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.

I agree with you on the lack of control. Unfortunately have had a number of health problems not in my control and negative interactions with medics. However, I’m keen to make an informed decision based on risk-the info shared by PPs has been very helpful and why I posted on here. Not sure people saying I’d be mad not to have the smear etc are super helpful. Lots of women don’t go and I think berating people isn’t helpful, especially if they are asking for information. But hey, it’s AIBU 😂

I’ve had the loop excision and I’m glad I did. I assume you want stats not anecdotes (though the nhs don’t have money to waste on screening programs not backed up by the data). However you are not pushed into treatment even with CIN 2 - they will just screen more frequently if you opt not to have the treatment. I’m not sure there’s anything to lose from having the screening.

For me, it comes down to the fact that you wouldn't necessarily have any symptoms and by the time you did it could be brutal. I wouldn't want to be put in that position. I wouldn't want to explain to my family especially, in my case, my children, that I refused a free test for cancer.

you have to be really stupid not to have them tbh. It could literally save your life.

After a traumatic birth two years ago where painful decisions were made without my consent, I understand you completely. I won’t attend a smear appointment and they have taken the reminder off my record.

Although I would encourage all of my loved ones to attend, I read a brilliant article on the topic which explained that our trust in doctors should have limits. Medicine is just like any other job. There are those who are outstanding, and those less able and ultimately less trustworthy.

Erm no. I haven’t been able to find further info and wanted to see if others could help-they have. That’s a very judgemental view.

Cervical screening tests for HPV, which causes the vast amount of cervical cancers if it doesn’t clear. There’s no treatment for it and the body usually clears it on its own.
if it’s positive for HPV that’s when they look closer at the cells for any cell changes.
no changes - no treatment. Just another smear in 1 year to check the HPV has gone.
if there are cells changes then you would be referred to colposcopy for further investigations and offered treatment if needed.
in my opinion it’s so important we get these screening tests to pick up anything quickly, there isn’t always symptoms of early stage cervical cancers.

I don’t bother anymore as I’m hpv negative. I’m trying to find a private service where I can get a smear and they will look at the cells rather than my hpv status

@B1rthdayD1lemna sorry what was in the other thread.

Well done Op for asking the question. It is not 'idiot science' to think about benefits and harms of screening.

I have tried to do this research for cervical cancer screening and struggled. I think it is because it is such an old screening programme, that the evaluations are not as good as more modern ones. Clearly C-cancer deaths have fallen lots since the event ic the programme- but they were ALREADY falling when the programme got underway. And now of course, have vaccine muddies analysis further.

I decided a long time ago that smear tests were not acceptable to me personally (too invasive) and as my risks are very low, I haven't been for 15 years. I won't attend breast screening either- again, low risks, and very equivocal evidence of benefit of the programme. Those are my - informed - decisions and others decide differently. I am very wry if dcreening that goes by other names - medicals, mental heath questionnaires, well-person checks, free BP measurements or opportunistic ECGs... these are all screening (usually entirely unevidenced) and may be inappropriate or require proper consent.

Good luck making your own choices.

There’s another thread on women’s gynae at the moment. Is that what you mean?

I WAS wrong, she had cervical cancer.

I had my first smear test earlier this year as I was just putting it off for years. Finally found a courage. It literally took the nurse 3 seconds. I even said after that “ that’s it?” Definitely was ready for something more!
Came back negative. Done.

Thanks-I appreciate your thoughtful response

There is really poor data on individual risk level under the new regime. I am extremely, extremely low risk for HPV given age, past and current sexual activity and general health is good with low levels of other general modifiable risk factors for cancer (eg drinking, smoking, living in polluted area etc). I will be more at risk to the nonHPV cancer, which current screening doesn’t assess for. It’s a painful process for me, and now it won’t even screen for the sort of cancer I would be at risk of. I’ve asked my GP practice x3 to explain the risks/benefits to a woman in my circumstances and they are unable, despite them pressing me to attend screens. I have also be mulling about a private test which is old school- ie eyes on my cells.

I don't go to smear tests, never have done.

Cervical cancer is only the 14th most common cancer for women.

We get tested as there is a viable test, not because it's a particularly high risk. I don't go round worrying about all the other more likely types of cancer I'm not tested for.

Weighing up the risk factors, known factors such as smoking, family history, taking the pill, having had an STI etc - I'm all zero on, so I figure I'm comfortable not getting the test.

Jade Goody definitely had cervical cancer.

Thanks for sharing. It could be as PPs have suggested that there isn’t good recent data on this

Go to your local sexual health rather than the GP, they’re so much more efficient there, they do it all day every day.

From this paper
https://www.medrxiv.org/content/10.1101/2020.03.17.20037440v1.full.pdf

In a typical population, the old-fashioned-looking-at-the-cells-smear-test missed 4.9 cases per 1000 women, and resulted in 95 false positives per 1000 women leading to excess colposcopy.
So a 0.5% false negative rate and a 9.5% false positive rate

For primary HPV testing, 2.0 cases were missed per 1000 women, with 99 excess colposcopies undertaken.
So a 0.2% false negative rate and a 9.9% false positive rate

I still can't understand why people would refuse a test to know. A false positive is a blessed relief.

I know 5 people who have had cancer removed from the screening programme that they wouldn't have known was there otherwise. Obviously we wouldn't never know when they would have found out, but I'm glad they did.

If you've got kids, take the test. Do not risk putting your children through the trauma of losing a parent in childhood. Believe me, it is awful.

In fact, just take the test, kids or no kids. There will be people who love you who do not want to lose you to a preventable disease.

I don’t really understand what your concerns are? People don’t get given the wrong diagnosis or treatment for cervical cancer or cancerous cells? Or it’s pretty rare.

I had a smear come back with possible pre cancerous cells, I was treated amazingly and professionally at the gynaecology hospital. I had biopsies taken etc…and got the all clear within a week after. I did have HPV but have since been given the all clear. None of it was traumatic or uncalled for. These tests are there to save lives.

Just go. It's over in minutes and it's nothing.

I had my invitation a couple of months ago and haven’t bothered for the first time. If they only test for abnormalities on detection of hpv I don’t think it’s worth it. I’m in my mid 40s now and been with the same partner since age 17 so 🤷‍♀️