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.

Primary HPV was fully implemented in England by mid 2020.
The 'smear' test - speculum and cervex broom to obtain the sample remains the same. The lab process is now HPV test first (see my earlier posts for details).

I’m sorry to hear this. I really hope you’re seen quickly and get the all clear

This depends on what the PP means by abnormal. As seen on this thread, there's a range of meanings being attached to words and phrases.

Yes this is me too.

I have not taken up the invitation for screening since it switched to the HPV test.

For the posters comparing frequency of follow up, what investigations and treatment they've been offered, please look at the patient flowchart number 3 as this gives the different pathways depending on what your cytology result, colpsocopy apperance and (any) histology result showed. https://www.gov.uk/government/publications/cervical-screening-care-pathway/cervical-screening-care-pathway#flowchart-part-3-abnormal-colposcopy-result-management-including-sample-taking-colposcopy-and-histopathology

Can I suggest that posters read the national screening committee link on the evidence for cervical screening as the programme currently delivers.
Also read the principles of screening https://www.gov.uk/guidance/principles-of-population-screening/principles-of-screening#:~:text=Screening%20is%20the%20process%20of,tests%20or%20treatment%20as%20appropriate. and criteria for a population screening programme https://www.gov.uk/government/publications/evidence-review-criteria-national-screening-programmes/criteria-for-appraising-the-viability-effectiveness-and-appropriateness-of-a-screening-programme

Screening programmes in general are not designed to detect rare diseases or rare sub-types. Not all cancers (or disease) will be prevented by a screening test. The limitations of screening tests should be (according to gov standards) been included in screening invitation and literature.
If anyone has symptoms then they need a diagnostic test/investigation, rather than a screening test.

Hpv tests are designed to pick up on an hpv infection, even if it is symptomless at the moment. Smear tests are designed to pick up on cell changes characteristic of hpv infection, they are not actually designed to detect cancers or other infections, although other infections and cancers may be noticed whilst reading the smear.

In other words, smear tests were designed to avoid cancer, not to find it. Cervical cancer caused by something other than hpv is far too rare to design a screening test specifically to try to avoid it, and if you already have it, then you'll be tested for your actual symptoms, not simply have a smear taken.

ie, smear tests are a very poor diagnostic tool for cancer, but a useful tool for detecting specific cell changes characteristic of hpv infection.

Don't go then. Simple. Never heard such nonsense. Everything carries a risk. Go live in a third world country where you won't have such agonising choices.

Wow. Did you not see the previous posts? There are particular reasons this isn’t a black and white issue for me, or do you not believe mental health conditions count as “real illnesses”?

Smear tests used to test for abnormal cells. Now they don’t. It’s not an improvement.

If waiting until symptoms appeared enabled successful treatment, don't you think the NHS would scrap smears?

Identifying cancer early is the biggest factor in surviving.

But you do you.

Have you read the national screening committee evidence on using HPV testing, with cytology as the second test?

I’m using the information I was given when my daughter was given HPV vaccine. It said she should still get smear tests because not all cancers are caused by HPV. So that suggests doctors/researchers felt the test of cells was important.

Apologies. There are different types of cell in the cervix. I understand that my cervix doesn’t have the more “normal” cell layout pattern which can then produce an anomalous result (a medical professional could yet correct me, that’s how I understood it!).

I lost my mother 5 years ago to cervical cancer. By the time she found out she had 3 months to live. She never had a smear.

She died a very slow and painful death and it was very traumatic to watch her suffer as she did.

If you’re happy to risk it, crack on, none of us can tell you to go. If you’re happy for your family to watch you suffer when it could have been prevented then don’t go.

It is an improvement - smear tests are still used to test for the specific abnormal cell changes caused by hpv, but only if the person has tested positive for hpv. A person is simply not going to have hpv-related changes that if they don’t have hpv, so no need to look at the smear in attempt to find something you already know almost certainly won’t be there.

Whilst cytologists may occasionally have found other infections or even cancers when checking smear tests, that is not what they were looking for, so a woman would have a false sense of reassurance if she relied on a smear test for anything other than looking for signs of hpv infection. However, the act of going to get a smear and hpv test can pick quite a few other gynaecological issues in any event, as the person taking the smear might observe them (eg unusual discharge, odd appearance of cervix, pain in abdomen) and therefore offer to take separate swabs at the time of the smear to test for those, separately, or suggest a referral to someone who specialises in gynaecological abnormalities.

Also, the hpv vaccine is not 100% effective, so it’s still worth checking for hpv infection in any event.

The information is the smear test for fuck’s sake

And what about the cancers not caused by HPV? Because it was made very clear when my daughter had the vaccine that it didn’t prevent all cancers.
Edit: they weren’t always just looking for HPV. They were looking for cell changes. I’m 60. I’ve read the info for a lot of years now.

I remember on a similar thread where someone said that anyone who does not have a smear should be denied NHS treatment if they end up with cervical cancer.
They then went on to say that their own sister had cervical cancer and had not been up to date with her smears.

MN is funny at times. All about your own bodily autonomy but when it comes to smear tests, everyone and their dog has an opinion on it and what they think you should do. The infantilising is off the scale too. Telling grown women to make sure their will is in order if they don't have the test. Saying that not having the test causes cancer. Um, it does not.
You see posters on here worried they will get cancer because they are a few weeks overdue for their smear test.

I’ve had 2 positives and then the resulting treatment. Both were for early signs of cell change. No one can tell me of theyd have resulted in cancer or when but they bloody can’t after they’ve been scraped off and the area cauterised! It wasn’t my best day ever but it was over with in under an hour and I walked back to the car. Way better than cervical cancer!

They were and are looking for dyskariosis - a specific type of cell change. They are not a diagnostic test, they are a screening test, and what they are screening for is hpv-related cell changes. They might also, incidentally, pick up a thrush infection, or other type of infection, but it would be foolish to rely on them for something they were not designed to detect. That’s why there are different tests for other infections and cancer.

My sister in law died at 34 leaving a 10 year old son because she didn’t go to a screening. When it was found it was too late. Don’t be silly.

The info I was looking for wasn’t in the info pack I received. I read it carefully. Some PPs were able to send on useful links and info, but this wasn’t in what I was sent, or o wouldn’t have started the thread

I’m glad to hear that you were treated and had a positive experience