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Original poster

Do I really need a smear?

137 replies

humblesims · 02/08/2017 08:09

Its that time again. The letter has come to make an appointment. I have always been responsible and had the smear test even though I hate it like everyone does.
But I'm fifty two. I dont want to go anymore. I'm menopausal. I have piles. My fanjo is not as neat as it was (I know that counts for nothing).
When does the risk of cervical cancer reduce? Will I still have to have smears when I'm in my dotage?

I know I'll go but...I'm tempted not to.

OP posts:
Angeldt · 16/08/2017 19:00

Just heard this evening my friends daughter who's around 35 and always gone when she's been called for them has died of an aggressive form on cervical cancer. So go.

Adawells · 16/08/2017 19:22

Proof, if ever there was that this test doesn't work.

Kat786 · 16/08/2017 19:34

While I am truly sorry this lady lost her life I have to agree with Ada. The lady went to every smear test they "invited" her to and sadly she still passed away. Another reason I don't attend!

Slimthistime · 16/08/2017 19:43

Angel I'm sorry to hear that
Presumably the smears did not pick up that she had it as they are not diagnostic tests.

PollyPerky · 16/08/2017 19:43

I respect everyone's decision too but I don't think it's right to cherry pick examples. it's a bit like saying great uncle Albert smoked 60 a day for 60 years and lived to 100, so smoking can't be that bad for you.

I could equally give examples of friends and neighbours who had tiny tumours diagnosed early, are still alive decades later and may not have been had they not had screening.

I agree that screening is not perfect for anything, but if cancer is there it's best dealt with before it metastases.

terrylene · 16/08/2017 20:53

Angel - sorry to hear that. That is what happened to my friend; she was 41. However she had had only 2 years between her previous two smears. It did throw me, but I have since found out that there are some cancers that the pap test does not pick up very well. Sad

Adawells · 16/08/2017 21:21

The adenocarcinoma is the type that is aggressive and that is often not picked up by smears as it's not on the surface of the cervix, and tends to be in younger women. The squamous cell type is the very slow growing variety which can be found by smears and can take years to form.

terrylene · 16/08/2017 22:06

That is the sort that Jade Goody probably had, isn't it. It is often the sort that you hear publicised when young women die of cervical cancer and people call for screening below 25.

It is very unusual and does not often show up on smears, whereas cell changes that do show up frequently on smears young women do not usually lead to cancer.

Kat786 · 17/08/2017 07:25

As for me and breast screening I did actually talk to a few relatives about it. I still wasn't convinced that it was a good thing to do. Then I read Professor Baum who was originally in charge of setting up the breast screening programme but now calls for it yo be scrapped. As to smears as far back as 2001 an article appeared in the Lancet or Pulse doctors journal about informed consent and smears. They're meant to declare the financial incentives explain the smear isn't very accurate and about false negative and positive and that our slide might be misread. We all know this doesn't happen!

Kat786 · 17/08/2017 07:27

PollyPerky with all due respect snd obviously I don't know your friends history but could it be these screen detected lumps would never have harmed? Of course I can understand they probably wanted to treat just in case.

PollyPerky · 17/08/2017 08:03

I'm not sure Kat how a lump that was cancer could never have harmed. I don't think oncologists start treatment willy nilly if it won't be of benefit (and I exempt DCIS from this.)

Who would want to wait to find out?

I don't believe the screening process is perfect. But IF I had a tiny tumour too small to feel I'd rather it was treated with a lumpectomy then left and needed radical surgery etc. The survival rate may be no different but quality of life?

Slimthistime · 17/08/2017 09:08

This article has further links to medical journals who believe women have been treated unnecessarily
www.theguardian.com/commentisfree/2014/apr/28/breast-cancer-mammograms-early-detection-research

Kat786 · 17/08/2017 11:15

I'm sorry to offend . I did say I didn't know any facts.

PollyPerky · 17/08/2017 11:40

The point about that article slim is that it doesn't go into much depth.

It does say that lives aren't being saved by early detection but that is only half the story.

Lives may not be lost, but a woman may end up having a mastectomy not a lumpectomy. she may lose lymph nodes and get oedema. She may need a reconstruction. she may need powerful drugs for years to come. All of this could perhaps be avoided with early detection.

So although the end mortality rate is the same, the process of saving that life may differ hugely.

Because what the figures will show are X cases and X survivors after X years. Not the misery of treatment.

Likewise the over-diagnosis. I'd want to see the breakdown of this. Is treatment a biopsy? Another mammogram? Or is it the full works?
is it treatment for DCIS which turns out not to spread?

The article is very emotional but doesn't give the information I'd want to see to make an informed choice.

Slimthistime · 17/08/2017 12:01

Like I said in my post, the article links to the relevant studies, but with MN site being a bit dodge at the moment, maybe they don't show on all devices

here's the British Medical Journal
www.bmj.com/content/348/bmj.g366

here's the New England Journal of Medicine
www.nejm.org/doi/full/10.1056/NEJMp1401875?query=TOC&

Slimthistime · 17/08/2017 12:03

the bit that jumps out of the second article is this

"The relative risk reduction of approximately 20% in breast-cancer mortality associated with mammography that is currently described by most expert panels2 came at the price of a considerable diagnostic cascade, with repeat mammography, subsequent biopsies, and overdiagnosis of breast cancers — cancers that would never have become clinically apparent"

PollyPerky · 17/08/2017 13:10

Yes, but if you are found on routine mammograms to have a tumour the size of a pinhead or years later one the size of a walnut, which would you choose? Both need treatment.

The waste of resources across the population may be relevant (and we don't know if these reports are driven by economics) but the risk for each woman stays the same. A risk of at least 1:9 over a lifetime.

Being selfish, I don't care about other women having their time wasted or having a biopsy that is negative, but I care about me and an early diagnosis seems preferable.

Kat786 · 17/08/2017 13:16

To go back to smears it's also interesting that no randomised control trials were done comparing smeared and unsmeared women. The test was just rolled out and inflicted on us! The test originated when Dr Pap who was also a zoologist became interested in the reproduction of small animals. The smear test he basically developed by giving his long suffering wife and indeed some of her friends lots of smear tests. His wife had one every day for years! The prostate cancer test is about as accurate as the smear test and it was decided not to offer it as a screening programme for the men because it could do damage. We however are expected to embrace the unreliable smear test happily..

PollyPerky · 17/08/2017 14:00

Be fair Kat in your comments Hmm A prostate test (assume you mean a biopsy not a blood test) is much more invasive for a man than a smear test for a woman.

I honestly don't get all the fuss about to have a smear or not.
I have them every 2 years. I pay for them. They take 5 minutes max and they are no biggy. Now I've had a clear HPV test unless I change partners, I may not have or need another smear test at my age.

Vonni1 · 17/08/2017 14:08

Go and get tested. I had my first smear at 25 when you first get called up and they found abnormalities. It was stage 3 prior to stage 4 which is cervical cancer but if I hadn't been tested and treated it would have developed. There is never an age to ignore this test. It saved my life.

Kat786 · 17/08/2017 14:16

PollyPerky you may find a smear no big deal and so may many others....in your opinion a prostate test is worse than a smear. I respect that. Others may not agree!

Slimthistime · 17/08/2017 14:19

Polly "Being selfish, I don't care about other women having their time wasted"

no one's asking you to care. Some of us would just like the NHS to present more information with their screening "invitations".

terrylene · 17/08/2017 14:32

legacyscreening.phe.org.uk/screening-recommendations.php
The NHS are working on it - look at 'Guidance Consultation informed consent'.

The letters have changed with help from Kings College and now tell you it is your choice to screen or not. The cancer charity that promotes smears did not like this being on the cervical screening letters and even got someone to raise it in the Commons in the Spring, but hopefully that was kicked into the long grass where it belongs as a lot of work has been done on this. You still have to go online to find this www.gov.uk/government/publications/cancer-screening-informed-consent and follow links to work out how to do it but it gives you a head start.

In the past, some of the guidance for the administration of the recall system said that doctors should 'counsel' patients who wish to be withdrawn from the system, but now it is clear that you just have to read and understand the leaflet they send you (doctors have no appointments to waste on this anyway Hmm )

PollyPerky · 17/08/2017 15:34

If you know how a prostate is accessed and that it would be a biopsy and not a swipe with a brush (as in a smear) I don't see how there is any debate over what is more invasive. That is looking at it factually, without any subjective emotions.

The NHS leaflets DO say there is a downside and DO say there may be some treatment which ends up being unnecessary.
They ask women to consider what they want.

Are you up to date?

SummerKelly · 17/08/2017 15:44

humble I am in the same position, I'm overdue mine. I did make an appointment but then I got ill and was coughing every time I lie down, which I thought wasn't ideal for a smear test! I'm nearly 50 and I feel much more reticent this time, I wondered whether it was changes in my body and just feeling a lot more delicate down there. I've been much more pragmatic about them before but now I feel a real aversion but I can't really explain why.