Women failing to attend smear tests

[guardianfree]

Women generally but young women in particular - 1 in 3 not attending.

www.independent.co.uk/news/uk/home-news/jos-cervical-cancer-trust-charity-smear-tests-terminal-illness-health-wellbeing-hospitals-a8171011.html

I know they're unpleasant (and often feel humiliating) but what can we do to reassure women that they can be life savers?

vegecook b12 supplementation and retesting has raised and confirmed my b12 levels. I'll never know the exact cause for why they dropped low but I can prevent them from dropping so low again.

"Yes and yet there are calls from this age group to lower the age because some have unfortunately died. I wonder if the hpv vaccine will make a very large difference in the future??"

Yes. The trouble is, those calls aren't especially helpful. It's absolutely tragic when a young woman in her early 20s dies of cervical cancer. It's appalling. And naturally, family and friends want to know why. The absence of screening for this age group seems like an obvious place to look. But unfortunately, it's not the answer - the current method of screening just isn't effective as a way of finding cases of cancer in this demographic, basically because so many of them are HPV positive.

What you do find, however, if you look through the case notes of these tragedies, is that GPs are missing tell-tale symptoms. Some of these women go back and back and back to the doctor, knowing something is wrong and are not referred on for symptomatic testing (a process that is separate from screening). We need to educate GPs better on this issue to ensure that this doesn't happen. (In my personal opinion, we need a revolution on GP attitudes to gynae health full stop - the level of flouting of NICE guidelaines when it comes to things like menhorragia is appalling).

whiskyowl

Yes GP's can be problematic. I think education is definitely the key, finding a way that appeals to younger women. I'm just reading a study about increasing uptake of screening by Roma women in Romania where uptake is a real issue.

Couldn't agree more whiskyowl.

NHS nurses would be compassionate in those circumstances

Nurses should be compassionate in all circumstances, but I think that goal is unrealistic.

NHS nurses would be compassionate in those circumstances

Another patient's family member once, justifiably, made a complaint about the way I was treated by an the nurses on a ward in an NHS hospital.

In the main they do a wonderful job, but they are only people and they carry their own prejudices.

So you cannot state that they, categorically, would all treat women compassionately.

Use some of the money that gets spent on guilt-tripping ad campaigns to develop a less intrusive method of cervical screening, rather than mess about with more adverts.

If it was as simple as POAS or giving a little blood, everyone would do it.

Yes I'm a man....yawn....... I just like to look at information from medical professionals rather than some tin foil hat conspiracy theorist........."

Well try reading Margaret McCartney, GP, author, broadcaster, columnist for the BMJ, doesn't have smear tests.

margaretmccartney.com/2013/02/05/women-cervical-smears-and-manipulation/

www.independent.co.uk/life-style/health-and-families/features/why-im-saying-no-to-a-smear-7577967.html

Smear tests - along with mammograms - started out life as a political initiative under the dreaded Edwina Currie. She saw cancer screening as a politically popular thing because everyone loves something that 'stops' cancer that saves lives

But as DR McCartney points out, no life is ever 'saved' unless you make someone immortal - it's just prolonged. One of the problems with any cancer screening progamme. is 'lead time bias'. If you identify a cancer 'early' in the year 2000 and a patient dies in 2020, then the patient will have 'survived' for 20 years. If the cancer is found in 2010 and the patient dies on exactly the same time they have 'survived' 10 years. So the 'early' screening appears to have prolonged the patients life but didn't.

Cancer survival is measured in years from diagnosis, not years from when the cancer first grew. That's lead time bias

I've quoted numerous statistics from cancer research and the ONS, presumably you think they're just silly women making stuff up as well?

Cervical screening is not valueless. It can reduce the already very small chance of getting cervical cancer somewhat, but we don't know by exactly how much because there hasn't been a randomized controlled trial in the UK. Against you have to set the likelihood of overtreatment if you have screening, much higher than the chance of getting cancer.

I apprectiate that's a complex argument, but it seems even women can understand ti!

sorry typo - understand it ...

Re women who've been raped/abused. I've spoken to enough women who've been raped - both in my personal life and as a rape crisis volunteer, to know it's an incredibly hard thing for many women to talk about. Even to an anonymous volunteer on the end of a telephone line. You often got slient calls, where women just couldn't speak. Or ones where they were talking about something that had happened years earlier they'd never told anyone about.

I wouldn't want any of those women to have to discuss their experience with some of the characteers who've taken smears from me. I'm a relatively robust, gobby woman, but I'm not going to start disclosing every single bad thing that's ever happened to me to every random medical professional I meet. I was sexually assaulted as a child, I've never told my GP., I've never told a lot of people I know, only those I really trust. It's not the reason I don't have smear tests, I don't have smear tests for the same reason I don't take statins - the very small chance my life will be prolonged is not worth the risk of overtreatment.

I am so, so f*ing angry about the way Jo's trust and the NHS treat women. (dunno if that''s coming across or not). I see someone has started a thread on the Jo's trust board abou this thread. My plea to them - listen to what we are saying, if you don't want to completely alienate us. We are real women telling the real truth. You don't get people on side by patronising, belittling and insulting them. Women aren't stupid and we aren't infants.

"Outside the developed countries, many women are dying from cervical cancer. In the UK our rates low, because of screening."

Evidence for that statement please?

If you go to this link, and open the document you can see a graph showing rates of cervical screening over time.

<a class="break-all" href="http://webarchive.nationalarchives.gov.uk/20160107053639/www.ons.gov.uk/ons/rel/cancer-unit/cancer-trends-in-england-and-wales/smps-no--66/index.html" rel="nofollow" target="_blank">webarchive.nationalarchives.gov.uk/20160107053639/www.ons.gov.uk/ons/rel/cancer-unit/cancer-trends-in-england-and-wales/smps-no--66/index.html

If you go to page 14 in that document, there's a graph showing rates of cervical cancer before and after screening. They fluctuated screening was introduced and - it's true - fell afterwards to a lower rate, but we cannot say that that is due to screening alone. Because there are many other factors affecting cervical cancer risk, such as smoking rates and how many children you have. We have to factor in these - and many other - confounding variables which is very hard to do in an observational study. Correlation isn't the same thing as causation

The graph covers the period between 1950 to 99. The incidence graph however only covers approximately 1970-1999. The lowest incidence pre screening was approx 14 cases per 100,000, the lowest post screening approx 10 cases per 100,000. Not that great a difference really.

Moreover however we didn't have rampaging cervical cancer before screening started. As I mentioned above one risk factor is children - the more children you have the greater your risk. Childbearing rates are usually higher in economically deprived countries, but are tending to drop in developed countries (like the UK).

I apprectiate that's a complex argument, but it seems even women can understand ti!

A few years back there was some research done in how risk well doctors understood risk.

It found was that the vast majority of doctors were pretty much statistically illiterate and didn't understand how risk worked. And these are the very people who are supposed to be able to explain it to women!

www.bbc.co.uk/news/magazine-28166019
This is an utterly fascinating article about it. Its eye opening.

Theresa May has just acknowledged smear tests can be uncomfortable in PMQs"

Hangs flags out Or maybe she just had a bad experience herself?

I just love Margaret McCartney and also Ben Goldacre for the way they explain the muddled thinking of so many medics.

Doctors are just people and statistics is damn complicated stuff - Goldacre is an absolute genius, not only in the way he takes stuff apart, but in the way he explains it to a general audience. Dunno how much they go into it at medical school, but I suspect it's not in depth. McCartney is also very good on the pressures on yer average GP - which she obviously knows all about being a GP.

Thanks for the link - it's a great read.

.perhaps take yourself off to a hospital with terminal cervical/breast cancer patients, perhaps look at the faces of these women who are dying and also look at the sad, petrified faces of their children....ffs!!!

I admit I haven't rtft but I got this far and had to respond. This post is disgusting. I do have smears but I am thinking of leaving it longer in-between each one in future, due to all the reasons already stated. Or I might decide not to go again. I am actually fine with smears, they don't hurt me or bother me in any way. I just don't like the idea of treating something that may never lead to cancer, something which the body very often deals with itself. I have also decided that I won't have mammograms.

I have cared for many people dying from cancer in my old job. My children lost their father to cancer. I have looked at their petrified faces. I simply don't believe a smear is very likely to save my life at all, especially when I am low risk of getting cervical cancer in the first place.

I have to die at some point, there are many things I could die of that can't be screened for. If I have worrying symptoms I will get them checked out, but I am not going to be guilted into any preventive testing from anyone.

People need to back the fuck off women who decide not to have them and worry about their own cervixes.

If women aren't attending screening tests due to embarrassment then that needs to be looked into, guilting them isn't going to help.

Yeah I did know they cannot strike me off for not rebooking. I have huge issues with them threatening me all of the time, and its really bad as the surgery I am at currently is actually the only one I can register with. I tried switching a while back and was told that its all down to certain areas and mine is the only one I can use. I have been trying for 4 months now to get my implant removed as I don't think its working anymore (long story short, it stopped my periods, and now they are back with a vengeance after none for 2 years) and they keep telling me its fine, doesn't need removed yet and such. But I want it out and want to go on the pill. I actually want to be sterylised but apparently I may decide I want more children...even though I know I won't. Been tempted to tell them I am actually a transman so I can get the treatment I want, but don't want to be on testosterone lol

I am genuinely very sorry when someone dies, believe it or not I had a traumatic major bereavement recently and someone in my family died from breast cancer under 50. One of the saddest funerals I have ever attended. I also have someone relatively close to me having treatment for breast cancer at the moment.

None of this changes my mind on screening, any more than the fact that large numbers of my family have dropped dead of cardiovascular disease at young ages and my brother two years older than me just had a heart attack will make me take statins.

Because we are talking about preventive medicine. All preventive medicine has some benefits and some risks.

For me the benefits (small chance of avoiding illness or prolonging life) do not outweigh the risks (much larger chance of taking a medicine/having a treatment that will not benefit me at all).

I do use some preventive medicine - I have a flu jab annually. That's because a flu jab literally takes seconds, and has only very minor, if any, adverse effects. I am so far from being a tin foil hat conspiracy theorist I positively love my flu jab, that lessens my chance of getting flu, a horrible illness I've already had twice in my life. Chances are I won't catch flu, but the point is the risks with a flu jab are negligible so benefit outweighs risk for me.

I'd never tell a woman not to have a smear test, or a mammogram, or anyone not to take statins. But I choose not to do these things myself. All I'm saying is understand the benefits and risks before you have any medical treatment.

And emotional blackmail using dying women is not a good look.

I also wonder about being medicated for it. Its tempting, My doctor has never offered that though bu apparently a few of my friends are given diazapam or something like that for their smears. I would prefer that but am unsure how to ask tbh

I've tried diazepam to no avail, although stumbling about giggling afterwards, while still off my face on a high dose of Valium, was quite amusing.

I just caught up with this from the Independent - and unfortunately the MP shows the depth of confusion over this subject.

www.independent.co.uk/voices/theresa-may-smear-tests-pmqs-cervical-cancer-screening-nhs-womens-bodies-health-a8175846.html

The 25 year old woman who tragically died did NOT need a smear test, she needed a gp who listened to her and referred her appropriately for investigations. Smear tests are not offered to under 25 year olds because in this age group there are so many cell abnormalities that would resolve themselves spontaneously, the test is useless.

However under 25 year olds can , very rarely, get cervical cancer or pre cancerous cell mutations - Jade Goody was first treated for abnormal cells aged 15. The answer however is not to extend smear testing to under 25s, it's to stop GPs fobbing off women who go to them with actual symptoms that need investigating. One problem is that GPs are so underfunded these days that they're very reluctant to refer anyone, though we can't really say what happened in this case. But the answer was never a smear test, which many people don't seem to understand is a screening test for asymptomatic women, not a test for cancer.

Hear hear U2 the pressure on women to have mamograms is immense and after reading the Cochrane report I too decided not to have a mammogram, however it’s not something I dare say out loud to any of my female friends, they would be utterly horrified at my decision I have done a huge amount of reading on the pros and cons of mammograms and my decision is an informed one, if I have symptoms I would get them investigated straight away of course, my doctor is none to pleased with my decision either.

I just watched a thing on the BBC - apparently it's not finding the time, it's being embarrassed about having not waxed the bikini line, or about any possible smell.

This is true, and makes me remember a well-known poster on here one time, on one of the regular pubic hair-removal threads saying that her friend who was a midwife, thought full bushes were hilarious. The Mner also thought it was funny - they obviously had a laugh over it together.

I'm not surprised that (especially younger) women are being put off, if you suspect the HCP is judging you, or even worse, laughing at you.

Betty it's shocking that you feel that way. It really highlights to me that these screening tests are not optional for women. Not medically and not socially.

Yes it’s like it’s my dirty little secret terfinator it’s been good to come on here and talk about it as I don’t feel quite so alone in my decision.