For me there is a couple of points here that I need to make.
Part of my decision not to go with screening is for my health. Given the stress of it, I have considered the impact on my mental health. I do feel that this is completely neglected by the attitude of government and doctors.
Given the way in which they are so aggressively pursuing this with women, I also want to point out the bleeding obvious. Which women out there are the ones most likely to avoid going for smear screening? One of the most likely answers is women who have perhaps been abused or raped in the past or have some other history of anxiety. This also, sadly means they are women who are perhaps more likely to be at risk of developing cervical cancer due to their sexual history and they are potentially more likely to be vulnerable / have a lack of trust in authority too.
By making the system aggressive and so paternalistic, it has the potential to make women, who are most vulnerable disengage with doctors. This then becomes, not just about whether they might die from cervical cancer but also about a batch of other health issues which may be life threatening. If it is alienating enough women from a doctor, then are the lives saved made by screening being lost somewhere else? Its a crucial question that no one really wants to answer.
Not understanding how important building up a relationship of trust between a patient and a doctor is the real downfall of making the system so aggressive and impersonal.
I'm afraid, to a lot of women, its not just as simple as just 'throwing a letter in the bin'. That letter has the potential to be 'triggering' in someway. Especially if it is badly worded, or gives the lack of impression of choice.
In the end the last letter I had from my previous GP said that since I had not responded to their last letters about attending a smear test, that if I did not respond this time they would remove me from their books. I felt like an ultimatum; have a smear or deregister. Since I get so upset at these letters and had previously felt bullied by the GP, there was not a cat in hell's that I was going to respond. Thus leaving me unregistered.
Reading through this thread, I find actually incredibly insensitive from a lot of people heaping on the pressure saying it saves lives. The way in which it is being done, is probably actually having the opposite effect in encouraging a number of women. Even if it saved your life; it STILL does not give you the right to ignore the complexity of the issue and be so aggressive in trying to bully others out of trying to raise concerns which effect them.
In addition to this, women who 'have had their lives saved' and use this as an emotive way to persuade others are also missing an unpleasant, but important truth. Not to disrespect people on this thread, and no one is going to thank me for saying this, I still have to make the point. A lot of women who have come back and had treatment resulting from an abnormal result, have not had life saving treatment, they have had unnecessary treatment which they mistakenly think is lifesaving. The reason they have the treatment is because in a great many cases, there is simply no way to tell the difference between a result which is life-threatening and one which isn't, so everyone gets treatment. The effect of this is to disproportionately represent the benefits of screening by anecdote and popular pressure. So to the people saying there are X amount of people on this thread who have had their lives saved, that might not actually be the reality, and we need to be extremely cautious about it.
I find the combination of that emotive response, peer pressure and the lack of sensitivity and respect for women most alarming. It means that we are stuck in a situation where there is no movement forward in trying to accept that there are flaws to the system and trying to find new ways to improve women's health (which is not exclusively about smear screening, but the emphasis makes it). Unfortunately, the current obsession is focussing on screening and making sure that targets are achieved which ends up neglecting other aspects of healthcare.
I also find the attitude alarming, because it does make me worry about the possibility of one day in the future that smears are made compulsory. Poland proposed doing this for working women a couple of years ago in response to EU drives to increase screening; with the implication being that if you refused one, then you pretty much couldn't get a job. I fear that, unless we challenge the way that the NHS is being aggressive now, that we are already very much on the slippery slope to this, and that consent will be something that is very much irrelevant.
My husband has previously mentioned, making complaints to those sending the letters, but I find the prospect both daunting and very scary in itself. I have no idea who I would actually be writing to, and whether they were actually part of the NHS either. I personally am not sure if I could handle the response; I fear it would be more of the same shit trying to get me to comply rather than actually listening to how I feel. It just feels like a faceless inhumane wall of policy. Not something that is genuinely concerned about my wellbeing, which is not just about my chances of whether I may or may not develop cervical cancer.