The current issue of the Journal of the American Medical Association contains an article whose headline is:…
"A sinister cabal of superior writers."
The current issue of the Journal of the American Medical Association contains an article whose headline is:…
Article comments
— go to most recent comments26 - Kate
I'm an Australian lawyer and have been concerned about the ethics and legality of cancer screening practices for decades.
I declined to have pap smears when I became sexually active. My Dr refused the Pill without the Pap smear, so I mentioned that the test had nothing to do with the safe use of the Pill and that my informed consent was required for the Test.
I had made an informed decision NOT to have the Test.
She gave me the script.
If women know their rights, then doctors won't push the point. They KNOW they're behaving unethically.
I doubt any Australian Dr would deny you the Pill today.
I do think women are still pushed into this testing though...unless you can stand up for yourself, you end up having the Test.
I don't believe any woman can give informed consent for smears or mammograms - the information given to women is misleading and incomplete and the risks and limitations go unmentioned. Strategies like paying doctors to reach high screening targets and making it a pre-requisite for the Pill are a violation of our rights - by ignoring the need to obtain our informed consent.
I believe any woman harmed by this Testing would have a sound case against her Dr, the medical association and the screening authorities.
I'm waiting for the class action....women are starting to realize they have been manipulated and deceived to their detriment.
There is a great article that cautiously discusses these points.
www.racgp.org.au/afp/200904/200903trevena.pdf
Doctors and others have to be careful when they criticize screening tests - the make an absolute fortune for pathologists, doctors and specialists and screening programs have to justify their existence. The screening people always respond savagely and quickly to any criticism.
When you've been misleading and harming women for years, you're very nervous about close scrutiny...it might mean that class action is just around the corner.
I hope that's the case.
How shameful to treat healthly women that way?
This testing has been a blight on the lives of many women.
I don't have testing, but I'm not saying all women should reject the Test.
I'm saying every woman should be given ALL of the information and the decision left for to make...
In that case, if you choose to have the Test, you accept the risk of harm.
Whether you have testing or not, you go into it with your eyes open...it's your decision.
I'm against dishonesty, doctors ignoring the need to obtain informed consent, paying doctors to reach targets and unethical strategies adopted to force women into screening.
They are my objections.
27 - Jenna
I went to a nurse practitioner for guidance about psychological counseling; she is not my regular NP. Out of nowhere she asks me when my last pap was. And I told her flat out that I was never having another pap EVER again. I have many reasons for not getting another one, many of which are mentioned above. She then starts saying that I'm "punishing myself" for not having one and that I might have an STD or cancer. There was a point in my life when I was sexually active with different partners and, yeah, probably did need them. I told her for years I never had an STD, HPV, or an abnormal test. I've also been in a monogamous relationship for 3 years and neither one of us has an STD. The she starts telling me that I can't trust anyone and that I need to protect myself ... which, in my case, is BS. Paps are horrible, degrading, humiliating , etc. I was made to feel like that if I didn't get one I was most certainly going to get cancer and die. I do admit that I have problems, I was sexually assaulted and as a result have PTSD. I have a lot of issues concerning sex and gender because of it, so what was her conclusion? Apparently she "needed to" perform a physical examination to rule out any problems. And I'm sitting there wondering how the hell she graduated from college. They'll do/say anything to get you to spread, and it's all in the interest of $$$. Needless to say I left without her touching me and I'm still looking for a doctor or NP who'll work with me instead of against me (if it's possible).
28 - Jane S
Susanne,
I agree...in Australia the topic of a pap smear comes up because doctors receive payments from the government when they reach a screening target - so its about money, not my health.
Some doctors will test anyone to get to the target...my MIL was hassled about a smear for about a year before she reported the doctor.
I should add my MIL had a complete hysterectomy for benign fibroids 7 years ago. Her doctor knew her history and that the exam was TOTALLY unnecessary.
Putting a woman through a penetrative vaginal exam for no reason...except to reach a screening target is disgusting. A lawyer friend said it could amount to an assault. Apparently thousands of women in the same position are still being tested...when did doctors become so unethical?
I think this screening business has alienated many women from their doctors.
My Aunt doesn't see the doctor anymore - she's so tired of talking about smear tests.
I would tell your doctor that you don't wish to discuss smears every time you visit and could she mark your file accordingly....
You'd like to focus on the purpose of your visit.
If you want a smear, you'll ask for one.
I think many women are starting to feel victimized, misled and manipulated by this testing.
Our doctors don't recommend annual gyn exams.
I have friends in the UK and Europe and none of them have annual gyn exams.
Hard to imagine its important when no other country recommends it.
I think we need to stand up for ourselves.
Tell your doctor straight....my body, my decision!
29 - Prue Mc
Jenna,
If you've made an informed decision not to have a pap smear, that's YOUR right.
You don't need to explain yourself to any Dr, just say, "I've made an informed decision not to have pap smears."
End of discussion.
They cannot force you to have pap smears and if you know your rights, they'll back off...
My husband & I were virgins when we met and even I have been pressured to have smears. I doubt I've even been exposed to HPV (which causes cervical cancer) and I'm not risking this test to cover a tiny risk of cancer. Many of my friends have had biopsies...they are degrading, humiliating and painful.
None of them had cancer - all incorrect test results.
They were put through hell for nothing.
This is absolute madness...to do this to healthy women!
My closest frinds have all decided not to have any more tests...having bits of your cervix cut out for no reason is not there idea of good health care.
Can you imagine if they tried this on men?
Previous generations were lucky...their bodily privacy and dignity were not threatened every time they went to the doctor with a cold or headache.
I think it might be time to declare war on doctors and their testing.
30 - Sam
I have some statistics that might be of interest.
The chance of benefiting from a pap smear is very small and the risk of biopsies for a false positive quite high...
Andrew Rouse, Snr Lecturer in the Dpt of Public Health at Birmingham University has released some figures on this point.
The chance of a woman surviving for 10 years if she does or does not have pap smears.
The absolute benefit of smears is SMALL.
Age at start of 10 year
period: 25
No of women alive at start of
10 year period: 10,000
Alive ten years later if they
have smears: 9963
Alive without smears: 9962
This is why several countries don't offer testing to women under 30. The risk of cancer is VERY low in this group, but the risk of false positives and biopsies quite high.
Age at start of 10
year period: 35
10,000 women...
the number alive after
10 year period with smears: 9863
Without smears: 9859
Age at start of 10 year
period: 45
10,000...alive at end of 10
year period with smears: 9713
Without: 9708
Age at start of 10 year period: 55
10,000 women....alive after 10 years
with smears: 9457
Without smears: 9450
Factor in the inaccuracy of the Test:
The risks for a woman having a smear: 7% chance of being recalled for further testing after each smear.
AT LEAST a 5-15% chance of a false negative.
The risk of colposcopy/biopsies...
Annual smears - 95% of women will have a colposcopy/biopsies in her lifetime with only a very small number having any malignancy. (mainly false positives)
Two-yearly - 78%
Three-yearly - 65%
Five yearly - 55%
The vast majority of these biopsies will be for false positives, NOT cancer.
So, LOTS of women will face false positives.
If you're a low risk woman, your chance of benefiting from this Test is TINY.
If you know the risk of this cancer, your chance of benefiting and the risks of testing, you're better able to make an informed decision about screening...free of fear and intimidation.
You'll find these figures.
You'll see from these figures that smoking is a MUCH bigger risk to your health than not having smear tests. Hope this makes some of you feel better.
This information is not readily available to women, but if you look at the British Medical Journal there are lots of articles on the absolute risk of this cancer (low), the real value of testing, its limitations and risks.
The article by Dr Angela Raffles..."The risks and benefits of cervical cancer screening" is worth looking at...
This Dr is heavily involved with cervical screening and HER figures are just as astounding...1000 women need regular testing for 35 years to save ONE woman from cervical cancer!
31 - Victoria J
We hear about the success stories.
The woman saved by this test.
We hear about the woman dying because she didn't have the test....the inference being, "stupid, silly woman...she brought all of this on herself"...
We never hear about the huge number of women harmed by this testing.
My friend had a cone biopsy three years ago. (under a general in hospital)
She called for her pathology results when she became concerned about not having chemo or radiation. She wanted a second opinion.
It was then confirmed she had a false positive and had never had cancer.
The "close call" was no such thing...she believes the doctors made her feel grateful or lucky to conceal the false positive.
After this ordeal...which she says was the most traumatic and degrading experience of her life, she became clinically depressed and ended up deferring her Uni studies.
Her relationship ended and her part time job became difficult.
She's now moved back home.
She'll never have another pap smear.
Some doctors are so dishonest...they actually tried to suggest she have smears more often...why?
She's never had cancer and having it more often would increase the likelihood of another false positive.
We never hear about women like my friend.
No one interviews them or puts them in their statistics.
Many women are not even aware of the dangers to their health when they have pap smears and many would walk away from a cone biopsy feeling "lucky" when they should be angry.
No, these women are not good PR...better to forget about them and throw them on the scrap heap with the other women hurt by this test.
My friend was once a happy, healthy and successful woman going places...her life has been devastated by this test.
No one told her of the dangers...like the rest of us she was just pushed into it, frightened not to have it after being subjected to all the propaganda.
This is NOT the way we should be dealing with this problem.
This cancer is rare...look at the stats.
Women should be advised of the risk factors so we can protect ourselves and told to watch for symptoms.
The huge amount of money spent to pick up the few women who actually have cancer while hurting so many healthy women could be spent on improving our health system for people who actually have cancer.
32 - Sarah
Thank goodness....fighting words at last.
My sister's cervix was so badly damaged after a biopsy for a false positive that it had to be stitched closed during her pregnancy.
This is horribly embarrassing stuff.
The doctors are laughing all the way to the bank...smear tests for everyone, biopsies for a huge chunk of women and then quite of few end up patients because of the damage caused by the biopsies.
Referrals to gynaecologists, high risk pregnancy specialists, infertility clinics, surgeons, urologists...
What a gold mine and all at the expense of healthy women.
In Australia we test teenagers and women in their 20's and test two-yearly guaranteeing we'll damage lots of women...patients for life.
What will it take to stop this nightmare?
I don't know a single person who has actually been helped by this testing.
I could name quite a few just in my family and friends who've been hurt in some way.
They'll never get the chance to do it to me.
I'm suspicious when a woman says she had bad cells removed...it seems to me it was probably a false positive or cells that would never have turned into cancer anyway...
I just don't trust these people. I think they mislead women all the time. (and that is being polite!)
I'll take my chances with cancer.
Its a very small risk anyway...look at the figures (thanks Sam!)
33 - Bec
My Gran and her friends can't understand this obsession with cervical cancer.
They have never heard of any woman getting this cancer. They know women who got bowel, breast or lung cancer, but never cervical.
Our retired family doctor said he saw ONE case in his entire career.
My friend is a statistician...he looked at cervical screening and the claimed "huge" reduction in the death rate since screening was introduced.
He says claims that it has reduced the number of deaths by 50% or more are misleading...unless you know the absolute risk of the cancer (How common is it?) the "reduction" figure is meaningless.
If 2 women get cancer and only one after screening is introduced...its still a very low risk because we're talking about very small numbers.
You can only assess the test and whether the risks associated with an unreliable test are worth it...when you know your risk of getting this cancer (sex before 16, multiple partners, STD's etc) and the absolute risk of the cancer. (and some figures on the reliability of the test)
He says the figures currently released are misleading women.
In the US about 1 in 3 or 4 women have had complete hysterectomies for benign conditions. This huge group is not taken into account when they calculate the reduction in the number of deaths from this cancer.
Any reduction is put down to screening...this huge group MUST have an impact on the numbers dying of this cancer.
I agree with the other comments...there is enormous dishonesty associated with this testing.
I think the same is true of mammograms.
Many women are shocked if you don't have screening....I've found its because they have accepted all the misleading information released by doctors. The constant urging by doctors makes it seem like the most serious thing in the world.
It's not...
I look after my body...exercise, eat well, keep my weight down, practise safe sex, limit alcohol intake and I don't smoke.
I think lifestyle factors are more important than having dodgy and embarrassing tests that end up hurting you.
34 - Greta
I'm Dutch and we have the same intervals as Finland.
Offered from age 30 to sexually active women and then every 5 years to 50, 55 or 60 (depending on previous results and medical history)
My mother had none because she was low risk so her doctors felt she was unlikely to benefit from the test but might face a biopsy or two for false positives.
My aunt is higher risk and had 5 tests in total...stopping at 50.
The prostitutes of the famous Red Light District follow the same time interval...more frequent testing or an earlier start age is NOT recommended.
This cancer is not so common...even a high risk women is unlucky to get this cancer.
Women are individually assessed by their doctors...not regarded as a group.
We don't have routine gyn exams or breast exams.
My mother and aunt started having breast exams at 50.
I was shocked to hear how women are harmed by being overscreened in other countries and with no choice - we always have a choice...and all these very embarrassing internal exams - you shouldn't agree to them.
If women make a stand, doctors won't get away with this shocking treatment.
35 - Anna
Most pre-cancer cells don't go onto cancer...doctors don't know the handful that will...so everyone gets treatment.
It's a highly unsatisfactory test.
All of this over-treatment leads women to think they were saved from cancer when that usually is not the case. When women under 30 have treatment it's HIGHLY unlikely that cancer would have developed and that's why screening isn't offered in some countries until women are 30.
I would doubt that your Mum's pre-cancer cells would make you high risk.
Look at the risk factors for the cancer....starting sex very early (14-16)
multiple sexual partners or having a partner who has had multiple sexual partners, having STD's...
If you're not sexually active, forget about it...this cancer is caused by a sexually transmitted disease.
If two virgins marry and are faithful, forget about it...no HPV
Most HPV does NOT go onto cancer...only a very small number of cases and the medical thinking now is that you need HPV and another factor...maybe a compromised immune system or smoking.
Basically, you're very unlucky if you get this cancer - look at the generations when there was no screening - very uncommon cancer.
Some say sexual promiscuity has increased it's incidence and that smears have stopped an epidemic - I doubt that...very dubious argument when you do your reading.
I've been following cancer screening for many years.
I think breast cancer is a much bigger concern. If your mother had breast cancer, you could be checked to see if you carry the breast cancer gene and regular exams from 25 might be a good idea.
How old was your mother when she got the cancer?
It's usually a bad idea to check the breasts of young women - they're hard to read before menopause and so exams often lead to biopsies.
I'd speak to a couple of breast cancer physicians...it might be enough to wait until you're 30 or older...
I wouldn't bother with a GP...better to see a breast cancer physician for the CBE.
I think the risk of cervical cancer is tiny in low risk women and very small in high risk.
I think if you have smears you have to accept there is a high chance of having cervical biopsies. I totally agree that if you intend to have screening then start later and then only 5 yearly.
Annual gyn exams (pelvic, rectal exams) for healthy women - complete and utter nonsense.
36 - Mike
I wondered how much longer it would take for women to work out this is all a money making industry.
Ask a pathologist and get to the truth.
Annual gyn exams ARE a waste of time and money. Do you have your brain scanned every year to check that it's healthy?
No, we assume it's healthy until we develop symptoms.
Symptoms are an indication of trouble and should be investigated but assuming you're all diseased until proven otherwise...is a bizarre way of treating healthy women.
37 - Susanne
The American Cancer Society guidelines for these exams says: All women should begin cervical cancer screening about 3 years after they begin having vaginal intercourse, but no later than when they are 21 years old.
What I want to know is why is age 21 so important here? Why do they say no later than age 21. Is it assumed by the medical community or society in general that most or all women have had sex by age 21? Or is age 21 when certain diseases become more likely and therefore more testing is required? What if a woman has reached that age and is still a virgin? I had my first and only exam at age 21 and I was a virgin. I was looking into getting BC pills as a possible way of curbing excess hair shedding that I was experiencing at the time.
Fast-forward a decade and I am still a virgin for a lot of reasons -- late bloomer, waiting for the right guy, not wanting to risk pregnancy, diseases, etc. I know that makes me a rarity or possibly a freak in some people's eyes, but why do all docs assume every single person out there is sexually active all the time or has been by a certain age? I just don't get the whole wording of the ACS's statement. I wish they and the Drs. would clarify things a bit more, esp. for those osf us who haven't yet become sexually active.
38 - Anna
Susanne,
The US guidelines are pure nonsense and could amount to abuse. Testing virgins is TOTALLY UNSUPPORTED around the world.
US doctors could not support this practice medically or ethically.
Any woman PUSHED or FORCED into this testing, virgin or not, has a legal case.
This test has risks and so it's VOLUNTARY - a Dr MUST obtain your informed consent.
Look at the figures posted above on your likely benefit from this testing.
Even a very high risk woman has a very low chance of benefiting from this test.
All women have a high chance of possible harm from false positives.
Putting women needlessly through a penetrative vaginal exam is outrageous....
This test is NOT for virgins or for women who've had complete hysterectomies for benign conditions.
Low risk women may choose not to have testing or have it infrequently starting later in life. (say 30)
High risk women should NOT follow the US guidelines - they are excessive even for a high risk woman - NO ONE needs annual or biannual smears and no one should think about smears until they're 25 or 30.
Don't fall for the US beat-up...look at other countries. They have effective programs without the massive downside from false positives.
In some countries, low risk women are openly told they are unlikely to benefit and may choose not to have smears.
Any woman having smears should accept she'll likely face a false positive and cervical biopsies at least once in her life - the more frequent the testing and the younger the start date - the higher the risk.
I can't understand how US doctors get away with this testing.
I guess they're all covering their backs terrified of legal action.
What surprises me is that they're not equally concerned about being sued by a woman harmed by this over-screening and over-treating. I suppose by keeping women ignorant most never work it out....
Women who tell you they were saved by biopsies in their 20's have likely had changes that would have resolved without medical intervention or they simply had a false positive.
I think it suits the medical profession to keep women afraid and for these "saved" women to spread the word and feed into the climate of ignorance and fear.
Somewhere along the line doctors conveniently forgot to mention this testing is entirely voluntary and MUCH, MUCH more likely to lead to biopsies for false positives than to a diagnosis of cancer.
39 - Chloe
It makes me sick to my stomach how readily women are supposed to expose themselves to medical gaze and probing....
Unless there is a very clear benefit FOR ME, they can keep their testing.
Having looked at this information, I feel a lot happier.
I refuse to live my life with my legs in the air.
You're right...men would never fall for this "treatment".
It also makes me mad how easily our doctors dismiss our modesty and dignity concerns - get over it, you're a woman.
What an ignorant and arrogant attitude.
I refuse to believe I'm pre-cancerous until a doctor gives me the green light every year.
I'll assume I'm healthy until my body gives me a clue - that was always the way.
I think this modern approach is distressing and unhealthy and it's debatable how many women are "saved" anyway...
I also hate the suggestion we're all sluts and so have everything UNTIL we're tested and given the all clear.
One doctor was insistent I have checks for all sorts of STI'S...
I've been with my BF for 12 years...I don't have all these diseases.
Doctors just assume we're all bouncing from bed to bed and riddled with disease.
I told him his attitude was offensive to me.
It seems clear to me the doctors exaggerate everything anyway...perhaps, it's money as well as covering their backs.
40 - Susanne
I just get so confused by everything. I sure as heck don't want to jeopardize my health in any way, but I also don't want to have to undergo invasive exams like these. In any other context or situation, what these Drs. are doing would be considered sexual assault. We are taught as children to not let anyone touch us in certain private areas, but then all of a sudden we are supposed to go to the Dr., strip down, expose ourselves, let them touch us in those places and be perfectly OK with that? I know it's all business and in a professional healthcare setting and all, but still. Can someone explain that one to me?
My mom was diagnosed with brain cancer several years ago and passed away after about a year and a half of fighting it. Ever since then, I have become terrified of anything having to do with cancer and I've developed a real fear of Drs. offices and tests and such. I fear going and having something done and being told I have something wrong with me, I fear not going and jeopardizing my health because of that, I fear going and being subjected to painful and humiliating exams. It's hard for me to make sense of it all and do what's right.
41 - Sam
Susanne,
I think with all this cancer screening we've lost faith in our own bodies - we're all focused on cancer and not life.
I think the healthiest approach is to look at your lifestyle and make positive changes.
Perhaps, that means losing or gaining some weight, exercising a bit more, cutting down on alcohol, developing healthy sleeping patterns and the big one - stop smoking!
Also, doctors make "mass" recommendations that mean very little to the individual.
It's easier and safer for them to do that...so a prostitute is regarded in the same way as a woman who has had one sexual partner.
In fact, there are degrees of risk...the prostitute will be higher risk for cervical cancer...but if you look at the absolute risk for that cancer...she's still very unlucky to get cancer.
She's in greater danger of STD's and infections.
If you understand the risk of the cancer and look at your risk profile...the fear subsides - you can put it into context.
The emphasis on this test is out of all proportion to the risk of this cancer.
I adopt a few strategies with all of this testing....
1) What is my risk profile?
2) Is the test unpleasant?
3) Is the test reliable? (That's a big one...an unreliable test is more likely to hurt you than to help you)
4) I weigh up my likelihood of benefiting from the test against my likelhood of harm (stress associated with the test, the danger of false positives and biopsies)
We only have one life - if this testing would detract from your life...then the answer is simple - make changes to improve your health and go back to the basics...
If I develop a symptom, I'll go to the Dr...in the meanwhile, my body and I don't need constant reassurance that all is well.
I think too much medical interference in our lives is a major negative and THAT can be damaging to your physical and mental well-being.
Also, why the focus on our reproductive system?
We don't have our brains checked every year...we don't need reassurance every year that we don't have a brain tumour...
You really have to question this focus...it is terribly unhealthy and unnecessary in my opinion and I won't be taking part in it...
I value my body and peace of mind.
42 - Danielle Wallace
I am glad I found this discussion. I am 20 years old (almost 21). I was told back in like eighth grade that I was going to have to start getting them soon. Then I was told in high school that it was when you are sexually active, now Im told its three years after that or when you turn 21, and through all of if this I have been sure of one thing...it does not sound like something I want to do. As I approach the age of 21 I get told more and more I need to start thinking about going to the "girly doctor" or need to start thinking about getting my "girly check up" and it just makes me angry. We live in America..judicially speaking people are innocent until proven guilty, I look at my health the same way...healthy until something comes up to show Im not. After a long fight women finally achieved the right to vote in America on August 26, 1920. What do you think these ladies would think of us now....they fought so hard for us to have equal rights and to be able to vote, and now we cant even stand up for our own bodies in a one on one fight with a doctor. It should not be that way. This cancer is so rare and we should not all be forced to live in fear of maybe possibly randomly getting it. My sister has been fighting off chronic meyloid leukemia and its after effects for three years now (currently cancer free!! YAY!!) she was pretty much the one in a hundred thousand child that got this form of cancer. Now you dont see the US testing every child for CML because one out of a hundred thousand got it. And even at that when they DID diagnose her it took them about six diagnoses to get it right and finally start treat her.
Anywho ive rambled too much probably haha all Im trying to say is women have come too far to let themselves be scared into something like this. Take a stand. I am 20 years old, and against doctors wishes I will NOT get my wisdom teeth out, my appendix out, my tonsils out, or get one of these silly exams until I see that its needed.
43 - Samantha
Danielle,
The UK and Netherlands have the lowest rates of cancer and the lowest number of biopsies and false positives.
They don't even "offer" screening before age 30...
The rare case of cervical cancer in a young woman is often not picked up in a smear anyway...
So, even if you're that rare case, the smear may disadvantage you by giving you false reassurance and a later diagnosis.
Many countries now agree that screenig before 30 is a bad idea.
Forget pelvic, rectal and breast exams every year - they're not even recommended in other countries.
If you have screening at 30 (assuming you're sexually active) then no more frequently than 5 yearly...
Annual or biannual smears endanger your health.
Breast exams should not start until you're in your 40's (unless you have family history) - they are unreliable and lead to unnecessary biopsies.
Mammograms - not before 50 and then do your reading first - lots of negative stuff coming out about the serious risks of breast screening.
I agree with your comments. Women have lost bodily autonomy - our dignity and rights are constantly violated to catch these rare cases.
How can that be justified?
My husband and I were virgins...I have no wish to have biopsies for a false positive and don't believe I will benefit from smears.
The risk of this cancer has been exaggerated by doctors to frighten us into testing.
I don't think doctors care about over-testing women or harming us by pushing us into screening and accepting the risks on our behalf.
It's been a hard battle, but I've always refused smears.
I trust my body and go to the doctor if I have a persistent symptom.
I've never had any gyn problem though...my cycle is perfectly normal.
I think it's sometimes unwise to just go along with the "mass" recommendations.
It's your body and your life.
44 - Samantha
Sorry, not the UK and the Netherlands...I meant to say Finland and the Netherlands in the first line of my post....
45 - Vicki
I think American doctors are starting to panic....women are waking up and questioning the need for all these deeply embarrassing and humiliating exams.
They can scream about their importance...but they can't explain away all the developed countires that don't even suggest them to their women.
I was an exchange student and lived in Australia for 2 years.
I KNOW these exams are not done elsewhere...
My Doctor tried insisting but when I fired back Australian doctors told me otherwise and I hear English doctors feel the same way...she backed down, looked frustrated and accepted my argument.
Convincing healthy women to get into stirrups every year to be reassured that everything is healthy is just disgusting.
Most women fear and hate this exam and to lie to us about it's importance should be a crime.
It's certainly a moral crime.
I now have no time for our doctors...how can you trust doctors who treat us this way?
46 - Susanne
It sounds as though things are quite different in the rest of the world than they are here in the US.
How exactly does one go about finding a caring, competent Dr. who listens, answers questions honestly, has a good bedside manner and does not try to shame, intimidate or frighten a person into having exams they don't want to have? I've thought of calling up a few Drs. just to see if they would allow me to come and talk with them -- no exams, just a chat -- to see what their policies and practices are. I don't think my insurance would cover so many visits, but I wonder if some docs would be willing to chat with me for say 10 minutes without charging for an office visit. I don't know how else to gauge what kind of Dr. they are. I could ask other women I know, but I don't trust others' opinions on something like this. One person might think their Dr. is great, but I might find her to have a rotten bedside manner. Any suggestions?
47 - Susanne
Also, does anyone know if US Drs. are paid to reach a screening target or get some sort of incentive as do the Asutralian and UK Drs. mentioned on here by some other posters? Just curious.
48 - Sam
Pap smears are huge business...even without incentives, the doctor charges for the smear and in the States, they'd charge for the full gyn exam.
When you consider that 95% of US women will face colposcopy and biopsies in her lifetime (only a very small number will have any sign of malignancy) that's a LOT of work and money for gynecologists, day procedure clinics, pathologists, hospitals (for the cone biopsies which usually require a general) and other specialists.
Then you have the women that will need extra medical care BECAUSE of the screening and biopsies.
Infertility experts due to scar tissue on the cervix,
High risk pregnancy specialists due to damage to the cervix...some poor women may need to have sutures in their cervix to maintain the pregnancy. (my cousin did)
Pre-term delivery - due to damage to the cervix.
Psychologists, psychiatrists, counsellors and sex therapists for the women left with psychological and psychosexual problems.
I've also read women can have health issues later in life as well.
All of this adds up to be an absolute fortune.
You have to remember just how many women are actually helped by this testing when you look at the damage caused by this testing.
1000 women need testing for 35 years to save ONE woman from cervical cancer. (Dr Angela Raffle - UK cancer screening expert)
The huge downside to screening should have meant this test was unsuitable for mass screening.
Unreliable tests for uncommon cancers are NOT helpful...they just hurt a lot of people trying to find the very small number that actually have a problem.
I've read a couple of articles where US doctors have said the "annual pap is just an excuse to get women in for their checks...to palpate the uterus and ovaries"...I thought that was an interesting admission given the majority of the world's doctors DON'T recommend any routine gyn exams at all, at any stage in a woman's life.
The smears support a huge and profitable industry.
Sadly, it seems easier to frighten women...I doubt many men would give a seconds notice to any unreliable test that ended up damaging their reproductive organs.
It seems the attitude is different when you're talking about our reproductive organs...they are somehow less important and our dignity and privacy is also less important.
I find that totally unacceptable...
It also seems clear to me that the medical profession don't want a reliable and non-invasive test for women...they'd lose a fortune. When they can frighten, force or pressure women into these exams and test, there is no need.
There have been huge advances in every other area, but no improvement on this test...why?
They know women hate it, they know it's unreliable and harms many more than it helps...
The urgent insistence by doctors and scare campaigns means fear motivates most women to have the test and go through the biopsy procedure.
If you have the facts, fear falls away...
I find it astonishing that you're considered an ignorant person if you refuse the test, yet this is supposed to be an optional cancer screening test...because it has risks as well as benefits (for a very small number) and is aimed at healthy women...we must provide our informed consent.
Why is all of that ignored?
Many women don't believe they even have a choice when it comes to smears and many don't in the States, if they want birth control. (and don't use the HOPE program at Planned Parenthood)
I've read it's the ignorant and uneducated that don't have screening...
My closest friend is a pathologist and she declines screening.
I have a Masters degree in Law and decline screening...
In fact, lots of educated women have the facts...we're the very people who'll ask questions and won't be fobbed off with scare campaign slogans.
I believe every woman should be given the facts and the decision to screen or not (or how often) should be left with her...without intimidation.
YOU are the only person who can decide whether you wish to participate in screening programs or on what basis...
I'd say to all women to go further than the brochures and your Dr.
Breast screening is also a huge worry. The evidence against mammograms is quite frightening.
New research suggests regular mammograms may increase the risk of cancer...they suspect the radiation and the bruising of delicate breast tissue.
I'll post a few articles for anyone interested in the subject.
In the States they push mammograms from age 40 - VERY BAD idea and very likely to lead to biopsies. (never before 50 and then only when you're satisfied and all your questions have been answered)
If you have family history, then I'd speak to a breast cancer physician and get some advice.
I fear any new product that threatened to take away the lucrative cervical screening industry would be most unwelcome to the profession and would be blocked if at all possible or for as long as possible.
There must be a more reliable and non-invasive test available...
I've tried for months to get information on the CSA blood test.
It's supposed to be 100% reliable...
If the profession were really concerned about cancer, they'd be actively and passionately looking for an alternative, not contining to push an unreliable test that harms so many healthy women. (and often misses the rare case of cancer as well)
Men refused the DRE in droves and got the PSA blood test very quickly...why are we still waiting?
We are the only ones who can change things, by saying No, this isn't good enough, not even close!
49 - Narelle
Couldn't agree more!!!!
In Australia a 21 year old woman was recently interviewed on morning TV - she had cervical cancer, the youngest woman to get this cancer in this country.
It's a rare case.
Public health policy should never be based on the rare cases.
I have no idea of her risk profile - whether she started having sex when she was very young and had multiple partners etc...(or her partner had multiple partners)
The big point - this young woman HAD a smear test 6 months ago and it was Normal!
Clearly the cancer had been there longer than 6 months...this cancer takes some time to develop.
The doctor being interviewed - instead of mentioning that pap smears cause more problems than they're worth in this age group (under 30) simply urged all women to get tested every 2 years.
Yes, he pointed out this woman had fallen through the net, but regular testing should pick up most cancers.
He failed to mention that this test is very bad at picking up the rare early cases and very good at producing false positives in this group and sending a large number of them for biopsies.
He failed to mention that without the "Normal" smear result this young woman may have gone to the doctor earlier with symptoms.
I'm sure many would be reassured by the Normal result and delay seeing a doctor only to end up being diagnosed at a later date.
So, even though the pap smear FAILED this young woman...
The story is still spun around to put smears in a positive light and to frighten more women into testing.
It's so dishonest and disrespectful.
In this country we test teenagers and 2 yearly guaranteeing a large number have false positives and biopsies.
I read above - 78% have biopsies - I'm not the slightest bit surprised...
I have always dodged this test...it has never made much sense to me. My mother and grandmother (and every other older woman I know) didn't have this test and none of them got cervical cancer.
Yet all of my friends who have this test have had treatment for "pre-cancerous" changes.
Looking at it logically...there is no way known these women would all have gone on to cancer.
Doctors can't pick the rare cases that will, so everyone gets treated...
Unless there is a reliable test, I'm not going to worry about this very uncommon cancer.
I'll stick with symptoms...and concentrate on protecting my health.
This is too big a gamble on the side of harm for my liking...and all so terribly invasive, stressful and unpleasant.
50 - Kate
What about the women that are publicly shamed if they get the cancer and haven't had smears?
Put on TV to urge others to learn by their mistakes.
What about putting the women harmed by this testing on TV?
The women left traumatized and injured and the women who might have survived had they ignored their Normal result and trusted their body and acted on symptoms.
That's what makes me mad...the one-sided brainwashing stuff...presenting one side of the story.
It's almost like any woman who doesn't agree to smears DESERVES cancer.
I agree with the other comments...some people will make a decision not to have these "extra" tests especially when they're unreliable - if they get cancer, they've been unlucky.
There is no guarantee the test would have caught the cancer anyway...
Yet this is viewed as the most serious and irresponsbile omission any woman can make...my friend was berated by her doctor for not having smears, yet the two packets of cigarettes my other friend smokes every day is never mentioned by her doctor - she has smears so her doctor is happy.
It's clear to me the heavy smoking is a much bigger risk to your health.
Sometimes I think the world has gone mad.
51 - Frances P
I feel the same way...
I'd consider a reliable test for a common cancer or for one that I'm high risk for...
I'd even cope with something very embarrassing, if there were no other way.
I'd just find the right female doctor.
But there is absolutely no way I'd buy into this test.
My older friends have all had treatment...so many that it got me thinking and I went looking for answers.
Had this cancer suddenly become an epidemic because all the medical textbooks said it was a fairly rare cancer?
Why the disparity between the number of cases before screening and the huge numbers of women being "treated" today?
I didn't like the answers...
My doctor tried to tell me that the test is worth the risk.
How can she make that call?
I have a friend who was so upset after a colposcopy that she became clinically depressed...she felt dirty, humiliated and violated.
I'm sure its the reason she hasn't gone anywhere near a man since that time.
She plans to remain single for the rest of her life.
She's supposed to have more frequent testing, but won't go near the doctor unless she's really sick and then only if they promise not to mention smears.
Her procedure confirmed she had no cancer, it was a false positive...but the end result has been devastating.
My friend is changed...and not for the better.
I count my friend as one of the forgotten casualties of this testing.
Nobody seems to care about them.
Most never agreed to the testing in the first place, yet they live with the consequences.
Some of the posts have really hit a chord with me.
Thank you for confirming I'm not unusual...so comforting to know others question all of this testing.
52 - Cherie D. in USA
My mom started telling my I should get a pelvic exam when I was a 16 year old virgin and I remember having nightmares about it worrying I'd be forced to have one against my will. I used to think I was a freak for never wanting a gyno exam and refusing to have one (even when I was pregnant). My husband and midwife kept at me for her to have a 'look' down there but I refused and they finally let it drop My midwife delivered my healthy son at home with no problems. I'm 42 now and I'm still married and healthy as a horse [lol].
I'm so glad I'm not the only one who has refused this humiliating, degrading, creepy crap doctors try to insist upon! Treating a woman like some kind of animal without any modesty is despicable, traumatic and embarrassing.
My icky doctor story:
When my son was 3 years old I felt a lump in my breast and I was terrified so I made an appt. with a doctor. He had me lie flat on my back for the breast examination and he looked horrified when he saw the stretch marks on my breasts from breast-feeding and gasped, "THAT is what happens when you breast-feed?!" I was mortified. My husband had to console me while I cried all the way home from the Dr. appt.
Anyway, my lumpy boobs were just horomonal symtoms from PMS. Oh and the Doctor's wife was pregnant at the time which is probably why the idiot freaked out over a few stretch marks thinking that his wife's beloved 'fun bags' might not looks so 'fun' after breast-feeding HIS child. pfft!
Perhaps it's wrong but I've come to truly despise doctors and don't even get me started on dentists.
I'm so glad more women are waking up to this and taking charge of their own lives and their own bodies.
Stay stubborn and strong, women!
53 - Cindy
Are people really recommending that others take actions like risking potential early death from a treatable cancer rather than undergo a simple gynecological exam?
Getting a good doctor you are comfortable with is important. I personally prefer a female gynecologist.
I think it is a mistake to generalize about medical developments that save lives by discarding them as obtrusive and worthless. Women should definitely make their own decisions--let them be informed decisions, though, not reactionary ones.
54 - Sam
I don't believe women can make informed decisions at the moment.
We simply don't get the information. We're misled, pressured or bullied into smears, the risk of the cancer is exaggerated, the benefits of the test are overstated and the risks barely mentioned...and informed consent is rarely obtained by doctors.
In this case, it's simply impossible for a woman to give informed consent and make an informed decision.
I know it took years for me to research the area.
I knew it didn't make sense - seeing so many of my friends having "treatment" for false positives.
I can now make an informed decision and as a very low risk woman, I've chosen not to have smears.
If I were high risk, I'd consider the Finnish program, which produces the lowest number of false positives and biopsies and they also have the lowest rates of cervical cancer in the world.
I'd NEVER consider the US, Australian or UK program. (The US does the greatest harm, followed by Australia and then the UK - at least the UK program doesn't start until women are 25 and then 3-yearly)
The number of women having colposcopy/biopsies in their lifetime are 95% (States) almost 78% (Australia) and 65% (UK)...while Finland is 55%....(still too high in my opinion, but the best you'll do with this unreliable test)
I'd never allow routine gyn exams (annually or any other time frame) they are totally unnecessary.
How on earth can these exams be justified at all when the vast majority of the worlds doctors don't recommend them?
In fact, my doctor believes they can be harmful...as they often lead to more investigation that can be distressing and harmful.
I'm for absolute honesty - give women ALL the risk information and leave it to us.
If women knew the facts, very few would follow the US or Australian program.
High risk women might choose to follow the Finnish and Dutch program.
Some women might choose to accept the very low risk of cancer (high risk women) or tiny risk of cancer (low risk women) rather than accept the high risk of biopsies for a false positive - and that is their absolute right.
I'm not saying you shouldn't have smears - that's entirely a matter for you.
I strongly believe that you and every other woman should be given risk information, so you can make an informed decision.
Any woman having annual or biannual smears has a very high chance of having biopsies in her lifetime.
Every woman will feel differently about that...a high risk woman might not mind going through biopsies for a false positive, a low risk woman might feel differently....
It makes me very angry though, when women are misled and deceived to their detriment.
If we accept screening knowing the risks, we go into it with our eyes open...
I don't think that is too much to ask of the medical profession.
55 - Julie
There is so much amazing information here...thanks to all of you, I can now make an informed decision.
It would have been great if even one doctor had offered any sort of information...I've never received any risk information...just told I had to have the test.
Thanks for giving me the information the doctors decided to keep to themselves.
How dare they accept risk on my behalf?
56 - Sheryl
53 - Cindy,
What is fine for you might not be fine for someone else. As long as you're informed and you don't mind the RISKS of having smears and biopsies then that is YOUR rightful decision.
Please, cut out the guilt trips about 'cancer' though would ya? Maybe some women don't want to suffer on behalf of a few who get 'saved'.
Thanks.
57 - Cherie D. in USA
DNA test outperforms pap smear
58 - Cherie D. in USA
The Gardasil Scam: HPV Does NOT Cause Cancer
59 - Cindy
Sheryl,
"What is fine for you might not be fine for someone else."
Indeed. Which is why I object to those who attempt to convince and influence others to take actions that could endanger their lives, without actually providing any documentation or references.
The incidence of cervical cancer has declined dramatically since the availability of the pap smear. To confuse and discard this fact based on emotional reactions to doctors' failures to inform patients about the facts and risks is not acceptable.
I agree that women should make their own informed decisions. That's why I object to women who seek to influence others based on their own personal conclusions--conclusions which may contain inaccuracies and exaggerations and may be based on presumptions or emotional reactions such as Cherie D.'s.
My own conclusions would be likewise tainted by my personal viewpoint, which is why I am not offering advice to anyone here, merely suggesting it's wrong to attempt to sway people's thinking without providing references and then claim to support them in making their own decisions.
In fact, considering it's such a serious subject, I find it negligent and certainly disingenuous to fail to provide references, whilst claiming you want people to make informed decisions. What exactly do you want them to be informed by? A bunch of unsubstantiated opinions?
Here is a reference that repudiates your claims about incidence of cervical cancer.
"The American Cancer Society estimates that 9,700 women will be diagnosed with cervical cancer and 3,700 will die of this disease in the year 2006. Fifty years ago, cervical cancer was the leading cause of cancer-related deaths in our country. Since then, the number of deaths due to cervical cancer has decreased by almost 75%"
Here is a reference that offers basic information about the pap smear, what tests are done, how false results are considered and addressed. See number 19 for how the pap test may be improved by changing collection methods. Real information might help a woman to address concerns about collection methods with a doctor, for example. There are other choices women might make rather than tossing the whole procedure out the window.
Doctors are just human beings and are fallible. Having problems with some doctors is no reason to discard the field of medicine. Again, I suggest women use doctors who inform them and with whom they feel comfortable. I suggest women inform themselves and recognize that opinions are a dime a dozen and people have a tendency to have fixed opinions about everything under the sun, and often form them with very little actual evidence.
60 - Susanne
Why aren't men subjected to HPV tests or why isn't there a bigger push for that as there is for women to have tests? Men obviously get it and spread it around too.
61 - Cherie D. in USA
59 - Cindy,
I wasn't advocating that every woman should forgo pap smears simply because I've been perfectly fine and healthy without one. Did you read all of the articles posted here regarding the subject? I agree that someone shouldn't make a decison based soley on someone else's personal opinion. I've also chosen not to smoke, drink or let myself become obese and to exercise regularily. I don't care for doctors and thankfully I hardly ever get sick and therefore don't usually 'need' one.
I certainly woudln't want anyone dictating to me what I 'should' do with my body any more than I'd want to dictate to someone else what they 'should' do with theirs.
My choice, my body. Your choice your body.
60 - Susanne
Aug 18, 2009 at 9:00 am
"Why aren't men subjected to HPV tests or why isn't there a bigger push for that as there is for women to have tests? Men obviously get it and spread it around too."
I'd like to know the answer to that myself since they contract HPV as often as women:
HPV in Men
Considering men can be real skanks, you'd think they'd be 'encouraged' to get 'tested' for HPV too.
At least the DNA testing looks promising...
62 - Susanne
Just as a side note, my mom died of brain cancer (the same kind Ted Kennedy is fighting). Around 10,000 Americans are diagnosed with this particular form of brain cancer each year and most will not survive longer than a year, maybe two if they're very lucky. Roughly half of those diagnosed are women, so you have around 5,000 women who get it and die from it each year. More women die of this form of brain cancer than do cervical cancer. Where's the outcry on that? Why not a huge push for yearly testing for all people on that? Makes no sense to me.
63 - Harriet
There has been a lot of discussion and criticism of pap smears in the UK over the last few years.
I felt like I'd been misled.
I saw the figures by Andrew Rouse on-line a few months ago (they have been shown above by another poster) and my blood ran cold - I was told this was a common cancer, a real threat.
The more information that the profession has been forced to release, the angrier I became...
The screening authorities have been under pressure by a few very outspoken doctors and women (harmed by screening) to fully inform women.
The screening authorites feared that if women had risk information, they might choose not to have screening.
It was therefore, in our best interests, not to mention risks and to present the cancer as a serious and common threat.
The primary intention was to catch the cancer and the women afffected by false negatives and false positives could be justified if deaths from this cancer were reduced.
One woman in the UK has been very vocal about getting the facts to all women....Mrs Hazel Thornton.
We wouldn't have a lot of this information without her efforts over quite a few years.
The Medical Council made some major changes (I'm sure as a result of the criticism) and doctors must now tell
all women they have a low chance of benefiting from screening and a fairly high chance of an incorrect test result that may involve further investigation that can cause harm (false positive) or may delay diagnosis (false negative)...the doctor must then obtain your informed consent.
I'll post the GMC recommendations...I know I copied them.
I also have some references for you...I have an arch-lever file full, but I'll go through it tomorrow and post a few links.
It can never hurt to get the facts even if that does no more than empower you to challenge your doctor, ask questions and find more answers.
I now feel more in control of my health and not so "put upon" if that makes sense.
Dr Angela Raffle and Professor Michael Baum have both been vocal on the risks of screening. They are both highly regarded people in the UK (and around the world) so the screening people hate them.
Dr Raffle is actually a consultant to the cervical screening program in the UK.
Quite a few of her interviews over the last few years have covered the risks of screening and the low risk of this cancer.
She was strongly opposed to the screening age being lowered to 20 and doesn't believe we should screen women over 50.
Her research figures sent shockwaves around the country....doctors cringed everywhere...
If you google her name and "cervical screening" you'll find her interviews and research.
Others here have mentioned the final figure...1000 women need regular screening for 35 years to save ONE woman from cervical cancer.
There are many great articles published in the British Medical Journal that every woman should read...
I actually paid for a subscription to get to these articles...that's how interested I was...
I feel happier that at least in this country, there is some healthy discussion and doctors are finally being forced to "come clean" with us.
Sadly, in other countries, no criticism of this screening is tolerated...people get very angry and upset.
I really prefer to have all the facts in front of me.
I'm a healthy woman and if I'm going to have a test that is a "just in case" thing, then I need all the facts.
Currently under discussion in this country are two approaches...
a) continue as before and provide women with the barest of facts. (the doctors decide what's best for the common good, not the individual) or,
b) Provide an offer to screen...giving women all the facts without fierce promotion by doctors and leaving the individual woman to make her decision. (This would also apply to prostate screening...LOTS of negative discussion and concern about that screening blood test here...)
I will now insist on the second approach.
I'm also very concerned about breast screening. Thankfully, that is also up for discussion in this country.
I don't think we can say that all screening directed at men and women, is a good thing for all people, with no reservations.
All cancer screening has risks and everyone's risk level will be different...
I'll post some links...
64 - Eve
The article that got me thinking....
My doctor caved when I presented it to her... said it was all true.
She also agreed that it was a question of risk... are you happy to take even a tiny risk?
I said if the test were always correct, maybe I would have the test... even though I hate it... but given it so often misses things OR sends you off for biopsies when you don't have cancer or any other problem... it's a different story entirely... In that case, I'm happy to take the tiny risk.
I'm one woman very grateful for open discussion on this topic - I want to hear your life experiences, I share your concerns...
Keep talking everyone...
65 - Harriet
The information:
"Screening Wars" by Dr Fitzpatrick
(Great Article)
Excellent article by Professor Michael Baum
This article
Cancer Screening - Worth the money?
Health Warning: Screening Can Seriously Damage Families
Unethical conduct by doctors in the UK (Smears for cash)
Angela E. Raffle, "Cervical Screening" British Medical Journal (BMJ) 2004
328:1272-1273
You might be able to access an extract to this article, but unfortunately you need to subscribe to reach the entire article.
I've picked up a few articles that talk about her research and some of the articles that have been published in the BMJ...
I really think it pays to do some reading, sticking your head in the sand can have serious consequences in this day and age.
As I say, whether you have screening (breast, cervical, bowel etc) or not...it should be an informed decision.
66 - Sam
RMDeMay, "Should we abandon pap smear testing", American Journal of Clinical Pathology, 2000
Info: One third of women who actually get this cancer have had one or more false negatives...(so they may have been diagnosed earlier WITHOUT screening)
Approx. 0.66% of women benefit from screening.
95% of women having annual smears will be referred for biopsies, with only a very small number having any sign of malignancy...and the article has other interesting statistical information.
Laura Koutsky, Cancer Prevention, Fall 2004, Issue 4
Infor: Almost 78% of women having 2 yearly testing (Australian program) will be referred for biopsies, when only a very small number will have any sign of malignancy.
I'll post the links when I have more time, but I found the articles a few months ago doing a Google search...
67 - Luke
Here is the Article by Richard DeMay... we looked at it in our medical bioethics course.
68 - Luke
By the way, I was left scratching my head after looking at the real benefits of cervical screening.
I think you're all very wise to critically evaluate the test and it's likely benefit for YOU..
So many women have incredible blind faith in the test....yet I didn't think the facts backed that up.
I'm sure the tiny number of women helped by the test would consider it an incredible life-saving test...but the vast majority of women who suffer a false positive or false negative might not agree...
That's why screening is a controversial area - the women who believe they were "saved" by the test (whether that's true or not) are in direct conflict with those harmed by the test.
I think that means screening should never extend beyond the individual...we all have the right to assess these tests...after all, we're putting our health on the line...either way
In prostate screening...not having the test puts you at increased risk for this common cancer (and cervical cancer is not common...breast is) but biopsies of the prostate can leave you with nerve damage that may take away your quality of life and damage your health for the rest of your life.
That is why it MUST be the patient's decision.
I demand ALL risk information and I want to know how many people would get this cancer in an unscreened population.
Otherwise...I simply don't have enough information to make an informed decision.
69 - Luke
Sorry...just reading my post I didn't express something all that well.
When I said some women have blind faith and the facts don't back it up...what I was attempting to say was....
To say it is a life saving test and leave it at that is insufficient in my opinion...it's a far more complicated question than that...far more complicated...I guess that's why we have no right to be outraged or judgemental if another person chooses not to be screened and we have no right to deter others from screening.
By deter...I see absolutely nothing wrong with people sharing their life stories or openly discussing the topic.
Ultimately, it really is one of those decisions we HAVE to make for ourselves.
I gave all the information to my girlfriend, as I felt it was important that she have all the facts.
Whatever she decides, it's her decision.
I strongly disapprove of doctors pressuring patients or presenting the benefits and choosing not to mention the risks of testing.
70 - Olivia T
This is a very good article - it clearly shows the HUGE over-screening of American women.
It also points out that one in every 13 smears in women under 25 leads to colposcopy and usually biopsies... yet cancer in this group is very rare. (Over-treatment)
Young women are excluded from some programs because their doctors believe the harm to benefit ratio makes it unethical to test these women.
The chart comparing the average number of smears women have in their lifetime in the various countries is also very interesting.
Finland is the clear leader in my opinion with it's screening program... it achieves population coverage of about 90% and by omitting women under 30 and testing only 5 yearly they send fewer women off for biopsies. Yes, it's true, Finland also has the lowest rates of cervical cancer in the world yet their women have only 5 to 7 smears in their lifetime.
It shows that population coverage is more important than frequency... I believe it also shows that giving women honest and complete risk information makes clear which women are most likely to benefit from testing... the high risk women.
Women also stop screening at 60 at the latest... some stop earlier.
I visited Finland two years ago and although most women disliked the test... because it was only recommended 5-7 times in their life and the risk of a false positive is lower than other countries (although clearly spelt out to patients... 55% still have colposcopy, most for false positives)... more women agree to screening. Women who chose not to screen are not pressured at all.
I think over-screening turns many women off... this is a difficult exam for many women and when you factor in the even more unpleasant biopsies... not surprising some women are driven away....
My high risk friend follows the Finnish program (she lives in Finland)... she was very promiscuous in her teens (going through a wild phase), contracted several STD's and is a heavy smoker, so she has several risk factors.
As a very low risk woman I had my first test when I turned 40... I haven't decided whether I'll have any more tests. I'm a medical researcher... so have had access to this information from the very beginning.
71 - Olivia
PS Germany also over-screen their women.
72 - Annie
I agree with that...if you inflate the risk of the cancer to frighten women into testing...rolling low risk and high risk together (even virgins in the States!) you'll frighten off or lose the respect of some women.
If you clearly point out risk factors and forget the embellishments...perhaps, the high risk women would be more likely to screen.
Perhaps, focusing on high risk women would be more effective than trying to screen everyone.
Of course, some very high risk women engage in high risk lifestyles and may be less interested in preventative health measures.
I think women are more likely to keep screening if they feel they have made the decision and don't feel pushed into it...
Even if you end up going through the nightmare biopsy business, you were aware of the risks.
When doctors push you into it, you start to feel manipulated and resent it and if you have biopsies for a false positive, you can lose faith in the testing, if you were unaware of the risks at the outset and went into it blind.
Just my take on it....
73 - Nathan
Article on
informed consent and screening and it's conflict with maximizing coverage.
74 - Jack
There is no greater indication to me that doctors behave unethically with this screening with no regard for patient choice and rights than to look at the article that prompted the comments that have initiated this discussion...
The 10 million US women still being smeared many years after Doctors were told loud and clear NOT to smear women who've had complete hysterectomies for benign conditions.
Why are we still putting women at NO risk of this cancer through smear tests?
Against recommendations...
Vaginal cancer is as rare as penile cancer and we're not checking men every year or so for penile cancer.
This is a blatant abuse of women's bodies and rights.
I think these women should take legal action and make an example of the profession...sadly, that is the only way some doctors get the message.
I wonder what happens when some of these women receive a false positive....LEEP procedure on a non-existent cervix?
My mother-in-law was pressured...she changed her doctor until she found a competent and/or ethical one.
She was disgusted that they would try and put her through more smears when she was no risk for this cancer.
This isn't confined to the States...it still happens in the UK and Australia...one of the motivations in those countries is almost certainly the screening targets that apply there...screen 80% of your patients and you collect a large cheque from the Health Dpt.
It seems some doctors would screen anything to reach their target.
75 - Mike H
We also looked at this screening test as part of our bioethics course.
One thing that seemed clear and is mentioned by Angela Raffles (world expert on cervical screening)... the test was introduced too early, before it had been properly evaluated and women have suffered as a result.
In the early days of screening, some women faced complete hysterectomies and other drastic measures for things they now know were most unlikely to have progressed to cancer and even for false positives.
It seemed to me that women were used as guinea pigs to improve the program and I think that's just totally unacceptable. Today any doctor that tells you this is a reliable test is either incompetent or unethical.
There is no dispute this is an unreliable test and puts large numbers of women through the high anxiety of a false positive - the over-detection and overtreatment is still a major problem with this test.
It alarms me that so many women are completely unaware of the risks of this testing, which makes a false positive even more frightening.
Doctors know most abnormal smears are nothing to worry about except they send your patients off for a very uncomfortable and for many women, confronting experience... and some women ARE left with mental and physical health issues. I felt very concerned at the end of the course.
It was also interesting to watch the women in the course... some were very strong advocates of screening at the start of the semester and many ended up being completely confused, angry or disillusioned at the end of it.
A couple still felt any negative, no matter how great, was worth it if it reduced your chance of dying from this cancer. (and testing does not reduce your chance of dying to zero, due to false negatives)
Everyone agreed though, that all women should be given honest information and because there WERE substantial risks to the testing, only the woman could decide whether the risk was "worth it"... even the most passionate advocate for testing should not influence other women and vice versa.
The attitude of each woman to test or not would depend on her individual risk evaluation and her personal management of risk in your life. Also, her assessment of the negatives of testing ie. whether she's prepared to have at least one biopsy in her lifetime for a false positive. Some women will be unlucky enough to face more than one... and accepts the risks associated with that...
I think this knowledge is incredibly important for all women and I think the accepted practice of keeping women uninformed borders on the negligent.
We all agreed the current information released to women was seriously misleading and inadequate and needed immediate review.
Good luck everyone... one occasion I'm happy to be male, but as mentioned elsewhere... we now face prostate cancer testing and it is far from a perfect test as well. The implications of a false positive with this test is even more hazardous - the prostate gland is deep in the body and much harder to access.
The likelihood of serious injury is a major concern... thankfully, it's now a hot topic of debate.... perhaps that's why it's surprising it's taken so long for cervical cancer screening to be critically assessed, debated and discussed...