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?

I have to say that I don't fail to attend, but I choose not to.

I'll have good read of the thread tomorrow.

Has anyone mentioned that nasty scratchy brush that they use now? Surely only a man would develop a tool that is more effective (I believe) but significantly more uncomfortable to the patient

The pressure exerted, on women to undergo a procedure with highly questionable benefits must have something to do with the target and funding structure. Or lack of information in the case of some of the non-doctor HCPs
Howzabout hats with "My Twat Is Not Govt. Property" on? Or knickers - which on reflection would probably be more useful.

It is the failure to follow up on symptoms (and ironically the fact that the precious, wonderful test can't be done when the symptoms are going on, unpredictably, for months) that is the cause of cervical cancer mortality or severe morbidity in young women. Not them not going for a smear.

I've not had time to read the whole thread yet, I plan to at the weekend, but does anyone else hate the name 'smear' test? To me it sounds quite insulting and degrading.

As a noun: 'a sample of tissue or other material taken from part of the body, spread thinly on a microscope slide for examination, typically for medical diagnosis'

As a verb: 'coat or mark (something) messily or carelessly with a greasy or sticky substance; "his face was smeared with dirt", or: 'damage the reputation of (someone) by false accusations; slander, "someone was trying to smear her by faking letters'

I attend for the god awful test, but I just cringe when I have to phone up and say the word. Much like I do when I have to say the word moist!!!!!

"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, "

Betty - I have taken myself off the mammogram list, like I've taken myself off the smear test list. Same reason - if you look at the cochrane review, there is absolutely no overall reduction in mortality with mammograms. So a mammogram MAY prevent breast cancer, however you may also end up having treatment for a cancer which would never have become life threatening and the treatment itself will actually kill you!

That's not to say that some individual women may not have their life prolonged by a mammogram, but at a population level, in terms of reduction of mortality there is no benefit whatsoever. I happily say this to people, though I'm obviously a bit wary about launching into the discussion with people who have had breast cancer themselves or lost a close relative to it unless I was very sure it wasn't going to upset them. You have to be sensitive to other people's circumstances, but I don't see any problem with telling the truth. Only about 50% of women go for mammograms, but they will probably never be stopped because of political pressure from interest groups.

The woman I know who is undergoing breast cancer treatment has two young daughters. She went for BRCA screening which was negative, and the nurse said they didn't know, in the absence of a positive result, why she had got early cancer, but not to worry because when her girls were grown up, they'd have a cure.

The nurse obviously intended to reassure her, and was probably trying to be kind - but all I can think is that she is now being put through endless anxiety (on top of cancer treatment) about not only why she got the cancer (answer - we don't know) but that her daughters may get it. Is this helping anyone?

Because I've got a strong family history of heart disease, I was told to go to a lipid clinic at the hospital (my doctor did a cholesterol test without consent, but that's another story). I trotted along and discovered they didn't offer genetic testing because it's too expensive. So having been put in the position of wondering whether I had a gene mutation which raised my risk of heart disease or not, I then had to go through a stressful and prolonged complaints process to get the test done. It was negative.

Three years of anxiety and stress (which have probably raised my risk of heart disease) for nothing at all. That's why I give screening a wide berth these days.

What is totally neglected with health screening programmes is the psychological harm they cause.

"The pressure exerted, on women to undergo a procedure with highly questionable benefits must have something to do with the target and funding structure. Or lack of information in the case of some of the non-doctor HCPs
Howzabout hats with "My Twat Is Not Govt. Property" on? Or knickers - which on reflection would probably be more useful.
It is the failure to follow up on symptoms (and ironically the fact that the precious, wonderful test can't be done when the symptoms are going on, unpredictably, for months) that is the cause of cervical cancer mortality or severe morbidity in young women. Not them not going for a smear."

I'm really very tempted to have that tattooed on my bum and then go for a smear, but Iike the idea of the hat very much. Yes, smear tests are a feminist issue - my GP advised me to take statins, but immediately backed off when I said no. No such luck with smear tests, when they only backed off when I sent a strongly worded complaint and took myself off the list.

This is partly a problem of the NHS being a behemoth that once it's got an idea in its head is hard to turn round, it's partly a problem of 'cancer prevention' being seen as politically popular, it's very much a problem of scientific illiteracy, but also hugely, it's down to sexism and misogyny. Women are treated as vain, silly creatures who can't make a decision about their own bodies.

First, let's not confuse different screening programmes. Breast cancer screening is a completely different beast from cervical cancer screening. The methods are different, the evidence base is different. I think there is a much larger question mark over breast screening than there is over cervical cancer screening.

Secondly, we need to distinguish between incidence and mortality.
There's a lot of evidence that cervical screening does reduce incidence of this type of cancer, indeed one could go so far as to say that there is scientific consensus that it does. The point is that it is preventative - it is designed to catch cellular changes BEFORE cancer has a chance to develop, when treatment is quick and comparatively easy. The effects on mortality are more difficult to determine, however there has been some interesting recent research that suggests that these may be really quite large:

www.ncbi.nlm.nih.gov/pmc/articles/PMC5117785/

I've put off going for my cervical screening as I still feel traumatised from giving birth, and some of the trauma was to do with the endless rough hands and fingers giving painful vaginal exams, often without properly asking and explaining first. The thought of anymore intimate procedures makes me feel sick and terrified.

When I speak with others online who suffer birth trauma it seems really common to avoid getting smears as a result.

I think that's a huge issue sunshine - I don't think the psychological issues some women experience with cervical sampling can be divorced from wider issues of the way women are treated in gynae/obstetric medicine. I really sympathise, because I had an absolutely horrific experience with gynae surgery (as well as having abuse in my background) so I do understand. Personally, I found that once I had done a couple of tests it did get easier, but it's different for each woman.

whiskyowl

Good study, personally I'd much rather take the test as a pre-emptive measure rather than the worry of something growing and spreading inside me that was preventable. Also I would imagine the cost would be much lower treating any disease found in it's early stages than the later ones?? Should be a consideration with the issues of the NHS at present.

There is an enormous problem with actual gynaecological (and pelvic)
problems being taken seriously. It's hard enough to have a conversation about what constitutes normal in terms of periods, post-natal symptoms and the suchlike.
I remember DD being told at school that ridiculous old lie about losing a few teaspoons of blood and perhaps having a bit of a headache during her period. I had spoken to her honestly about it before, so she wasn't frightened when it was far more than that, but at least one girl in her class wasn't, and panicked she was seriously ill. The same thing happened in my class at school, 25 or so years earlier.

It's cheaper to treat abnormalities at an earlier stage than it is full blown cancer, but equally there's also the cost of all the colps, biopsies etc for changes that would never have required any treatment. Not that I think it's reasonable or realistic to expect an individual woman to factor that into her decision making.

Definitely agree this also needs to be seen in the wider context of taking gynae problems seriously and with general problems in the way pregnant and birthing women are treated in the UK, as the latter has an impact long after the event of giving birth. Salient point made upthread about the lack of pain relief. Though I don't have smears, if I did have a colp or biopsy there is zero possibility that I would consent to it without pain relief.

Unfortunately the NHS does have to consider finances, as is plain to see at present. At one of my cervical screening sessions I had a polyp on my cervix and the doctor tried to take it off without any pain relief! When I nearly kicked him in the head and said a few expletives he agreed to have me come back in under general anaesthetic, much to my delight.

Smear tests are the problem. I have been sexually abused and raped as a teenager and had 1 very traumatic birth (it's the care rather than events that caused me trauma) and a smear test is very much like rape/sexual assault. The NHS are not interested in making any accomodation for the thousands of women who have been sexually abused in their lifetime.

a smear test is very much like rape/sexual assault

Sadly this is how it feels - coercive, dismissive, painful, helpless...

It's funny how the NHS especially needs to consider finances when it comes to pain relief for stuff involving female reproductive organs isn't it?

More women die of heart sisease than of cervical cancer. Yet we don't get screened on the regular for that. Why not? Why are our parts more valuable than the rest of us?

A smear test is very much like rape/sexual assault

I agree. And the fact that you're supposed to not mind makes it all the worse.

"Yet we don't get screened on the regular for that. Why not?"

One screening at the 40+ on NHS (both sexes)

No, I don't know why it's not more often.

Thanks for the link to the Landy study, I was looking for it. Assuming all the methodology and conclusions are correct, let's look at what if finds.

"To conclude, we have shown that screening has an even larger impact on cervical cancer mortality than it has on incidence, and that if everyone attended screening regularly, 83% of cervical cancer deaths could be prevented, compared with 70% with current screening."

Ok, that sounds really good, let's look at what it means in numbers.

"The estimates of the number of deaths from cervical cancer that could be prevented by regular screening or that are prevented by current screening rely on the assumption that the RRs calculated based on 5-year excess mortality approximate the RRs for cause-specific mortality. In this study, we group deaths by the age of cancer diagnosis not the age at death. Hence, screening (starting at age 25) will (most likely) increase the number of fatal cancers diagnosed at 25 years, even if it reduces (cumulative) cervical cancer mortality. Under the current screening programme, as the population age a large number of deaths that are not preventable by screening will occur after age 84 years, decreasing the relative benefit of screening overall."

So what they're saying there is that if a woman is diagnosed aged 25 with a cancer that eventually kills her aged 84, they're treating that as a fatal cancer in the 25-29 group.

What about the numbers?

"In England, there are an average of 796 deaths a year (2011–2014 average) from cervical cancer in women of all ages (Office for National Statistics, 2015). It is estimated that screening currently prevents 69.7% (95% CI: 66–73%) of cervical cancer deaths. However, if everyone attended screening regularly 82.9% (95% CI: 82–84%) of deaths could be prevented (i.e., half of deaths currently occurring could be prevented). Applying the RRs in Table 4 to the observed number of deaths in each age group, we estimate that there would be an additional 1827 deaths per year from cervical cancer in the absence of screening, and a further 347 deaths per year could be prevented if everyone attended screening regularly between ages 25 and 64 years."

These are all estimates, they're statistically sound estimates, but they're estimates, they have to be to carry out this kind of study. So we're talking screening 'saving' 2,200 lives per year.

But lets go back to what Dr McCartney reminded us of. You don't 'save' someone's life, you prolong it, unless you make them immortal.

So we're reducing mortality from cervical cancer, but in reality, how long will we actually prolong life by? Let's look back at those cervical cancer death statistics by age. Deaths increase with age, most women who die of cervical cancer are 85-59.

www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/cervical-cancer/mortality#heading-One

So there you are aged 85. You haven't died of cervical cancer, hurrah! What's your life expectancy?

Oh no, it's 82.9 years, you died already.

www.huffingtonpost.co.uk/entry/life-expectancy-uk_uk_59ca2b4ee4b01cc57ff533f2

Actually assuming you live this long, you'll probably die of dementia, personally I don't find that an attractive prospect.

It's interesting how many women commenting here feel that they're being subjected to what is in essence sexual assault. I think that's entirely understandable. But women just keep getting told, seemingly that they HAVE to have smear tests. No they don't.

I was particularly annoyed by this on the BBC. (warning the piece may be very triggering for some, which is why I'm not quoting from it here).

www.bbc.co.uk/news/health-42790919

No, what bothered me was the bland statement at the bottom: "If you have concerns about attending a cervical screening following a sexual assault you can contact Rape Crisis for support. "

So hang on, rape crisis (mostly volunteers, hugely underfunded) are meant to pick up the pieces of NHS bullying of women. I hope, sincerely that any woman who does ring rape crisis is told that her feelings are perfectly valid and she should do just what she wants to and feels comfortable with. I'm pretty sure that's what would happen, I'm pretty sure it's what I would have said if when I was a RC volunteer. But really how dare the BBC expect rape crisis to pick up the pieces when women have been retraumatized by bullying media, NHS and charities that claim to care about women?

By the way, it was said above you can't compare mammograms with cervical smears. Well yes you can. Mammograms lead to no overall reduction in mortality according to the cochrane review. That doesn't mean that they don't prevent deaths from breast cancer though. It just means there are increased deaths from other things.

One thing that can increase death rates is actually treatment for cancer, which, particularly for breast cancer, can increase heart disease rates. Particularly galling if your cancer would never have become life threatening, but then I suppose you're not in much position to care, being dead.

So simply saying 'we'd avoid 2,200 deaths from Cervical cancer - even if it's correct, doesn't equal 2,200 deaths overall prevented.

But it's probably not correct, because many factors affect mortality from cervical cancer and it was steadily falling before the introduction of screening - see the link I posted a while back to the national archives, you can also find it, and a ton of other stats here.

margaretmccartney.com/2012/04/10/womens-hour-cervical-screening/

I'm 24 and I don't want to book it. Sounds too painful and pointless.

My optometrist referred me to an eye consultant about a mole in my eye and I never booked an appointment for that either - I don't want to take a day off work for something that will 99.99999% be fine. And if it's not, well I guess it was fate then. We've all got to die of something.

Seriously. I can’t get one.

I’m 35, I haven’t had one for about 8 years. Every time I ring my practice they tell me to try again next month. And I don’t remember to call every month, which is my fault. But if they want people to have them, make them available!