Cervical Smears-Not to Go?

[B1rthdayD1lemna]

So I’ve always been very compliant with anything medical but after a number of really bad experiences (most NHS but some private) I’m now more sceptical.

I’ve been invited for my latest smear test, and inspired by another current thread on women’s health, I wanted to ask IABU if I don’t go?

I know for some people smears can be painful and even traumatic. I’ve been lucky not to have been in that situation. However, I am concerned about the downsides-mainly, the risk of false positives. Basically where something “abnormal” is treated but where it wouldn’t have actually caused harm. I think these are a recognised downside for preventative screening programmes, but I don’t know what the risk is for smears and breast screening. I’m not in an at risk group so far as I know. If I noticed a problem I would definitely get it checked out but just want to take a risk-based approach.

She might not be, but considering the financial state of the NHS, I can’t see that they would want to spend money on unnecessary testing/ screening. If they could justify cutting the cost, I think they would. Just as they are withdrawing from covid vaccinations

Yes, but initially they are looking for HPV. Not for abnormal cells, as per pap testing.

We can't fabricate facts that will make you feel empowered to make the 'right' decision

Speak to your health care practitioner about supporting you through the smear test with your high level of anxiety instead of trying to convince yourself that taking a risk-based approach is reasonable. Of course it isn't.

You are responsible for your own health care provision, but also attempting to legitimise your approach. As a nation we already have an issue with women going for a smear, attendance is back to pre Jade Goody levels. Don't build on that.

I don’t have an issue with anxiety around the smear itself, but I definitely agree women should be supported so that they can go ahead with screening in a way that makes it more manageable for them

Thanks everyone for thoughtful responses. I am interested in the issue of over-diagnosis and wanted to understood if/how this might apply to smear testing. Thanks to those who have shared medical info/papers. I also have to balance a known risk that I have (severe health anxiety leading to suicidality) which obviously isn’t something most people have to deal with. I will reflect and read properly the medical
info shared. Just to reiterate, I’m not discouraging anyone from having a smear. I suspect what I will do is have the smear but delay it slightly so that it doesn’t coincide with any periods of stress likely to trigger my anxiety.

Here are the NHS CSP England patient management flowcharts
https://www.gov.uk/government/publications/cervical-screening-care-pathway/cervical-screening-care-pathway

If a woman's test shows HPV positive with abnormal cells and she declines colposcopy, then she'll be contacted a couple of times by colposcopy to give information about the result, investigation and possible risks of not being investigated. Then she is discharged to GP care. The GP would hopefully have a conversation with the woman to understand and discuss the reasons.
The screening database system that sends the invitation and result letters is automatically set for an invitation in a year's time from the date of the test that indicates colposcopy referral. This is a failsafe measure; so she would not be refused the test in year's time.
There's a series of invitations again at the 12 months mark.
Primary care, cytology/ HPV testing labs, colposcopy and the screening database agency all have roles in failsafe.
You can read more about it here (it's a bit complicated to explain fully here).
www.gov.uk/government/publications/cervical-screening-cytology-reporting-failsafe/cervical-screening-failsafe-guidance

My lovely sister died a horrible, traumatising death from cervical cancer last year aged 32. She did not go for smears. She died 10 weeks after diagnosis. Her death was entirely preventable. Please go

Yes that's correct because primary HPV testing was found to be more sensitive than primary cytology in data from the UK pilot sites. The specificity of HPV test for CIN2+ may be lower as the test is "is there high risk HPV present in accordance with the test range". The cytology is the used to assess "and are there any cells that show abnormal or possibly abnormal changes" - it adds the specificity.
No screening test is 100% sensitive or specific. It's a balancing act.

YABU - my friend had a false positive and went for further investigation and was found to be fine. That is what happens in the majority of false positive cases.

I used to work with a woman whose daughter died of cervical cancer when she was 27 - it was awful. She was a lesbian so thought she was fine BUT had sex with men also so she needed trusting

Especially with those who work same hours as their doctor practice.

With many employers, they do not allow employees to attend doctor appointments in work time.

Women can’t be picky about when they book their smear test, providing it’s not during their period

I'm with you OP. I haven't had one for 10 years for several reasons.

1. I've always found them extremely painful. Last time, at my GP surgery I bled quite badly, so had to be referred to the colposcopy clinic (so the test could be carried out by a gynaecologist who knew what they were doing). Smear was normal as all previous others have been.
2. I understand they only now screen for HPV. As I've had the same partner for 30 years (and don't plan on changing!) I consider my chances of developing HPV very slim and, in light of my previous point, makes the above discomfort all the more unnecessary.
3. I'm not all that convinced that, generally speaking, the procedure itself, ie, scraping such a sensitive area of the body with a plastic brush, is all that good for you. My risk/benefit analysis is that, as I'm not a high-risk patient (re point 2) this procedure causes - and indeed has caused - problems both physically and mentally that weren't there prior to treatment.
4. Finally, I'm always a little sceptical about the fact that GP surgeries are paid a fee for these screenings. So then I think: 'Are they really doing this for the goodness of my health'? Same with LARC - was perfectly happy on the pill for decades yet every single time I had my review, without fail, the nurse would try to get me to switch. I later learned surgeries receive a cash incentive for this also.

So these are my reasons, you have yours. What other people think of those reasons is neither here nor there.

As a caveat to all of the above I would say that anyone in a high risk group (sexual partners, family history, obvious symptoms) should probably get tested. But, based on my own risk/benefit analysis, I'm happy with my decision at this time. Sounds like you are too.

This isn’t true.
Sometimes people are treated unnecessarily.
This thread is concerning as it seems many people are consenting to screening without a true understanding of both the benefits and risks involved.

Women wrongly believe that they are not at risk from HPV, the leading cause of cervical cancer if they are in a long-term relationship. The virus can remain dormant for years and then reactivate.

The thing that annoys me most about them now only testing for HPV is that they were very clear when the HpV vaccine was introduced that recipients would still need smear tests ‘because HPV isn’t responsible for all cervical cancers’. DD was in the first (or maybe second) cohort so there was a stack of info provided. So they are aware that absence of HPV does not equal no risk of cancer but can’t be arsed to test for it anyway after women have had such an intrusive and uncomfortable test. It’s outrageous really.

Nobody can say, except in retrospect, whether screening was or was not worth it for them, personally. Looking at it purely statistically, I could have decided I was extremely unlikely to be one of the unlucky ones and not bothered, as per Jumpingthruhoops, who has also calculated she is statistically unlikely to be one of the unlucky ones. However, if I had never had any smear tests, I think it highly likely I would have developed cervical cancer, given the eventual CIN 3 result, so there you go - statistics didn’t really help me make the “right decision” as an individual, because I wasn’t in a statistically high-risk group, but was unlucky in any event.

In retrospect, I am infinitely happier with having had a small chunk of my cervix removed, post-having all the children I wanted anyway, than I would have been with having a radical hysterectomy, removal of lymph nodes, possible subsequent lymphoedema, chemotherapy and radiotherapy.

This is very recent though. It was a full smear in 2021 when I last had one

Ok so you know you've had these abnormal smears. But are you getting any treatment? Or is it " watch and wait" because if you didn't have it sorted 3 years ago then I don't see the advantage of knowing then

So you just had a HPV swab rather than an actual smear test?

Exactly, we can only make decisions on the medical knowledge available at THIS time. We know that some strains of the HPV virus can lead to dyskariosis which can lead to cervical cancer in some women. Some women with dyskaryosis will not develop cervical cancer but we don't have the ability at present to be able to identify them. Some women will be over treated as it's not a perfect system currently. Maybe further research will be able to in the future but meanwhile we have to deal with the here and now. How lucky we are to be even having this debate.

I always generate a false positive or at best inconclusive at smear due to having unusual cells in my cervix. I then get referred to the hospital, blood test, further swabs, confirm all is good. Much better to do that than to find something worse. Just get the test done!

They are obviously looking at your cells due to this history. They aren’t bothering to for the rest of us. Just an HPV test.

That’s not quite right - I have a standard smear, just like everyone else- it will then return a result that’s abnormal or false positive. That’s why it gets looked at further.

But a normal smear only tests for HPV now. If you are positive for that they’ll look further. I’m not. And I haven’t been sexually active for long enough for it to be pretty much a certainty that I’ll never test positive. Nobody is ever looking whether my cells are normal - even though not all cervical cancers are caused by HPV. It’s disgraceful.

This isn’t right. You aren’t trying to get the cervix with at home tests, just vagina which will tell you if you have hpv. They are done correctly 99% of the time.

Jade Goody- if you don’t know her case read up on it. This is one area of health that I would never ignore regardless of physical and mental discomfort.

I had my own smear last week. I was dreading it, but was put at ease, it was uncomfortable but not overwhelmingly so.

finally I’ve had a smear come back with abnormal cells and I tell you I wouldn’t wish that upon anyone.