Smear tests to subordinate women

I think the Polish Govt are proposing something that amounts to a major violation of womens' rights and bodies.
All cancer screening is elective, our informed consent is legally and ethically required...it does concern me that women rarely receive balanced information on the risks and actual benefits of cancer screening. We're entitled to the truth; we all have different risk profiles. So often screening is regarded as mandatory for women or we're foolish for declining it - not so!
As a low risk woman, it was an easy decision to decline pap testing - almost 30 years ago now. Lifetime risk of cc - 0.65% (near zero for a low risk woman) - lifetime risk of referral in Australia - a whopping 77% - almost all are false positives.
Few women know that testing women under 30 is of no benefit, but produces lots of false positives and can lead to harmful over-treatment. At least the UK doesn't test before 25, which spares these young women.
It is also clear that too many pap tests are being done and that risks our health. It seems a woman could simply have a HPV test at age 30 and if negative for high risk strains of HPV and monogamous or no longer sexually active, could forget testing. At the moment this option is not given to women - it's cheaper and easier to roll all women into the screening program.
They also "assume" a woman's risk profile might change - this is paternalistic - women who test negative to high risk HPV could be advised to revisit the subject if there risk profile changes or even have another HPV test in 5 years time. (a HPV blood test is available in Australia, but kept quiet)
Continuing to pap test low risk women just exposes them to risk.
Women who test positive could be offered 3 or 5 yearly testing (and self-test kits are available) and re-test for HPV after a few years - most women eventually clear the infection.
My reference: "Cervical cancer screening" in "Australian Doctor" July 2006 by Assoc Prof Margaret Davy and Dr Shorne. (produced for doctors, not women!)

I've also rejected mammograms also on the basis of information that is not released to women - the very real risk of over-diagnosis. The UK is lucky to have some amazing advocates for informed consent for women - Prof Michael Baum, Angela Raffle ("1000 women need regular smears for 35 years to save one woman from cc" BMJ 2004) Hazel Thornton & others. Sadly, Australia has no one protecting the rights and health of women - very few women here are giving informed consent for screening - the entire emphasis is on achieving govt-set targets and our doctors even receive undisclosed target payments for pap testing - unethical as this places them in a potential conflict of interest.
Men are treated respectfully in cancer screening and informed consent matters - they get the risks and benefits and are free to make up their own minds, while women are kept in the dark and counted like sheep. Not good enough....
A great reference is Dr Joel Sherman's medical privacy forum - in the side bar of "womens' privacy concerns" you'll find some great references.
Do your reading and make informed decisions about screening - do what's right for your body and level of risk.
patientprivacy.blogspot.com/2009/05/womens-privacy-modesty-concerns.html

OP, there is an interesting discussion to be had about the way that society views male and female bodies, and their different functions. There is another interesting debate as to why women in Poland are being forced to have an intrusive (but useful) medical test, which is horrific.

It's a HUGE leap to assume that the patriarchy wants us legs akimbo and full of speculums to break our spirits and keep us under control. About as factual as your assertion that two X chromosomes make women essentially fitter than men.

FWIW every smear I have had has been conducted by a female nurse or GP. Without exception.

Smear test are a screening tool employed to catch cancer before it takes hold.
The political views of the OP are harming women.
As the poster above mentioned, if ONE woman reads this as gospel and is affected by her views she's responsible.

Of course going for smear tests doesn't prevent cancer - it's a screening test just like going to the dentist doesn't PREVENT oral cancer, but it allows the possibility of pathological changes being detected. Just like a smear test.

Using condoms isn't a priority for many women - they may be in stable monogamous relationships and prefer to use other contraception. They may be trying to conceive.

I do worry about your agenda here on this thread - you don't seem to be here to discuss, debate or deliberate the cervical screening programme, or want to discuss your opening post regarding enforced smear tests in Poland (which was an interesting debate). You seem to have an agenda to actively denigrate cervical screening with spurious reasoning and a lack of definitive evidence and I find that worrying. If even one woman decides not to attend for her smear because of what you have posted on here then you should be ashamed of yourself.

OP I think you are truly insane. It's frightening and yet oddly compelling.

I think it is highly irresponsible to tell people not to have tests because the risks are small-no consolation for the person who shouldn't get it, according to paper, but does.
My dentist tells me he is checking for mouth cancer-I don't say -mind your own business! I am pleased.
When the bowel test came through the post I thought 'what a good idea'-not 'how dare they be so presumptive and obtrusive'!

"If you're not taking the pill (and plenty of evidence shows that non-barrier contraceptives are correlated with cervical cancer) then you are being nothing but paranoid if you go for smear tests"

You are talking rubbish, in a subject you clearly know very little about. I was not taking the pill and yet was diagnosed with CIN III - seriously advanced precancerous cells, which would turn to cancer-in-situ if left undiagnosed/untreated.

Being slightly unhinged and ranting on internet forums is all well and good, but it is the slight possibility that even one woman might believe you and stop going for smear tests that bothers me.

"The risk of cervical cancer is the same as the risk of mouth cancer. ANd yet neither men or women (for men have mouths too) go for yearly mouth cancer check ups."

You have been told quite a few times on this thread that dentists do check for mouth cancer, although they don't tell you this. Yet you don't get it. Why would that be?

"If you go to your smear appointments you are being paranoid and/or a hypochondriac"

What nonsense, I just enjoy a jolly good poking with a cold speculum. I can tell the doctor gets off on it too. Phwoar!

I have every test offered-I am not paranoid or a hypochondriac-it just makes sense. I recently did a bowel screening one through the post. My dentist regularly screens for mouth cancer. I have mammograms. Turning them down seems madness to me.

Eldritch - Yes. All the cookies are yours

I am biracial, do I win?

Sakura - Scientific proof please. Female separatist websites don't count. You get minus points if they're transphobic too. I'm not into pointless hatred.

When you talk about genetic superiority, you will sound like an eugenicist. Seriously, does anyone talk about genetic superiority for good reasons?

I also have a biracial child, do I get a cookie too?

Finally, I am a feminist so don't throw the anti-feminist card at me.

Thanks mamachocolate and slhillly for the informative posts.

I'm sure it is worked out along those lines, and it's good to understand them.

This development is certainly quite odd, as the Polish health minister is trying to pass a bill that if a woman refuses the screening, she will not be allowed to work. Nothing to do with saving lives or saving state medical bills as such: www.womensviewsonnews.org/2011/05/protest-against-compulsory-medical-exams-of-polish-women-workers/

Some Polish doctors have protested against this too.
Ethically, there is no medical reason to enforce screening on any person unless the disease is contagious and fatal if untreated - we are talking about conditions like smallpox and Lassa fever here, certainly not cervical and breast cancer.

While breast cancer is fairly high up the list, cervical cancer is not as high up as lung and colorectal cancer, whose complications are equally deadly - a chest xray as a screening test is certainly not as uncomfortable to a woman - but I don't see this being offered. Professionally, I would say this is an odd and worrying development in the political landscape of a country.

with apologies for the triple post, as the HPV vaccination programme becomes established, I fully expect that cervical screening will not be routinely available for women in age ranges where most are vaccinated, because the chance of disease should fall in this cohort, and screening will be uneconomical/the false positive rate will be unacceptably high compared to the detection rate. eventually the screening programme will be abolished because there will be no point maintaining the labs/expertise etc for an ever decreasing number of tests. will women in the unvaccinated cohorts then protest that they want to be screened? I think it will become a feminist issue again, from a different perspective.

sakura

the fact that an X chromozome is stronger than a Y

this keeps being repeated, but where does this "fact" come from? is it a deduction from the longevity of women vs men or from somewhere else? the evolution of the Y chromosome interests me, but I wouldn't say one is stronger than the other. I would be interested to read the basis of your "fact".

himilaya

Someone who knows Bayesian stats better than me can explain it better... but gist is that the rarer the disease is the higher the chance of having a false positive result. So sometimes people may decide quite rationally that it is not worth being screened - they would rather live with the small risk of having the disease than expose themselves to the much larger risk of undergoing unnecessary treatment.

to make an informed choice, you need to know
A. the chance of a false positive (the chance you will be told you need follow-up even though you are healthy),
B. the chance of a true positive (the chance you will be told you need follow-up when you do have CC or precursors to it), and
C. the chance you have CC/precursors.

if C is 0 (you are a nun, a lesbian who has never slept with men, a virgin) then you don't need to be screened. if B is fairly high (close to 1) then the test is sensitive and you can be confident that if you need treatment, the screening will pick it up. If A is fairly small (close to 0) then the test is specific and you can be confident that you won't get sent for treatment you don't need. but as A rises, and particularly if A is bigger than CxB, then you would worry that more people get sent for necessary than unnecessary treatment. with a quick google I haven't been able to find these figures for CC in the UK but for a screening test to be adopted, these figures will have been worked over closely, and they are reviewed periodically to make sure it is worth continuing with. the NHS does not like to spend money unnecessarily (especially on women - just look at the state of maternity services).

Sakura, on another note, I'm not sure why you were posting all that stuff about CC being effectively an STD. On the off-chance that it was aimed at me, I know about it. It's why I said what I said about a legitimate debate about whether the NHS can do more on prevention.

sakura, you did not respond to the substance of what I said.

I will try to be as clear as possible. We would be being really stupid - spectacularly dumb - if we chose which diseases to screen for simply on the basis of how prevalent they are. We need to take into account several factors:
1 Can we spot it early? Is there a fairly reliable test?
2 Can we do anything about it if we do spot it? Do the interventions available do more good than harm, on balance?
3 Is it worth the effort, compared with the other things we can do to cut the harm caused by this disease?
4 Is the harm caused significant enough to justify the screening programme, compared to spending the money on other diseases?

You are overly focused on point 4. The other three are just as important. I explained that for mouth cancer, there is more value in other interventions, especially cutting smoking and drinking rates.

And your theory about money makes no sense in the context of the UK. Gynaecologists do not do screening in their private work, so the profit motive simply does not exist in the way you assert. The national screening programme is carried out by GP practice nurses, mainly. They are not profit-driven. While practices get some income from screening, I doubt that many of them could demonstrate to the satisfaction of their accountant that it makes them a profit to do this work. Practice finances are too murky for that.

It is utter madness to describe the screening programme as "testing healthy bodies for no reason at all". It is testing people who run a small but real risk of being about to develop something that could kill them for the purposes of preventing them dying.

I'm all for testing healthy bodies-they may not be healthy- and I would far rather find out early enough to do something about it. By the time you think there may be a problem it may be too late.
No one is forcing you-everyone is able to make their own choice-mine is health checks. I think my cholesterol level is low-this doesn'tmean I would turn down a test if offered- I might be wrong. I'm not going to say to my dentist 'don't do a mouth cancer check'.

Exotic - Its not necessarily weird to not take up screening (or to not offer it)

You only need for a test to have a small chance of false positives for there to be a much higher probability of a false positive than of finding something wrong.

Someone who knows Bayesian stats better than me can explain it better... but gist is that the rarer the disease is the higher the chance of having a false positive result. So sometimes people may decide quite rationally that it is not worth being screened - they would rather live with the small risk of having the disease than expose themselves to the much larger risk of undergoing unnecessary treatment.

This is the point about informed consent. I remember reading somewhere about an experiment where they ask Doctors to solve some basic probability problems using Bayesian probability and a huge proportion got it wrong -- it points to the cock-up rather than conspiracy theory about why Doctors are so bad at explaining this stuff to patients (male and female) ...

I am regularly screened for mouth cancer by my dentist-it is one of the things that he does.
I find it weird that people wouldn't take any screening on offer.