AIBU to be fed up with smear test threads?

[PatsyNoPasta]

There seems to have been a run of smear test threads recently, encouraging women to get one done.

I'm sure we all know all about them. Can we drop the subject?

Thank you.

Its fine to promote cervical screening.

The trouble is when that promotion is based on anecdotal, emotive, emotionally bullying language rather than the balanced presentation of risk and freedom of choice is not properly respected and is generally derided.

It should be easier to opt out of too. I don't understand the poster who said people might not know about them when I can't stop being bombarded by invitations despite trying to.

The issue at the heart of the OP's point, I think, is that screening promotion relies of a culture of fear rather than a culture of fact.

So in that respect I don't think the OP is BU. I think that we should be more critical of such threads and encourage intelligent and informed debate of risk rather than simply badging others.

Informed consent given freely without coercion is the corner stone of relationships between doctors and patients. We fail to recognise this at our peril.

I wonder if it's perception, that makes the fear thing stand out more than the facts? I am a hcp and perform smears as part of my job. I am always careful to explain why we offer smears - that evidence based research has led to the cost of the screening being out weighed by the potential cost without the screening.

as part of a national programme letters are sent every 3 or 5 years depending on your age. If you don't respond you will be sent three invitations and finally a defaulter letter before being put back on the list. Your gp has to do this unless you send a letter requesting to be removed from the list to opt out.

There are lots of reasons for women to not want smears as many have said and it is not just embarassment. I have spent several sessions with women who have had experiences that make having a smear difficult for them, working to explore and find solutions to those fears.

On a positive note I think the introduction of hpv testing will reduce the the number of women who have an abnormal smear but no hpv having colposcopy.

They frustrate me too, but more because the advice, while well meaning and well intentioned is out of date.

If you don't fancy having a smear, have a urine HPV test instead...all this hysteria about smears saving your life etc just goes to show how ill-informed so many women are, yet remain blissfully unaware of their own ignorance.

Cervical screening is vital, but smear tests are a crude and outdated method of achieving this goal.

I wonder if it's perception, that makes the fear thing stand out more than the facts?

I think its primarily how the NHS has chosen to promote smears actually. They get more take up of screening programmes if they don't give balanced information. There were some trials done into how they presented risk for bowel cancer screening; those patients given more information made an informed decision NOT to take part. Which is very interesting. Despite this if you see adverts for cervical screening they almost always neglect to give you balanced information. In fact one of the most successful campaigns has been one with a photograph of a little boy looking very sad with the caption 'Mum didn't have test - now I have no Mum'. Which is pure emotional blackmail and actually incredibly derogatory to women's intelligence.

Margaret McCartney pointed out a few years ago just how little information is given out by the NHS when she pointed out that this 13 minute video on the subject being promoted by the NHS had less than 10 seconds about false positives and even less about over treatment. By contrast she pointed out how men were given 'decision tools' with figures and statistics about the pros and cons.

This is why we have endless threads with women badgering others to have smears with pages and pages without a single comment about risks because all of those women don't know or don't want to know or even don't want to know them. Its absurd. If you were to suggest that all women should have a baby in hospital because you know someone who nearly died and had to have a Emergency CS you'd be jumped on with information and how women should be able to make a choice. Imagine a similar poster of a little boy saying 'Mum didn't go to hospital to have my little brother - now I have no Mum and no brother'. The contrast is alarming and we aren't questioning this enough.

The long and short of it is cervical screening is promoted in an incredibly aggressive and often completely unethical way which removes the ability of women to make an informed choice because the government wants you to behave in a certain way, without regard as to how that might affect you and your life as a result.

Cervical screening is not wrong in itself. However it is wrong to coerce women into a medical procedure - particularly an intimate one - without properly discussing its side effects as well as its benefits. This is what I have a massive problem with, and why I find the smear threads on MN somewhat sickening as unfortunately few posters are brave enough to challenge and question them, as they usually get abused for doing so as its "all about saving lives". Its not - its about being treated with respect and being allowed to make an informed decision about your health.

That's a really good post RedToothBrush, and I entirely take the point of it but if that's what works, then surely that's why the campaigns take the tone they do. I'm not sure I believe that if the promotional material was more balanced that take up would drop because women are 'better informed' or have 'evaluated the risk for themselves' but, in many cases, (I'd certainly have done this) because that's something that needs to be done, but can be allowed to drop down the endless list of things-to-be-done because it's not such a priority anymore. In fact, I, in the current climate of more strident literature, put my smear off because I had other things to do (and bloody hated them) and ended up dealing with cancer.

I don't know, I agree that HPV screening (which I have regularly now) is a much more reassuring and accurate test for the potential occurrence (or in my case recurrence) of CC, but that's not currently standard practice. Campaigning for it to be so seems like a worthwhile cause, but I'm less sure that campaigning to change the current smear literature is such a good idea.

I hated smears and was terrified of them. I've a real horror of any invasion of my personal space, let alone that sort of exam. What you get to experience if you do need CC treatment knocks all that into a cocked hat though.

There's an undercurrent in some posts as well of 'being manipulated by the government/other authority figure' to go for cervical screening that seems to imply that it's done with a somewhat sinister motivation. Yes, manipulation is happening to an extent, but that happens with LOADS of health issues (Change 4 Life for example) and it's not actually a massive conspiracy to do terrible things to women, it's promotion of what is currently the standard way to be regularly tested for a mostly avoidable cancer.

Sorry, I probably shouldn't participate in this discussion at all. My bias is all too evident.

I think women get bullied and/or over persuaded into many medical treatment

This is so true. I am dreading a GP appointment I have next week. No doubt the doctor will talk endlessly about a smear test for the time I'm there (again) and pay very little attention to the reason I actually went

I've made an informed decision not to participate and that decision should not be challenged after I've stated (multiple times) I understand the risks and still don't wish to take part. It drives me nuts. I now tend to avoid my GP at all costs unless I feel like I'm dying which is much more harmful to my health than refusing a smear which may prevent cervical cancer even though I'd be classed as being in a very low risk group!!
sigh /end rant

Oh op, you daft turnip. It's a chat forum, mostly populated by people who own cervixes. You must be exhausted feeling you have to read every single thread on here you poor thing.

Why not take a break, go to your local library and cull the sections you think have too many books of the same subject in? Just throw them out the window until people jolly well learn.

I think there are some threads about babies and parenting on this site too. I hope they aren't too annoying.

MN is entirely populated by people who own eyes*, but you don't get ten threads a week reminding people to book sight tests just in case the optician picks something serious up, do you? Why the focus on other women's fannies and boobs? The OP is not any sort of root vegetable for challenging the peer pressure surrounding intimate health screening.

*apologies to anyone who genuinely doesn't have an eye.

I think the issue, is the fact that if you are effectively hookwinked into screening when, if you had been given the information, you would have taken a different course of action it undermines trust in the whole service.

I do find it interesting that doctors will often recommend patients a course of action with less risk of death but more risk of long term problems however when put into the situation themselves they feel that quality of life is more important and will choose more risky life threatening treatment.

My point being that different people think different risks are more important than others and make different decisions to what you might expect given the knowledge. It isn't necessarily just about saving lives, its also about quality of life. It just depends on what your priority is.

You are right, its not just about women's health issues, but it part of a wider creeping tide of industrialising care rather than giving personalised care. So its less about 'government conspiracy' and more about the government falling to treat people as humans with different priorities and treating them more like targets and statistics.

It is also creating a generation of 'worried well' who have nothing wrong with them, but take up a huge proportion of services when those who are unwell can't access them. The culture of fear, is feeding people who have massive anxieties about their health.

Therefore the assumption that screening is 'good for us' is questionable on a couple of levels. Some people believe it is. But not everyone shares that view and there is a good argument for that point of view. Because we all have different perspectives and priorities in life which should be respected.

I'd just like to know who made the OP in charge of what people are and aren't allowed to post on MN.

There is lots on MN I find irritating and over done. That's why I make prolific use of the hide button. It works really well, look... whining thread all gone.

I am dreading a GP appointment I have next week. No doubt the doctor will talk endlessly about a smear test for the time I'm there (again) and pay very little attention to the reason I actually went

Precisely. If harassment about smears (or weight or smoking) actually puts off people from going to the doctor when they have real need, it could actually be putting their health at risk because doctors are being too aggressive in their pursuit of their patients' health.

This isn't being looked at, when risks are assessed and it should be. On a national level, there is no point in preventing 10 deaths from one thing, if the way they do that costs 10 deaths from something else because of the way the first is promoted.

Oh dear. I may have been the culprit who started the first one yesterday, as I was petrified about having my first. Then a few more popped up later, which were not mine. I couldn't say for sure if it was a coincidence or whether I prompted them.

I would like to take this opportunity to apologise deeply to the OP and any others who were offended by my seeking reassurance about what was a very worrying procedure for me. In my nervous state I had mistaken this for a forum where one could gain support and advice from others who had experienced similar. I got that in bucketfuls on my thread but we must all have been labouring under the same illusion.

What on earth was I thinking

Red - but there are very few long term problems associated with smears themselves or treatment for abnormal cells.

I suppose my thinking is that cervical screening may not be actively good for everyone (though fucking awesome for me) but the extrapolation that if it isn't good then it must be bad. I reckon it's neutral for most people, with outliers on both sides - people like me who've massively benefited from not being dead and people on the other side who struggle with the process. Overall it probably comes out as a neutral overall, but for individuals the wins are pretty big.

Sorry on my phone - what I meant was not actively good is not necessarily equal to actively bad.

I hope your smear was ok in the end FyreFly.

Maybe I over simplify it in my head, but the way I see it is;

Reminder ever so often about smears (preferably through letters from surgery) - absolutely fine.

Nagging, pushing, guilt tripping (my friend couldn't have one at 20 and became ill, for example), bullying, blackmail (denying contraception), emotional blackmail (you're going to die, you selfish arsehole), by friends, GPs or inconsiderate forum users - very much not ok.

Quite honestly though, I believe there is enough information out there, enough reminders either from our surgeries or media to remind us to get smears. Having some smug thread about how someone is preaching to their friend about the matter, one who says she doesn't want one, is not helpful at all. It's a choice, it's absolutely ok to chose not to have one.

Spud, as you point out, its good for some people and bad for others.

We should respect both sides of the coin.

I have no problem with intelligent discussion over it. Its when it descends into bullying or saying that others are risking their lives by not having one, it is problematic.

I also think its fine to encourage others by saying its not as bad as your thought as that's supportive. But not to belittle others who still choose not to partake or say its not about embarassment.

I have more issue with the promotion rather than the actual procedure tbh. I think we need to find better ways to do it, rather than relying on scare tactics and peer pressure as that definitely does have issues which are not being properly addressed.

The trouble is, these threads rarely end well because there is such polarised opinion on it. Sadly that's where the issue lies - its about opinions rather than facts and respect for others is usually the first casualty of that.

Agree completely Red. I wonder if there is a way to fully opt out? I'd like to visit my GP again without the worry of this whenever I go to make an appointment

we should be more critical of such threads and encourage intelligent and informed debate of risk rather than simply badging others.

I agree with redtoothbrush and other people.

For a long time I actively avoided smear tests, not because I feared the procedure, but because I resented being manipulated and presented with poor facts and risk assessment.

These days I have them because I figured that I might as well. I also had my first mammogram last year even though I have serious misgivings about over-treatment of pre-cancerous cells that may revert to normal if left. That treatment would probably be disfiguring and might result in other serious health problems and there isn't enough said about that.

I don't know what I'd do if any mammograms in the future picked up pre-cancerous cells or something that if left, might progress so slowly that I'd die of something else beforehand.

I'd hope I had a sensible doctor to guide me though ultimately the decision would be mine.

I have a lingering resentment that women are encouraged to think of their bodies as being the enemy with things lurking to ambush us.

I do take statins but that's because I had dangerously high levels of 'bad' cholesterol. I scored 10 when I think you're supposed to score between 5-7 at the most. But if I hadn't scored that, I'd probably have declined them.

Hereditary, not dietary btw, so there was nothing I could do on that score. In fact my GP said my level of 'good' cholesterol was high, indicating a good diet.

She refrained from patting me on the head about that because she's not patronising. She treats me like a rational human being.

I don't want to die but I accept that we all have to die of something.

I took so long typing that post that you've added more RedToothbrush.

I agree with everything you've said.

Does anyone know why drs push them so hard when it's such a minimal risk?

The way the drug Herceptin was promoted was extremely suspect and pernicious.

There was a sustained and very successful campaign in the media that gave the impression that heartless beancounters in NICE and the NHS wanted women to die of breast cancer to save money.

Heart-tugging stories about children being robbed of their mothers. I know of one high-profile woman with breast cancer who was actively courted to become an ambassador who eventually said she understood statistics and relative risk and told them to fuck off.

AFAIK Herceptin is an extremely effective treatment for breast cancer in some cases. Similarly the drug Tamoxifen.

But as I understand it, both of them are treated with caution by clinicians because of serious side effects, such as heart damage. Therefore they are a medicine of last resort rather than first.

These people aren't bean counters. They don't want their patients to get remission from one life-threatening illness only to get something else that will destroy their quality of life and end in an early death - just not from cancer.

But they were misrepresented in a relentless and extremely well-funded campaign strong on emotions but short on facts.

I wonder where the money for that came from?

limitedperiodonly

The funny thing is people get worked up and quite passionate about the privatisation of the NHS, but aren't aware of how various groups are actively exploiting it through the public and how this isn't always for the benefit of our health.

Its strange how privatisation is seen as the only threat to the NHS and very little thought of these other influences.

If we banned threads I had no interest in, there wouldn't be much of a forum left...