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?

Wrt Jade btw, just in case anyone reading is thinking you ask for a smear when you're symptomatic, as she was- don't! Smear tests are for women not experiencing any cervical cancer symptoms. If you are, you may waste valuable time trying to get a smear test.

I don’t go for them. I’ve had enough of hamfisted practitioners wielding their speculums and making me bleed. If self testing were available I’d participate and I suspect many others would too.
And yes, I have heard all the arguments in favour and it doesn’t change a thing. My body, my decision.

As I said before, who decides what the rate of take up should be?

Should it be 100%? Or is 75% an acceptable rate?

Who decides? At what point do we allow women to make decisions as an adult? Who are these people to decide 'what is best for us'?

A few basic points:

1. If they want to up rates, then making it as easy as possible is step one otherwise there will always be reasons why its not practical
2. Are certain groups of women acting differently to others? If so, what is driving it? Is education playing a part? We need to understand exactly what is really going on.
3. The point of consent in medicine is that you make an informed choice without undue pressure. In the case of smears undue pressure is used as a deliberate tactic in health promotion and information is regularly withheld to help increase rates. The ethical contradiction is appalling.
4. This type of unethical practice under mines trust in HCP across the board and a hidden side effect of excess pressure to have a smear can lead to women avoiding the doctor for unrelated issues, thus potentially putting them at risk of other health issues which could be life threatening in the most extreme cases. You might save a few lives from cervical cancer but is it increasing death rates elsewhere in a way that can not be measured?
5. How does shaming women to have a smear or calling them stupid for not having one, persuade them to go to the doctor? Its just as likely to put them off and reinforce the problem by making them believe even more that their fears will be dismissed by HCP as petty or trivial or otherwise invalid.
6. Yes side effects are still important, even if you can die of cervical cancer. Its a personal choice to decide whether having a treatment which will harm you in other ways is worth it. Seen through the prism of a 90 - 100% chance of severe anxiety or flash backs versus a small change of having cancer then some might want to take that gamble because of the quality of life. Seen as a decision about the possibility of being able to have kids or risking a chain of events that leads to unnecessary treatment isn't for everyone.
7. Also screening is different from diagnostic tests too. Ignoring symptoms is a totally different kettle of fish. Yet women with symptoms are seen as less of a priority and struggle to be taken seriously potentially because of the focus being so heavily on screening.

Treating women as stupid or with contempt in health promotion is likely to be counter productive across the board. Listen to what they are saying properly rather than doing a shitty little survey and carrying on with the emotional blackmail shit.

Risk is measured by different people in different ways. What a medical professional would decide to do themselves, if not necessarily what the dry statistician would recommend based on the data in front of them. Why? Because life experience isn't about data and statistical risk is it?

Unless you properly understand and respect what motivates people, you'll never be able to change behaviour.

The only screening I know about prostate cancer is a blood test for PSA. It’s also notoriously unreliable.

But yes, I suspect that the reason why women have made to feel guilty/pushed to get some procedures done wo any explanation is because they aren’t seen as worth explaining to. After all, we all know that women don’t/can’t understand science anyway dint we?

Re screening, worth also thinking about another effect rarely talked about. The nocebo effect. It’s basically the opposite of the placebo effect in that knowing that you will have x procedure (or medicine) will have a detrimental effect in your health, even if it’s an inert substance/procedure.
In effect, having a smear test, then waiting for a resultt, maybe having to do another procedure to check can have a negative effect in the body too....

Mammograms are basically X-rays that carry cancer risks by default.... lots of discussions around if whether actually having said mammograms don’t actually increase cancer risks because of that.....

Jane-
It's often not even presented as choice, people are pressued into it or made to feel incapable of making a decision about their own body.

There was discussion on news this week about breast cancer gene testing and it made me think, if this became standard screening- how many women are going to undergo mastectomies of healthy tissue to minimise risk however small- and would people still be saying "it's not worth the risk" and pressuring women into it.

So we should stop all screening programmes should we.......

Let all adults be 100% for their own health, I'm guessing we should also scrap vaccination programmes and stop doing research as well, is that the answer?......

Don't be absurd. No one is suggesting anything like that at all.

You haven't engaged with the question about how you would increase uptake, I notice.

I think medical literature has a lot of play on That subject too.
GPs are basically trained in this subjects by the pharmaceutical companies and their sales people (whatever they are calling themsleves nowdays). These are people who arevtrining to present things un such a way that it LOOKS like not doing a smear is a big deal.
Think about ‘it increases the chances of catching a cancer early by 70%’ compare to ‘the chance of catching a cancer early thanks to screening moves from 23% to 25%’ (all invented numbers btw! I’m just trying to give you an idea of what I mean)

It has been shown too that the more literature is available to GPS and the public the worst knowledgeable they are abotbthe subject and the more they over estimate the rates of success as well as under eatimate any issue (risks or false positives etc...)

Basically the pharmaceutical companies have a big part to play in that situation as it will be in their interest to increase the number of screenings....

Missy, I'm wary of that.

You might never live long enough for X to kill you, but you might go through all the stress anxiety and physical process to 'prevent' you dying.

And once you've given your DNA to be tested for one thing, is it stored on a database? Could this be hacked? Could this be then used to test for something else? Would you be discriminated against by an insurer for not having a test or because you had a test which showed something up? Would this by default have an impact on your children?

Lots of ethical issues stored up in that little gem.

And besides which we all have to die of something eventually. Even if you eliminate one thing, then what else instead?

Is there a reason you're holding other people responsible for your inventions walking? Is it to save you engaging with the premature birth and miscarriages issue?

Walking-
No we should provide people with optional screening, the facts to be presented and then allow a choice- without the pressure tactics and emotional blackmail.
But I also think screening should have limitations- because you can't go through life wanting to check for every risk single factor and removing healthy tissue "just incase".
I also find that doctors sometimes dismiss people who present with actual symptoms- I once went with irregular bleeding in my early twenties and was told it was probably my pill without further investigation. My friend had a raised area of tissue in her breast and was told it wasn't anything to worry about as she was too young to have cancer- and it was cancer.
I'd rather doctors focused on actually diagnosing illness when presented with symptoms than pressuring healthy people to have screeining and in most cases unnecessary intervention.

Walking, nope.
The answer is to
1- give appropriate and unbiased information to people (men or women)
2- let people actually chose for themselves (eg not everyone will want to choose to have chemo because of it’s sided effects and the effects on quality of life)
3- have proper research done. That means research that can be reproduced (not the case in more than 60% of the research currently published)
4- appreciate that actually whatever decision you are taking there is a risk (that’s about screening, having a vaccination etc...) and knowing what is the actual risk
5- have much wider research done. Most of it is done on white male/female which we know cannot be translated automatically in other ethnic groups. (And yes that’s actually including vaccines too)

So we should stop all screening programmes should we.......

I'm not sure what you're getting so angry about? If you want to have screening tests then have them! Other people have looked into the scientific studies and decided they don't want the test. That's fine too. It's really none of your business what other women do.

I have often found that when this issue is discussed the response to those who decline is anger and contempt. I think it makes people angry that women have the audacity to decide what to do with their own bodies. Because it really doesn't affect anyone else at all.

Testing for the BRCA gene is expensive and you have to have counselling. As it stands at the moment it isn't easy to get, you need a close relative with a diagnosis or I think 2 close relatives with relevant cancer, breast or ovarian.

The chances of breast cancer with the BRCA gene is really high, up to 90% depending on which gene it is.

If you have the gene it isn't automatic mastectomy, you get offered annual CT scans. Well that is what I've been told, going through process now.

Let all adults be 100% for their own health, I'm guessing we should also scrap vaccination programmes and stop doing research as well, is that the answer?......

No, adults should be responsible for their own health. They should be offered options and the ability to make an educated choice freely and without pressure.

If people aren't taking up those options then simply bullying them or berating them for not doing so, won't change their mind. You have to understand WHY. Not what you assume is stopping them or your small minded prejudice about women being stupid or selfish.

Just stop, and LISTEN to why women are not engaging with the system rather than telling women what they should and shouldn't be doing.

The DNA stuff is crazy because we know that genes can be switched in and off by environmental factors and emotions.

So really the answer from that sort of test shouldn’t be a massectomy but working in eliminating environmental factors (diet, lifestyle etc...).

Walking Given that you think there are 'specialist sevices for traumatised women' you have either been very lucky or need to go and educate yourself about women being bottom of the list in almost every area of NHS healthcare provision.

You do know you're commenting on a thread in Feminism don't you? Feminists know women should have agency over their bodies and lives and are well versed in critical thinking. You know, weighing up risk, reading research and stats and reaching informed decisions rather than just blindly doing what we're told?

AssassinatedBeauty

Education, drop in clinics with a creche, drop ins at mother and baby groups, education at school, better training for nurses......definitely more campaigns that look at vagina's, educate women about how different they all are, that they are not smelly, that porn has massively influenced how women feel their vagina's should look and that no one cares about if your vagina is shaved or hairy (particularly medical professional's). I work with young women and I have heard all manner of ridiculous things about their vagina's and wanting plastic surgery to have a perfect one......is that enough for you?? What are your suggestions??

Lack of knowledge is a problem. When I first had scans for ovarian cancer I was asked by more than one woman if I had missed my smear test and they were amazed that a smear test hadn't got anything to do with ovarian cancer.

The DNA stuff is crazy because we know that genes can be switched in and off by environmental factors and emotions.

So really the answer from that sort of test shouldn’t be a massectomy but working in eliminating environmental factors

I've had lots of advice and support and definitely have BRCA gene in immediate family. From what I have been told there is no evidence that environmental factors have anything to do with it, the mutation to the BRCA gene doesn't cause the cancer, it is a mutation on a gene that fights cancers so it isn't a question of it being switched on or off, it has just mutated so that it doesn't fight the cancer. Well that was my understanding of the talk I was given. Certainly no pushing of the idea of a mastectomy.

Yes, that's all a really good start, everyone here would agree with you on most of those I suspect. So why the anger and haranguing, when you could constructively add to the discussion about how to increase uptake rates?

I believe hpv can be detected with a urine test or swab.
When I was a teenager I recall everyone got a chlamydia urine test in the post-
Why can't women be sent one for hpv and return sample in post-
If it's positive, then and only then invite them in for a smear on the basis of that present risk factor

• that's how I'd increases participation, by aiming screening at the people who need it and who it is likely to benefit.

Of course I don't know how feasible this would be on a cost basis but would save a lot of women an unnecesary smear.

I think what needs doing includes;
Providing specialist practitioners including those with the experience and skill to make it as far from unpleasant or traumatic to those who have suffered abuse or trauma as possible.
Providing appointments at convenient times.
Encouraging attendance whilst acknowledging that screening cannot catch or prevent all cases of cervical cancer.

Also if some young women are not attending through shame of their bodies then much work still needs to be done on counter acting this, on building positive, strong self esteem.

The level of anger and contempt this issue provokes against those not wishing to be screened genuinely is fascinating.

Oh Hi, I'd be one of the traumatised women no one believes exists.

There is one clinic in the UK that offers smears for women who have been victims of rape/abuse. It's in London, if anyone who can get to London in a day wants the info, I'll happily pass it on, but I can't get there.

The assumption that women like me should just be fine with some random HCP they've never met ramming a speculum into their vagina without lubrication and then having a painful procedure done or they're somehow letting the side down is vomit inducing.