5 Responses to “GMTV’s Dr Steele is wrong to promote cervical screening in under 25s”

  1. Derek Tunnicliffe September 29, 2011 at 8:14 am #

    Not necessarily a direct comment on screening but on the whole “techie” approach to medical care generally, you might like to see “Abraham Verghese: a Doctor’s touch” on TED.com (recorded in Adenburgh, July 2011).

    Some of it is over-sentimental but the overall message rings true: and is in tune with your views, I think, Margaret?

  2. niki September 29, 2011 at 10:23 am #

    “If we wanted to serve young women better, we could start by explaining what screening is and whom it is for and be clear about its harms and limitations.” BMJ
    Of all the times that I have had a pap smear, including my first at 23 (and a virgin, the doctor assumed I wasn’t one, I suppose) I have never been given one skerrick of information about cervical cancer and pap smears. Just the assumption that I will do as told if I wanted birth control. I don’t think my sitaution is unique either.
    Now I actually have some information about it I choose not to have smears, partly becasue I consider myself low risk and partly because of the bitterness I feel of they way I have been treated by the medical profession regarding this test.

  3. Margaret McCartney
    margaret mccartney September 29, 2011 at 12:26 pm #

    thanks for that, Derek – medicine in the end is from and to individuals. When we place technology – or protocols – in the first line, I fear for our value of humanity.

    Niki, could I encourage you to post your response on the bmj.com website. you can get a full link to the article above. I think it’s important that your views are heard by doctors,. best, mgt

  4. Elizabeth (Aust) September 30, 2011 at 5:18 am #

    I think niki is spot on, most women are just expected to “do as they’re told”…very few women even consider screening a choice, especially pap testing. GPs will hassle, lecture and scold women in unrelated consults spurred on by the screening authorities who recommend opportunistic screening, basically ambushing women in consults – a very uneven playing field.
    Then we have our doctors getting target payments from the Govt, yet most women are unaware of these payments and it’s never mentioned in the press, in brochures or in waiting rooms.
    Screening is DONE to women, very few women are giving informed consent – it’s impossible when we get no real information and are told we MUST or SHOULD have the test – it is never presented as an “offer” that a reasonable woman might choose to decline or even do less often…
    I got to the facts early and have always declined testing (as a low risk woman) – it meant the Pill was unavailable for me, I had the same contraceptive options as my grandmother. I was not prepared to have a bimanual pelvic and breast exam plus pap test to get the Pill. My reading told me these things had nothing to do with the Pill and that the routine pelvic and breast exam were of dubious value. It’s now admitted they’re unhelpful and potentially harmful and of course, screening is supposed to be elective. I could have taken legal action, but as a young professional woman I didn’t have the time. There were very few female doctors around then…many of my friends were deeply traumatized by those exams – forced on them to get the Pill. Some felt like they’d been assaulted…
    The unfairness of it all alerted me to one thing that has served me well – you cannot simply trust doctors – you have to seek out a good one. I felt these male doctors were taking advantage of women – loving every minute of the cervical screening program and the power the Pill gave them to demand women into almost anything….

    When the Pill was freed up in Australia (about 15 years ago, roughly) I could have taken the Pill, but knew it would open up the pressure to have pap testing, something I’d rejected. I didn’t want to have that conversation and pressure every time I needed a repeat. (I was also established on the Billings Method) I believe the screening program is the reason we’ll never see the Pill off-script – it’s a way of capturing women for testing.
    My GP knows I’ve made an informed decision not to have breast exams, mammograms or pap testing and it’s never mentioned – she’s placed a note on my file.

    We still test young women in this country and test all women every 2 years maximizing harm to the more than 99% who’ll never benefit from testing. Our referral rate for colposcopy/biopsy is a massive 77% for a cancer with a lifetime risk of 0.65%. There has been talk for years that we should exclude young women for their own protection and move to 3 yearly screening for all women, but nothing happens – we have no one here pressuring the program to put women and their health and rights first. Over-screening suits everyone…vested and political interests.

    I was alarmed to see some research was being conducted in Australia (published in the “Lancet”) – cross checking pap test records of young women with Gardasil records – only possible here because we’re one of the few countries that still tests teenagers and young women. I believe the program hasn’t been changed to facilitate this research: did anyone ask these young women whether they were prepared to have pap tests and risk their health for no benefit to enable this research?
    Of course not – these programs have always operated outside the Law and ethical standards and we have no Dr McCartney, no Hazel Thornton or Prof Baum to challenge and pressure these programs.
    I’ve watched the awful damage this program has done over the last 30 years, but the over-screening and over-treatment continues…the unethical conduct and biased information continues…and there is still a complete lack of respect for informed consent for women.

  5. Elizabeth (Aust) September 30, 2011 at 5:33 am #

    This article confirms more research is anticipated, so it seems we’ll keep pap testing teenagers and young women until they’ve served their purpose.