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?

Whatever your view of her, and whether you agree with her message to have a test, surely everyone should applaud (not snigger at) the Prime Minister for talking about testing and the fact it is uncomfortable in Parliament

My optometrist referred me to an eye consultant about a mole in my eye"

Hello, a nevus (mole) in the eye can be a sign of cancer. If you don't want to get that checked out, then that's up to you. A nevus can be benign, just like a mole on your skin, or it can develop into cancer, just like a mole on your skin. In your situation, I'd go to see the consultant. I'm doing you the courtesy here of assuming you're being serious, but just in case you aren't....

This situation is not comparable in any way with a smear test, because a smear test is carried out on asymptomatic women. It isn't a test for cancer (this can't be stressed strongly enough), its a test for cells that may become cancerous. Most of the time they won't, so the chances are you will end up undergoing unnecessary treatment.

The difference here is between screening of asymptomatic women and women who already have symptoms. I once had a lump in my breast and I went to the GP straight away. I wouldn't have a mammogram though.

@OlennasWimple, I certainly agree the PM shouldn't be sniggered at for answering a question, however I think it's a pity she didn't answer it by explaining why smear tests aren't offered to under 25's, basically that cell changes in this group are so common you would have a huge number of false positive results.

I also think it's a pity she didn't address the real issue which is that the GP should have referred the young woman who tragically died for further investigation. Perhaps Mrs May could have asked Mr Hunt why GP's are reluctant to refer patients - one good reason is the funding crisis in the NHS.

"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."

No, that's not correct. Your entire post is based on a fundamental misunderstanding of the way incidence is counted. Someone who (improbably) had CC at 25, and again at 84 would be counted as having it twice, not once.

You are also ignoring the fact that with screening, the aim is prevention. The programme is not looking for cancers so much as for cellular changes that could lead to cancers (CIN). The idea is to catch it before cancer even has a chance to get going. The screening intervals are set with this in mind.

"By the way, it was said above you can't compare mammograms with cervical smears. Well yes you can"

No you can't, at least not very far. Mammograms use an x-ray. That supplies a dose of radiation. The whole debate on breast screening is about the harms of that radiation versus the benefits of screening. Cervical screening does not involve x-rays, and therefore the harms of the test are very different. Every screening programme has its own unique balance of harms/benefits.

I have a nevus too and always go for checkups. I don't want to lose my eye or my sight. Again up to people to make their own decisions re health but I tend to see it in moral/social terms, i.e I have a personal responsibility to look after my own health so that others, namely my kids and Mum don't have to! I think the NHS is doomed and there are so many people who don't look after their health, take no responsibility and that cannot be sustained. Nothing is ever guaranteed of course but there are some certainties, in terms of behaviours that lead to serious illness, smoking as an example. We can argue about screening programmes and I do think they will improve, as science progresses.

The whole debate on breast screening is about the harms of that radiation versus the benefits of screening. My GP said that was why BRCA carriers have MRI or CT scans rather than mammograms.

We've all got to die of something. But preferably not at 24 YoloSwaggins.

“The smear test is hugely important,” May said. “Sadly what we see ... is too many women not taking it up. I know it’s not a comfortable thing to do because I have it, as others do. But it is so important for women’s health and I first of all want to encourage women to take the smear test. Have that test.”

No mention of informed consent. Just “have the test”.

How far can you go eith 'informed consent' if someone chooses to not be informed??

How far can you go eith 'informed consent' if someone chooses to not be informed??
Are you suggesting that those people who decline smears are not informed about the risks and benefits?

PurpleDaisies

Yes, some women do not understand risks and some do not care. I work in sexual health, there is ALOT of misinformation out there which means that some are taking risks because some do have the level of education about particular issues (relating to sexual health), therefore they do not have informed consent.

whisky

Elsie said
"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."

You said
No, that's not correct. Your entire post is based on a fundamental misunderstanding of the way incidence is counted. Someone who (improbably) had CC at 25, and again at 84 would be counted as having it twice, not once.

But she didn’t say about having it twice? As I read it she meant diagnosed aged 25 with cervical cancer but it does not kill her until she is 84. One incidence of cervical cancer not two.

Does anyone know is it possible to have cervical cancer for 60 years and if not kill you? I know it was an extreme example from Elsie but is it possible?

"No, that's not correct. Your entire post is based on a fundamental misunderstanding of the way incidence is counted. Someone who (improbably) had CC at 25, and again at 84 would be counted as having it twice, not once."

No, my post is based on the paragraph I quoted. Please read it again. I'm making a point about the methodology used. They're saying that they're counting the age of a fatal cancer as the age at diagnosis, not the age of death.

You don't 'get' the same cancer twice. You get it once. You go into remission if your treatment is successful. Even if you go into complete remission, (no evidence of cancer) you can still get recurrence.

www.webmd.com/cancer/remission-what-does-it-mean

"No you can't, at least not very far. Mammograms use an x-ray. That supplies a dose of radiation. "

Yep, I know, not only have I got physics A level - I've had loads of X rays. Chest X rays, dental x rays, my leg x rayed when I broke it aged 5, and various other bits through the years. They haven't given me cancer. There is really no evidence I'm aware of that mammograms, as recommended by the NHS, cause cancer at any significant level but if you have any, bring it on. The radiation in a mammogram is less than a fifth of the exposure you'd get annually through normal background radiation, and mammograms are only recommended over 50 every five years.

There is a theoretical risk that the radiation can cause cancer. They tell you that to avoid being sued I suspect. But I should think that is only really a risk in countries that recommend them annually from young ages.

The harm of mammography is in overtreatment for cancers that would not become life threatening, not in the mammogram itself. Cancer treatment can kill you, Herceptin - for example - can cause heart failure.

Mammography does reduce deaths from breast cancer, what it doesn't reduce is all cause mortality.

www.ncbi.nlm.nih.gov/pmc/articles/PMC4415291/

LLETZ or cone biopsy can cause infections, which theoretically can lead to sepsis, which can lead to death, in the absolute worst case. (no idea if this has ever happened, the NHS don't really tell you stuff like that, they just say contact your doctor if you have any signs of infection, but given you can die of sepsis post childbirth, nearly happened to a friend of mine, I don't see why infection post LLETZ should be different). Yes, neither is a smear test, but there's very little point in having a smear test if you're not prepared to have any abnormal cells removed.

"You are also ignoring the fact that with screening, the aim is prevention. The programme is not looking for cancers so much as for cellular changes that could lead to cancers (CIN)."

I've made that point in nearly every post I've put on this. Read them. It's my entire objection to cervical screening - the very high possiblity. of overtreatment. Which is also my objection to mammography, which is why I'm saying they're comparable.

I have moles in various places, which I have checked periodically. The most a mole check involves is your GP examining a section of your skin with a torch. It's not painful, invasive or traumatising.

I can also access various pieces of advice on looking after my moley skin to lower my skin cancer risk factors, like I can pick up information on lifestyle changes to promote heart or liver health. Not so the cervix. If there were things I could do to ensure my cervical health proactively, I would probably do them.

Hi, whisky yes, I was giving an extreme example - the point I was trying to make is about the way medical information is presented, and more importantly, I was trying to point out that "preventing" cancer may not increase your actual lifespan by much. You could prevent cancer and die of a stroke on the exact day you would have died of cancer. See the link about mammography and all cause mortality above - Mammography does decrease deaths from breast cancer but overall death rates are exactly the same.

It's a good question though, so by the magic of Dr Google

www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/cervical-cancer/survival.

63% of those diagnosed in the UK with cervical cancer survive ten or more years.

Cervical cancer survival gradually continues to fall beyond five years after diagnosis. 63% of women are predicted to survive their disease for ten years or more, as shown by age-standardised net survival for patients diagnosed with cervical cancer during 2010-2011 in England and Wales.[1] Out of 20 common cancers in England and Wales, ten-year survival for cervical cancer ranks 8th highest overall (and 6th highest for females only). These high survival rates can be attributed in large part to cervical screening. Screening can detect cervical cancers at an early stage when treatment is most likely to be successful.

Unsurprisingly, younger women are more likely to survive for longer - which is kind of the point I was making.

Cervical cancer diagnoses are actually most common in women aged 25-29 (this probably IS a result of screening, ie very early cancers are being found). But deaths are most common in women aged 85-89.

Note also the point I was making earlier about lead time bias. Cancer survival is measured in years from diagnosis. If you get diagnosed five years earlier by screening than you would have done by investigation of symptoms, it makes it look like you've survived five years longer. But you haven't.

They don't really measure survival after ten years for the purpose of stats, so we don't know what the maximum survival ever is. Perhaps it's in the guiness book of records.

In terms of development time pre cancerous cervical cells can take 10 to 15 years to progress to cancer.

www.arhp.org/Publications-and-Resources/Patient-Resources/Fact-Sheets/cervical-cancer

I gave up on smear tests, aged mid-to-late twenties, because I got caught up in about three years of repeated false postives.
Which meant my sample was unclear, so a month or two later, I was requested back to the health centre for another smear, just to make sure.
The second result always came back clear, no problem. Every time.

But every time, I was given another appointment in about 6 - 12 month' time, just in case.

And at that test, "the sample was unclear, so a month or two later, I was requested back to the health centre for another smear, just to make sure." And so on.

I wish to point out, in my case, that this was 30-odd years ago and I am still Not Dead.

I decided that the very real and unnecessary worry was not worth it.

I have rejected mammograms, now, for the same reason - for me.

Anyone makes a different decision, that is fine by me. Make your own decision.

A friend had a similar example of 6 monthly recalls for a long while, then it cleared up. She recently got a letter telling her she was due a smear, and as she already had a appointment for contraception asked if it could be done at the same time. She was told it could, but then the receptionist went mad at her because she was 'too early' for her smear.

And they wonder why women don't have them?

Oh and re women who are BRCA positive and mammography.

"The Daily Mail’s headline is misleading, suggesting to women that mammography may be dangerous and increase cancer risk. This is not the case. The research looked at all forms of diagnostic radiation and did not focus only on mammography.

In fact the link between mammography screening and higher cancer risk in women with these genetic mutations who had received a mammogram before the age of 30 was not statistically significant.

The newspaper does not make clear that the use of screening methods not involving radiation for high-risk women is recommended ‘best practice’ in England (the same is not true in other European countries). However, access to MRI scanners can be limited so the waiting time for an MRI scan is often longer than for a mammogram. "

Yep, who'd have thought the Daily Mail publishes misleading stuff about cancer eh?

There are a fair reasons, not being waxed, embarrassment, fear of smelling bad ect.
Mine is my possible vaginismus, GP wants me to have a smear before i can start treatment but will be a very painful process and so i have been putting it off for a year now x

I’ll literally take up any screening or testing my GP suggests. I ended up having smear tests every 12 months for a good few years after they thought they’d seen borderline changes; they hadn’t. Even the nurse at my practice wasn’t sure why I was on 12 month recalls, but I’ll take everything I can get

I find smear tests very VERY painful My last one was due back in November and i just dont want to do it. Im 44 im no longer sexually active (which may be the reason why it hurts so badly) when health professionals insist that its just a bit of discomfort i cant help feeling that they are minimizing womens pain.

I totally understand Helena I force myself to go because my mum was diagnosed with stage 3 cervical cancer at 30, but I hate it and find it very stressful, humiliating and painful especially as a rape survivor. I have to have some wine in advance to relax me enough to get through it. I'm not sure I would do it if it weren't for my mum.

Eresh im sorry to hear about what happened to you and that your mum became ill.

Another problem is that my periods are all over the place now and i would have to keep cancelling appointments because of period suddenly arriving.

Thanks Helena. Thankfully she survived it.