To remind you to look after your cervix (cervices?!)

[FourForYouGlenCoco]

I know it's been done plenty of times, but one more won't hurt, right?
So long story short:
Went for (overdue) first smear last year, after DC2 was born. Borderline changes & HPV - sent for colposcopy, they went for 'watch and wait' and asked me to come back in 6 months.
Went back, severe dyskaryosis/CIN III. Back again a few weeks later for lletz under local.

The hospital is an hour+ away. The logistics of it all, organising someone to take DC1 to/from school, trekking baby DC2 back and forth with me - not fun. But I am so so relieved I didn't put it off, so relieved I didn't just assume everything would be alright. In the 6 months between colposcopies, cell changes happened really fast. If I'd left it...who knows?
The lletz was really not that bad either - I was very apprehensive beforehand but it was maybe 5 minutes and done. Minimal pain, minimal bleeding afterwards, and definitely a damn sight better than cervical cancer.

So please, please, PLEASE book your smear if it's due or overdue. Go to your appt, don't bury your head in the sand, don't put it off. I know it's not how you'd choose to spend an hour, but it's really not that bad. And it's so fucking important. So do it.

There is a urine dipstick for HPV but there is no such thing as a urine dipstick for cervical cancer.

HPV dipsticks are still undergoing research and have not been rolled out officially.

Take for example this from Wiki

en.wikipedia.org/wiki/Cervical_cancer

I couldn't get past the diagram of a woman and her inner sexual organs. The normal uterus does not lie just below the umbilical cord (bellybutton) unless they are at least 20 weeks pregnant or have multiple fibroids. If you cannot get the diagram of a woman's internal organs right, then the rest is moot.

That poster was me...

HPV dipsticks are still undergoing research and have not been rolled out officially

Yes they have, my oncologist has prescribed them for me and I have been using them since my treatment finished.

• 97.7% of cervical cancer is caused by HPV.

• Smear tests only show cell changes that have been brought about by the action of HPV.

• Hence the remaining 0.03% would not be caught by a smear test

It therefore makes a lot more sense to urine test everyone for HPV, then to offer a smear test or a colposcopy to women with a persistent HPV infection (90% of HPV infection will be cleared by the woman's own immune system within 2 years)

So you think cervical cancer screening is nonsense because you don't like the illustration used on a wikipedia page?

You do realise that Wikipedia isn't produced by the NHS?

Nobody is saying cervical cancer screening is nonsense.

Some people are saying that the current screening programme is obsolete in the light of technological advances and changes in social attitudes (i.e. the stigma associated with STIs is significantly less these days than it once was)

Maybe this will convince you.

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

There are over 31,000,000 women in this country. 3,224 will get cervical cancer and of those 890 will die. It's awful that they will die. But there is nothing to advise on how it's 100% preventable and it mostly say's that it happens because of a lifestyle choice.

However all of those 31 million women will be asked to go for a cervical smear. They may well do and die anyway. They may well choose not to and die anyway. That can be seen as a lifestyle choice. The statistics have hardly changed give the amount of women who are asked to go for smear tests (which are costly).

Nearly all of those women have the intelligence to know if they need a smear test or not, they do not need a reminder sent out by post. And they also know whether they want them or not.

And if you forget, then whose fault is it? It's your fault. You should have control over your health decisions. In fact, there was a study done about sending out reminders for smear tests and the majority of women actually pre booked already. There is a saving right there.

Maybe you should read the relevant page on the website?!

www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/cervical-cancer/diagnosis-and-treatment#heading-Eight

At least 2,000 cervical cancer deaths are prevented in the UK each year through screening, it is estimated.

Cervical cancer 3-year relative survival is higher among people diagnosed via screening than those diagnosed via any other route, data for 2006-2013 show

Screened women in the UK aged 35-64 have a 60-80% lower risk of being diagnosed with cervical cancer in the five years following their screening, compared with unscreened women, it is estimated.[3] The benefit of screening on cervical cancer risk increases with age

In order for a screening programme to be introduced by the NHS, it has to meet certain criteria. It isn't designed by an evil man in a lab who wants to make women as uncomfortable as possible. It's not a game of oppression.

If you don't want the test, don't have it. But banging on about things whe you don't understand even the most basic statistics on the matter and aren't capable of looking them up is totally irresponsible.

I need a reminder sent by post I'm not a walking diary!
If you don't want one don't have one but you have no right to tell other people they can't talk about it openly.
Your horse is very high, you need to get off it.

My point Alpaca is that once upon a time, the current screening program was indeed the best we had to offer.

The trouble is, science (and society) have moved on significantly since then and the NHS, being the creaking behemoth that it is, has been unable to pivot as it should to reflect the new order of things.

Newer and better ways of preventing deaths from cervical cancer now exist and we need to embrace them, not slavishly hark back to the olden days and NHS targets.

No you don't need a reminder by post. Not if you actually care about your health.

Do you need a reminder from your GP that your appointment is on such and such a day? I don't get that.

...and in fairness, the fact that cervical cancer is caused by an STI has been massively downplayed as, well, who wants to tell a cancer patient that their illness is self-inflicted or indeed put women off coming forward for screening in the first place due to stigma?

I can see that it was a well-intentioned policy, but I really dislike this infantilisation of women by what is inescapably a very male dominated medical profession.

If it's a woman's right to choose ( which it is) then there's nothing wrong with choosing to point out the potential issues with not having a smear. A choice , like any other.

Well I get one Elendon and that works just fine for me.
Does dictating to women give you a hard on?

Medicine isn't really male dominated. There's about 60% women in terms of med students, qualified doctors is somewhere around 55% men 45% women.

Now it is much more balanced, but just taking a snapshot of the situation as it stands today doesn't give the true picture.

There is a culture within women's health that we somehow need to be protected from ourselves, information should be withheld so as not to upset us and in general, that doctor knows best.

This has been ever thus, and whilst I think it fantastic that times are changing, the legacy issues that this culture has created still exist, its just disingenuous to suggest that a few more women in med schools today will magically right centuries of ingrained sexism.

Tbh, the levels of ignorance around HPV and cervical cancer that I have seen on MN really prove my point.

I'm a nurse. I don't have smear tests and neither do the female nurses and doctors I work with. It's my choice. It's their choice. I respect a women's right to screen or not screen. There is enough information out there to enable every woman to make an informed decision.

ToadsforJustice - that's a very unusual coincidence that none of the nurses and doctors you work with get smears (have you asked them all?).
I'm a HCP and every single time this conversation has come up each and every HCP I work with has.

All the Drs and nurses I know get their smears, how odd toads. But that's probably because we know someone who missed her smear test and died of cancer, she was 29.

We had a conversation about how to increase screening rates at our surgery and we were somewhat bemused at the irony that the female team (four HCP) didn't screen.

We had a conversation about how to increase screening rates at our surgery and we were somewhat bemused at the irony that the female team (four HCP) didn't screen.

There are three things to take from that:

1. Women who are well informed are choosing not to have a smear (women who are better educated on the whole make better decisions about their overall health which leads to other questions about how we approach health care)
2. HCPs have different behaviours for themselves to what they think is best for their patients (well documented in studies). Ask yourself why that's the case. Doctors tend to prefer to have a treatment with a higher death rate than one with a higher rate which has life changing consequences. It's not just about preservation of life but also quality of life. Doctors tend to prioritise the former over the latter for their patients as that's what they are sworn to do - which highlights the need for patients to take an active role in decision making.
3. Is the question about how you increase the rate of smear tests actually the right question to be asking? It assumes that women SHOULD have one and if they don't they are somehow making the wrong decision.

Are you asking
A) how many at risk women we have on our books? What is their general health like?
B) are the women we have on our books well educated in their general health, as well as in having a smear test?
C) is this treatment actually right for each woman on an individual basis and why are we even thinking about this in blanket terms of a target. (Is this really patient centred care or target driven care? Can we promote the difference in order to improve confidence in screening programmes?)

This is precisely why I have problems with the screening programmes in this country. They tend to be aimed at women. They tend to be based on the assumption that patients can not make an informed choice or more correctly that they don't make 'the right choice' in the eyes of screening bodies. They tend to be far too black and white in process.

Margaret McCartney's excellent book the patient paradox highlights a study that was done relating to the new bowel screening test. It's finding was that informing people about the very basics and the availability of the test improved take up rates. However properly informing patients led to a lower rate by comparison.

I do believe that so many things in our society and how to improve it are not just about asking questions but also asking the right questions and not making simple black and white one size fits all decisions.

Oh and the ultimate controversial questions:

Is there a NEED to increase rates at your surgery? Is that what patients actually want? How might an overly aggressive approach have negative effects? How can you avoid harm in this way?