cancer Screening and Management Guidelines Committee. J Low Genit Tract Dis. 2025;29(2):144–152. https://doi.org/10.1097/LGT.0000000000000885 ↩

8. ORS 12.110 and ORS 12.160 (ORS chapter 12 — limitations of actions). Oregon State Legislature. https://www.oregonlegislature.gov/bills_laws/ors/ors012.html ↩ ↩² ↩³

9. Oregon Revised Statutes Annotations — ORS 12.110 (Gaston v. Parsons). Oregon State Legislature. https://www.oregonlegislature.gov/bills_laws/ors/ano012.html ↩ ↩²

10. Gaston v. Parsons, 318 Or 247 (1994) — opinion text, Oregon Reports, digitised by the Caselaw Access Project. https://static.case.law/or/318/cases/0247-01.json ↩