Women failing to attend smear tests

The whole debate on breast screening is about the harms of that radiation versus the benefits of screening. My GP said that was why BRCA carriers have MRI or CT scans rather than mammograms.

I have a nevus too and always go for checkups. I don't want to lose my eye or my sight. Again up to people to make their own decisions re health but I tend to see it in moral/social terms, i.e I have a personal responsibility to look after my own health so that others, namely my kids and Mum don't have to! I think the NHS is doomed and there are so many people who don't look after their health, take no responsibility and that cannot be sustained. Nothing is ever guaranteed of course but there are some certainties, in terms of behaviours that lead to serious illness, smoking as an example. We can argue about screening programmes and I do think they will improve, as science progresses.

"So what they're saying there is that if a woman is diagnosed aged 25 with a cancer that eventually kills her aged 84, they're treating that as a fatal cancer in the 25-29 group."

No, that's not correct. Your entire post is based on a fundamental misunderstanding of the way incidence is counted. Someone who (improbably) had CC at 25, and again at 84 would be counted as having it twice, not once.

You are also ignoring the fact that with screening, the aim is prevention. The programme is not looking for cancers so much as for cellular changes that could lead to cancers (CIN). The idea is to catch it before cancer even has a chance to get going. The screening intervals are set with this in mind.

"By the way, it was said above you can't compare mammograms with cervical smears. Well yes you can"

No you can't, at least not very far. Mammograms use an x-ray. That supplies a dose of radiation. The whole debate on breast screening is about the harms of that radiation versus the benefits of screening. Cervical screening does not involve x-rays, and therefore the harms of the test are very different. Every screening programme has its own unique balance of harms/benefits.

@OlennasWimple, I certainly agree the PM shouldn't be sniggered at for answering a question, however I think it's a pity she didn't answer it by explaining why smear tests aren't offered to under 25's, basically that cell changes in this group are so common you would have a huge number of false positive results.

I also think it's a pity she didn't address the real issue which is that the GP should have referred the young woman who tragically died for further investigation. Perhaps Mrs May could have asked Mr Hunt why GP's are reluctant to refer patients - one good reason is the funding crisis in the NHS.

My optometrist referred me to an eye consultant about a mole in my eye"

Hello, a nevus (mole) in the eye can be a sign of cancer. If you don't want to get that checked out, then that's up to you. A nevus can be benign, just like a mole on your skin, or it can develop into cancer, just like a mole on your skin. In your situation, I'd go to see the consultant. I'm doing you the courtesy here of assuming you're being serious, but just in case you aren't....

This situation is not comparable in any way with a smear test, because a smear test is carried out on asymptomatic women. It isn't a test for cancer (this can't be stressed strongly enough), its a test for cells that may become cancerous. Most of the time they won't, so the chances are you will end up undergoing unnecessary treatment.

The difference here is between screening of asymptomatic women and women who already have symptoms. I once had a lump in my breast and I went to the GP straight away. I wouldn't have a mammogram though.

Whatever your view of her, and whether you agree with her message to have a test, surely everyone should applaud (not snigger at) the Prime Minister for talking about testing and the fact it is uncomfortable in Parliament

Seriously. I can’t get one.

I’m 35, I haven’t had one for about 8 years. Every time I ring my practice they tell me to try again next month. And I don’t remember to call every month, which is my fault. But if they want people to have them, make them available!

I'm 24 and I don't want to book it. Sounds too painful and pointless.

My optometrist referred me to an eye consultant about a mole in my eye and I never booked an appointment for that either - I don't want to take a day off work for something that will 99.99999% be fine. And if it's not, well I guess it was fate then. We've all got to die of something.

But it's probably not correct, because many factors affect mortality from cervical cancer and it was steadily falling before the introduction of screening - see the link I posted a while back to the national archives, you can also find it, and a ton of other stats here.

margaretmccartney.com/2012/04/10/womens-hour-cervical-screening/

By the way, it was said above you can't compare mammograms with cervical smears. Well yes you can. Mammograms lead to no overall reduction in mortality according to the cochrane review. That doesn't mean that they don't prevent deaths from breast cancer though. It just means there are increased deaths from other things.

One thing that can increase death rates is actually treatment for cancer, which, particularly for breast cancer, can increase heart disease rates. Particularly galling if your cancer would never have become life threatening, but then I suppose you're not in much position to care, being dead.

So simply saying 'we'd avoid 2,200 deaths from Cervical cancer - even if it's correct, doesn't equal 2,200 deaths overall prevented.

It's interesting how many women commenting here feel that they're being subjected to what is in essence sexual assault. I think that's entirely understandable. But women just keep getting told, seemingly that they HAVE to have smear tests. No they don't.

I was particularly annoyed by this on the BBC. (warning the piece may be very triggering for some, which is why I'm not quoting from it here).

www.bbc.co.uk/news/health-42790919

No, what bothered me was the bland statement at the bottom: "If you have concerns about attending a cervical screening following a sexual assault you can contact Rape Crisis for support. "

So hang on, rape crisis (mostly volunteers, hugely underfunded) are meant to pick up the pieces of NHS bullying of women. I hope, sincerely that any woman who does ring rape crisis is told that her feelings are perfectly valid and she should do just what she wants to and feels comfortable with. I'm pretty sure that's what would happen, I'm pretty sure it's what I would have said if when I was a RC volunteer. But really how dare the BBC expect rape crisis to pick up the pieces when women have been retraumatized by bullying media, NHS and charities that claim to care about women?

Thanks for the link to the Landy study, I was looking for it. Assuming all the methodology and conclusions are correct, let's look at what if finds.

"To conclude, we have shown that screening has an even larger impact on cervical cancer mortality than it has on incidence, and that if everyone attended screening regularly, 83% of cervical cancer deaths could be prevented, compared with 70% with current screening."

Ok, that sounds really good, let's look at what it means in numbers.

"The estimates of the number of deaths from cervical cancer that could be prevented by regular screening or that are prevented by current screening rely on the assumption that the RRs calculated based on 5-year excess mortality approximate the RRs for cause-specific mortality. In this study, we group deaths by the age of cancer diagnosis not the age at death. Hence, screening (starting at age 25) will (most likely) increase the number of fatal cancers diagnosed at 25 years, even if it reduces (cumulative) cervical cancer mortality. Under the current screening programme, as the population age a large number of deaths that are not preventable by screening will occur after age 84 years, decreasing the relative benefit of screening overall."

So what they're saying there is that if a woman is diagnosed aged 25 with a cancer that eventually kills her aged 84, they're treating that as a fatal cancer in the 25-29 group.

What about the numbers?

"In England, there are an average of 796 deaths a year (2011–2014 average) from cervical cancer in women of all ages (Office for National Statistics, 2015). It is estimated that screening currently prevents 69.7% (95% CI: 66–73%) of cervical cancer deaths. However, if everyone attended screening regularly 82.9% (95% CI: 82–84%) of deaths could be prevented (i.e., half of deaths currently occurring could be prevented). Applying the RRs in Table 4 to the observed number of deaths in each age group, we estimate that there would be an additional 1827 deaths per year from cervical cancer in the absence of screening, and a further 347 deaths per year could be prevented if everyone attended screening regularly between ages 25 and 64 years."

These are all estimates, they're statistically sound estimates, but they're estimates, they have to be to carry out this kind of study. So we're talking screening 'saving' 2,200 lives per year.

But lets go back to what Dr McCartney reminded us of. You don't 'save' someone's life, you prolong it, unless you make them immortal.

So we're reducing mortality from cervical cancer, but in reality, how long will we actually prolong life by? Let's look back at those cervical cancer death statistics by age. Deaths increase with age, most women who die of cervical cancer are 85-59.

www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/cervical-cancer/mortality#heading-One

So there you are aged 85. You haven't died of cervical cancer, hurrah! What's your life expectancy?

Oh no, it's 82.9 years, you died already.

www.huffingtonpost.co.uk/entry/life-expectancy-uk_uk_59ca2b4ee4b01cc57ff533f2

Actually assuming you live this long, you'll probably die of dementia, personally I don't find that an attractive prospect.

"Yet we don't get screened on the regular for that. Why not?"

One screening at the 40+ on NHS (both sexes)

No, I don't know why it's not more often.

A smear test is very much like rape/sexual assault

I agree. And the fact that you're supposed to not mind makes it all the worse.

More women die of heart sisease than of cervical cancer. Yet we don't get screened on the regular for that. Why not? Why are our parts more valuable than the rest of us?

It's funny how the NHS especially needs to consider finances when it comes to pain relief for stuff involving female reproductive organs isn't it?

a smear test is very much like rape/sexual assault

Sadly this is how it feels - coercive, dismissive, painful, helpless...

Smear tests are the problem. I have been sexually abused and raped as a teenager and had 1 very traumatic birth (it's the care rather than events that caused me trauma) and a smear test is very much like rape/sexual assault. The NHS are not interested in making any accomodation for the thousands of women who have been sexually abused in their lifetime.

Unfortunately the NHS does have to consider finances, as is plain to see at present. At one of my cervical screening sessions I had a polyp on my cervix and the doctor tried to take it off without any pain relief! When I nearly kicked him in the head and said a few expletives he agreed to have me come back in under general anaesthetic, much to my delight.

It's cheaper to treat abnormalities at an earlier stage than it is full blown cancer, but equally there's also the cost of all the colps, biopsies etc for changes that would never have required any treatment. Not that I think it's reasonable or realistic to expect an individual woman to factor that into her decision making.

Definitely agree this also needs to be seen in the wider context of taking gynae problems seriously and with general problems in the way pregnant and birthing women are treated in the UK, as the latter has an impact long after the event of giving birth. Salient point made upthread about the lack of pain relief. Though I don't have smears, if I did have a colp or biopsy there is zero possibility that I would consent to it without pain relief.

There is an enormous problem with actual gynaecological (and pelvic)
problems being taken seriously. It's hard enough to have a conversation about what constitutes normal in terms of periods, post-natal symptoms and the suchlike.
I remember DD being told at school that ridiculous old lie about losing a few teaspoons of blood and perhaps having a bit of a headache during her period. I had spoken to her honestly about it before, so she wasn't frightened when it was far more than that, but at least one girl in her class wasn't, and panicked she was seriously ill. The same thing happened in my class at school, 25 or so years earlier.

whiskyowl

Good study, personally I'd much rather take the test as a pre-emptive measure rather than the worry of something growing and spreading inside me that was preventable. Also I would imagine the cost would be much lower treating any disease found in it's early stages than the later ones?? Should be a consideration with the issues of the NHS at present.

I think that's a huge issue sunshine - I don't think the psychological issues some women experience with cervical sampling can be divorced from wider issues of the way women are treated in gynae/obstetric medicine. I really sympathise, because I had an absolutely horrific experience with gynae surgery (as well as having abuse in my background) so I do understand. Personally, I found that once I had done a couple of tests it did get easier, but it's different for each woman.

I've put off going for my cervical screening as I still feel traumatised from giving birth, and some of the trauma was to do with the endless rough hands and fingers giving painful vaginal exams, often without properly asking and explaining first. The thought of anymore intimate procedures makes me feel sick and terrified.

When I speak with others online who suffer birth trauma it seems really common to avoid getting smears as a result.

First, let's not confuse different screening programmes. Breast cancer screening is a completely different beast from cervical cancer screening. The methods are different, the evidence base is different. I think there is a much larger question mark over breast screening than there is over cervical cancer screening.

Secondly, we need to distinguish between incidence and mortality.
There's a lot of evidence that cervical screening does reduce incidence of this type of cancer, indeed one could go so far as to say that there is scientific consensus that it does. The point is that it is preventative - it is designed to catch cellular changes BEFORE cancer has a chance to develop, when treatment is quick and comparatively easy. The effects on mortality are more difficult to determine, however there has been some interesting recent research that suggests that these may be really quite large:

www.ncbi.nlm.nih.gov/pmc/articles/PMC5117785/