To consider opting out of cervical screening?

[justcurious40]

I am very fortunate to have just received normal results for my latest smear test.

However, the weeks I spent waiting for the results were hard as I suffer badly from health anxiety.

I am nearly 42 and have been having smears since the age of 19, so I now have 24 years of smear tests behind me without ever having an abnormal result.

It is my understanding that something like 98% of cervical cancers are caused by hpv, which is sexually transmitted. As I have been with my husband since 1999 and am 100% sure he is faithful, would it be unreasonable to opt out of the screening after so many clear tests with no hpv detected?

I think some Scandinavian countries and the Netherlands use hpy screening as their primary test and only offer smears to women who are positive. So I am thinking of having a private hpv test and, if that is negative, opting out of the screening.

Before anyone says it, I know that cancer and cancer treatment would be a damn sight more horrific than having the screening and being anxious waiting for results. I'm just questioning the need for screening under these circumstances. Thanks for reading.

We are lucky enough to live in a country that allows us to have a potentially life saving test, free of charge.

Your body, your choice. But I think you're a bloody fool!

Iamyourequal, it's not crass at all, its the facts which are well researched which show that the lifetime risk of cervical cancer is 0.65% and the lifetime risk of unnecessary treatment after an “abnormal” smear test is 77% .This means that the vast majority of women who had treatment actually didn't need it.

Any test that picks up false positives in over 70 per cent of people is not fit for purpose. We would not tolerate these sort of false positives in other tests. Why is this acceptable?

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

Cervical cancer mortality is related to age, with the highest mortality rates being in older females. In the UK in 2012-2014, on average each year almost half (47%) of deaths were in females aged 65 and over

And yet cervical screening is not offered to women over 65. Absurd.

I've read the thread but am struggling to get my head around this.

So am I right in thinking:

• hpv vaccination can dramatically reduce the likelihood of cervical cancer
• in future (& now for some pilot areas) cervical smears will only be reviewed for hpv and if negative the cells will not be reviewed
• so if you've had hpv vaccination there's no point in a smear test

So what is the probability of having cervical cancer without being positive for hpv?

How will non-hpv cervical cancer be detected?

Can I just have the hpv vaccine and not worry about smears in future?

OP I really would not recommend opting out. My friend was 'fortunate' like yourself to have 3 clear smear tests in a row, only to then experience very prolonged and heavy bleeding 6 months after her most recent smear at that time. Many visits to GP, later being diagnosed with cervical cancer. Turns out the last 3 tests had in fact shown changes despite her receiving negative results and this is only in the last few years. We are very fortunate in this country to have these tests done for free, I can not think of one single reason to not keep routinely going for them.

I have regular smears but I don’t think YABU. I did a lot of research and was convinced that I didn’t need them, based on what I read. However, I end up panicking and just having them done anyway!

I opted out. I had two horrendous attempts at a smear. I’m very low risk and I researched the pros and cons.

You will get repeated letters and reminders everytime you go to the dr. I stopped this by sending a formal letter (there are templates online).

- so if you've had hpv vaccination there's no point in a smear test

Vaccination only covers a few high risk strains of HPV. Regular smears will still be necessary, until they have done enough studies and looked at the data. It is likely that in the future, the intervals between screenings will be much longer than the current 3 years.

If the risks from going for a smear are greater than the risks from not going for a smear, that is the main reason why someone would opt out.

I did so with the approval of my GP, because I'm ultra low risk.

I opted out a few years ago after having a particularly painful smear test. I was late 50s, had never had an abnormal result, and hadn't had sex with a man for nearly 40 years. I told the GP I considered my risk of getting cervical cancer was very low, and she agreed.

Terfinator, yay!
This means that the vast majority of women who had treatment actually didn't need it.
Smear testing as currently managed is Bad Medicine. Costs a lot, 'saves' very few lives, causes massive anxiety and is instrumental (via unnecessary cervical procedures) in increasing the incidence of miscarriage and of problematic pregnancies (last 4 months on a sofa, horisontal, anyone?) through cervical incompetence.

The women who die of this are, on the whole, and always have been, elderly. They are not screened. Go figure.

"My twat is not government property"

YANBU. I’ve opted out but some doctors will try and bully you into getting the smear anyway. It feels like borderline sexual assault to me to have a person in a position of power not accepting ‘no’ to having such an intimate test.

I had one GP only agree to one 3 month prescription of the contraceptive pill with no repeats unless I agreed to having a smear! (this is in Australia). I should have made a complaint but I was too shocked by the way I was treated to consider it at the time,

Forgot to add that I’ve avoided visiting GP for medical issues due to the pressure to have the smear. I’ve also used up valuable appointment time saying no to the test when I went to the GP for a completely unrelated issue such as back pain or a bad cough.

I'm not going to tell you what you should do, but I will tell you my experience.

I hated having smear tests, so kept putting it off. In 2012, at the age of 49, I thought I was starting to go through my menopause, because my periods became very heavy. They'd always been fairly heavy anyway, so I didn't think anything of it.

Then, for a couple of days, I really started to feel unwell. Nothing specific, but just not great.And then, one evening, I started throwing up, and I had terrible pain in my torso, it was worse than being in labour.
I ended up in A&E, in the resus room with kidney failure. It turned out that I had stage 3 cervical cancer, and the tumour had grown to block my kidneys.
I now have only 1 functioning kidney, which has a stent in it. The time will come when the stent gets blocked and I will need a nephrostomy. I had a nephrostomy for 6 months when the stent got blocked before, and it was horrible. I dread having to have another one, which the next time will be permanent.

I also still have the tumour. It's been kept under control over the years with radiotherapy and 3 cycles of chemo, but it's been over 5 years since diagnosis and I'm very aware that I've been so lucky to have lasted this long, even though I'm now disabled and can't even do much more than make a cup of tea.
I've had to have several hospital stays over the years due to infections or other problems and have now developed anxiety.

I don't know how much longer I have, but if I could go back in time and have it detected earlier so that it could be treated and I could go back to normal, I'd go, and have those smear tests I missed.

For everyone saying that OP is BU because some cases of cancer aren't caused by HPV, what do you plan to do when the screening test changes over to a HPV test. Or what would you suggest I do, as I live in one of the many countries that has already made the switch?

Fwiw I've opted out of the screening as I've had only two partners, one was a virgin and one I've been monogamous with for years. I'm just not at risk of getting HPV and the test is for HPV (I'm in Australia).

Yes I suppose my and OPs husbands could be cheating, but if that's a concern then shouldn't we also be getting regular tests for HIV, gonorrhoea and syphilis as well?

Did a pp say that having a smear test can actually cause abnormal cells/smear results

Motoko - I don’t know what to say other than you have my sympathy

My beautiful friend was terrified of the thought of a smear test...

My beautiful friend was dead at 33.

She didn't have HPV. She did have cervical cancer.

Because she didn't have smear tests she died. Before doing so she underwent far more invasive and frankly horrific treatments than early detection would have needed, and in all likelihoid she'd be here now.

Your body, your choice. Just be aware of the possible consequences because her anxiety over the treatments and dying so young were far worse than a couple of weeks waiting for a result. Not having the test doesn't change the possibility of you getting cancer - it DOES change the chances of it killing you if you do.

I'm not interested about smears or mammograms.

My sister died of cancer and neither of these prevented her death. She was just 35.

It's really horrible but sometimes people just die. My sister did nothing wrong.

Yes, you would be unreasonable. Some women do not have the luxury of free smear tests. If I were you I would work on controlling anxiety, which will pay dividends in life in future. I speak as someone who had anxiety and had CBT for it on the NHS.

Of course you can what you like with your life. But conquering anxiety and keeping safe sounds so much more appealing to me.

I hate having smears. More than I hate anything else. Which sounds extreme, but it really is the case.

Some people may not be able to understand that. But my hatred is strong. I find them incredibly painful.

My issue with this screening test is the lack of informed consent. I also find it concerning that there is a financial motivation for gp surgerys to hit screening targets. And lets not forget that cervical cancer is very rare. Lung and bowel cancer is far more common yet there is no screening test and therefore no financial motivation to screen.

The screening test does not detect all types of cervical cancer. Between 10 and 20 % of cervical cancers are Adenocarcinomas and others. Jade Goody had adenocarcinoma yet her death was used to promote the same test that couldn't detect the type of cancer she had. This test is useless to women with other types of cervical cancer.

Half of all women with cervical cancer are aged over 65. Yet screening stops at 65. Why?

‘’In the NHS cervical screening programme around 1000 women need to be screened for 35 years to prevent one death’’

I was thinking that’s not much and then I thought I live in a town of population 40000. Presume approx half are women. This means I could have 20 of my cohort group die needlessly from cervical screening in my own town if they stopped screening

I don't think it's quite that straightforward.

In your town 20,000 women would have around 11 smear tests each over 35 years. Many women will have a history of sexual abuse or have birth trauma and will find the experience traumatic and painful.

Over 70% of those women will get an "abnormal"result and have unnecessary painful treatment. Many will suffer severe anxiety, pain, trauma, and give birth to their babies prematurely.

Twenty women out of the 20,000 might well have cervical cancer.

Out of those women around ten women will be over 65 who aren't screened anyway due to their age. Around four of the other women will have tested negative as the test couldnt detect that type of cancer they had. That leaves six women. How many of those were a false positive, how many had symptoms that the gp ignored? To me this test looks like it has scandalous rates of false positives and not much better odds at detecting actual cancer than flipping a coin.

I don't find it acceptable that 14,000 women in your town underwent unnecessary awful treatment for no reason and that out of the 20 women with actual cancer only 6 benefited from this test. It's absolutely scandalous.

I too have been with my husband since 1999 and have attended regular clear cervical screenings since first invited to do so. Last year I had HPV detected for the first time. Nurse said it has nothing to do with cheating partner it’s just that it has lay dormant for many years.

Me too ^^ which leads me to think that hpv testing isn't enough.

I asked MN to get an expert in so we could have a proper, informed discussion about this. They requested I put a thread up asking if anyone else would be interested. Unfortunately, only a few people replied. I really do think we need more information and not necessarily from one source, so we get a balanced view. Please, if you agree ask MNHQ for a we chat or some form of getting us all decent info.

I can't believe the amount of people that think HPV can only occur if you've had more than one sexual partner, that's bloody madness.

I PP said it above, you can get HPV at any time, no matter how many times/people you've had sex with.

I find the hectoring on having smear tests done in primary healthcare in the
U
K in sharp contrast with the sensitive way mammograms are approached when you reach 50 with the pros and cons being explained and how you can ask for more info before being screened. And of course breast cancer is more prevalent than cervical cancer