Women’s Hour – cervical screening

 

Here are some of the references used in Women’s Hour today.

There was not enough time to discuss the stats properly. What is crucial is the fact that there is a lot of guess work – there has (shockingly) never been a proper RCT of cervical screening in normal risk women. So all estimates involve some guesswork, or modelling. (Archie Cochrane famously said of cervical screening that there has been “never has there been less appeal to evidence and more to opinion”).

Have a look at the 13 minute video on cervical screening http://www.cancerscreening.nhs.uk/cervical/publications/its-your-choice.html (with approx 10 seconds devoted to false positives, less to overtreatment) and compare with the prostate cancer screening decision aid http://www.prosdex.com/index_content.htm.

Men are given numbers, pros and cons, and offered an informed choice – women are given platitudes about yoga, green tea and chocolate cake. The cervical screening leaflets do not spell out the risks of overtreatment and the potential cervical effects and association with preterm birth.

Repeat: I am not against screening per se. I am opposed to unthinking screening, to doctors paternalistically herding women into getting screened, and women being denied and informed and honest choice.

Bristol cervical screening incidence and screening reductions

http://www.bmj.com/content/326/7395/901

 

Risk factors for cervical screening

http://cancerhelp.cancerresearchuk.org/type/cervical-cancer/about/cervical-cancer-risks-and-causes

Debate on cervical screening

http://www.bmj.com/content/315/7113/953.full

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(04)17260-7/fulltext

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(98)21007-5/fulltext

Incidence of cervical cancer over time

http://www.ons.gov.uk/ons/rel/cancer-unit/cancer-trends-in-england-and-wales/smps-no–66/index.html (fig 6.7, page 51)

Stats on cervical cancer incidence in the UK

http://info.cancerresearchuk.org/cancerstats/incidence/commoncancers/uk-cancer-incidence-statistics-for-common-cancers

Incidence and mortality of cervical cancer in nordic countries

http://www.biomedcentral.com/1471-2407/11/240/figure/F1?highres=y

http://www.biomedcentral.com/1471-2407/11/240

Incidence cervical cancer in different countries

http://info.cancerresearchuk.org/cancerstats/types/cervix/incidence/

48 Responses to “Women’s Hour – cervical screening”

  1. Helen Fox April 10, 2012 at 9:44 pm #

    So glad to hear your views on smear tests. I’ve been refusing them for years, having read similar views to yours in the excellent ‘What Doctors Don’t Tell You’. Same for mammograms. I’ve only ever had one – a painful, violating experience – and will never ever have another. Some research suggests thermography is a more accurate test for breast cancer. I would be interested in your views on the treatment/managing the menopause without HRT. Seems to be a very unsexy and sadly neglected bit of modern medicine

  2. Elizabeth April 13, 2012 at 11:29 pm #

    I see damage control has started already…
    It is laughable to say women receive balanced and complete information on screening. The estimate of lives saved is, as usual…inflated. I wonder if the research was sponsored by the program? The Dr may see 6 unscreened women a year with cervix cancer, but screening may not have changed a thing…adenocarcinoma is often missed by testing – women may receive a poorer prognosis after being reassured by a false negative pap test and ignoring symptoms…assuming it can’t be anything serious as the pap test has ruled out cancer…yet these doctors have nothing or little to say about the harms and limitations of screening. This has always been a problem…on the terribly rare occasions here when someone makes a critical comment about cervical screening, the program just goes into damage control…deny, deny and throw in some outrage for good measure…Oh, and claim the moral high ground…”we’re busy saving lives!”
    http://www.eveappeal.org.uk/media-centre/news/2012/04/comment-on-dr-margaret-mccartney-interview-on-woman's-hour-re-cervical-screening/

  3. Jane April 14, 2012 at 10:51 pm #

    For many years I have refused smear tests despite the pressure from every Health Care Professional I have encountered. This is a personal choice.

    What are women supposed to make of all the information and “fact” that is out there on cervical screening. I have read that “1000 women need to be screened every year for 35 years for one woman to be saved”. I have also read that in the UK 5,000 women are “saved” a year. Which statement is to believed?

  4. Margaret McCartney
    margaretmccartney April 14, 2012 at 11:32 pm #

    Dear Jane
    the honest answer is that I don’t know. The bottom line problem is that cervical screening has never been subjected to an RCT for women in normal risk (there is a bit about the history in my book, and more detailed in another book, A History of the Unfortunate Experiment at the National Womens’ Hospital). Because of this, there is more uncertainty than there should be, and all the answers rely to a greater or lesser extent on modelling based on best estimates, which of course vary. This means I think that women should be aware of the uncertainty in both directions in the meantime; there are loads of uncertainties in medicine in general and while we should be trying to reduce them, it’s not possible to exclude them – it becomes far more problematic when we pretend they don’t exist. I don’t know if you’ve seen this
    http://jms.rsmjournals.com/content/17/1/52.1.full

  5. janet davies April 15, 2012 at 10:00 am #

    As a Practice Nurse I have a close interet in this discussion as it developes. I have major concerns with the smear screening program, but with the introduction of HPV testing the ” minor ” abnormalities will be ignored if the HPV test is negative. Why this can’t apply to all abnormalities I don’t know. I feel confident though that the dreaded smear test will be phased out and the HPV vaccination program and continued testing will take it’s place.

  6. Elizabeth April 15, 2012 at 4:52 pm #

    Janet,
    You may be interested to see the new hrHPV program that’s been recommended by the Dutch Health Council. We can now identify the 5% of women at risk from cervical cancer (at age 30) those HPV positive and the 95% not currently at risk. Dutch women will be offered 5 hrHPV primary triage tests at 30,35,40,50 and 60 and only those positive will be offered a 5 yearly pap test. There is also a self-test option already bring used, the Delphi Screener. This program better protects the vast majority who are not at risk from cc and is more likely to prevent these rare cancers. There is no need to be worrying and harming the masses.
    Sadly, there is no critical discussion here in Australia where women are seriously over-screened and over-treated…there is absolute silence from our doctors, except to promote the over-screening program, basically misleading women and providing bad advice.
    http://www.gezondheidsraad.nl/en/publications/population-screening-cervical-cancer

  7. janet davies April 17, 2012 at 9:16 pm #

    Thank you Elizabeth that’s an encouraging piece of information, let’s hope Britain and Austaralia catch up soon.

  8. Sarah hill April 19, 2012 at 4:56 pm #

    The dreaded smear test saved my life and my fertility but I am not a mortality figure so guess I don’t really count.

  9. niki April 20, 2012 at 6:47 am #

    Did it really Sarah? I hate to be cynical but so many times on blogs women have claimed that it saved them but they do not understand that an abnormal pap does not necessarily mean cancer or precancer. Did you know that 88% of cin 3 clears up without treatment? Most women have no idea of that fact. Did you have a biposy for a proper diagnosis? A pap smear is not a diagnostic tool it is merely a screening tool. So unless you can provide more details of your case I am afraid that I will remain sceptical.

  10. Michelle McKenna April 20, 2012 at 11:23 am #

    I took part in today’s discussion on BBC Radio Scotland. I was very disapointed you did not discuss further risk factors when I mentioned being age 28, non smoker, only two partners, never a sign of pre cancer cells in previous tests I would say if I was weighing up my risk I would have been considered very low risk yet I was diagnosed with cervical cancer. Like the comment above my fertility was saved as well as my life. Please also take these figures into consideration while assessing the benifit of smear testing.

    I wonder how many lives need to be saved for you to think something is worth while. I wonder if it was a friend or family member who was diagnosed after screening if you would feel any different. I know 1000 people having a smear test with 90-93% all coming back negative just to save that one persons life another’s fertility and several others from ever progressing is well worth it for me, my family and friends. That is if the 1:1000 ratio is correct http://www.bmj.com/content/339/bmj.b3115 suggests otherwise and cancer research 28th July 2009 put the figure at 1:69. Who is correct?we don’t know for sure. What we do know is that in England where they do not screen woman under 25 many dr’s refuse to test young woman when they present with symptoms and in the past 6 months alone several young lives have been lost. If we moved to thinking diagnosis would GP’s still smear test? Would woman be aware of symptoms to go to there dr in the first place? Although many of those with cervical cancer know once you experience symptoms it is often too late.

    I fully agree if woman have assessed there risk and do not feel the need to have a smear that should be respected. In an ideal world everyone would be health conscious and be aware of risk, we don’t live in an ideal world. I have to admit I am very thankful you are not my GP or a year ago when I had presented with irregular periods I fear you would not have offered a smear test once you had accessed my risk given that 15 months before I had a clear smear. I am sure you are an excellent GP and if I later presented with bleeding after sex or other symptoms you would have suggested a smear then – would that be too late, certainly for my fertility hopefully not for my life!

  11. Margaret McCartney
    margaretmccartney April 20, 2012 at 11:39 am #

    hello
    just quickly
    erratic bleeding is not an indication for a screening smear but for diagnostic tests, which may include colposcopy rather than just a smear on it’s own – routine smears are only for asymptomatic women. As erratic bleeding can be a symptom of cervical cancer (though rare) a negative smear on it’s own would not be enough to exclude cervical cancer in these circumstances, hence you would need (amongst other things) often a colposcopy test, but not as a result of a screening result, but for investigation for symptoms.

    so had you presented with irregular periods, after a discussion about your medical history and symptoms, and with other tests being considered, a ‘normal’ smear would not be enough to exclude the need for colposcopy.

    in other words, this would have been symptomatic testing, not screening.

    The other way to look at this would be that the normal smear you had 15 months previously did not pick you changes that affected you in the 3 years subsequent to that (when you would have been due a next screening cervical smear).

    Unfortunately, some women having had a normal smear and who develop symptoms do not attend their doctor as they feel that they had a normal smear recently therefore can’t have a problem. This isn’t correct and is another potential harm of screening tests that happens in the real world situation.

    hope that helps.

  12. Jane April 20, 2012 at 2:49 pm #

    I have had ‘negative’ smear tests all my life and have been diligent in making sure that I was screened regularly.

    My last smear test in 2009 was negative as usual. I would have been due for another later this year.

    However last year I developed ‘symptoms’ and have since been treated with radical surgery and radiotherapy for cervical cancer.

    What on earth was the point of having all those uncomfortable smear tests if they didn’t show abnormal cell change ?

    DON’T trust smear tests and listen to your body instead.

  13. Elizabeth (Aust) April 20, 2012 at 5:57 pm #

    The thinking has always been skewed in cervical screening…just because someone gets a brain tumour, I’m not going to dash off for a scan. I also don’t respond to orders and that is apparently unacceptable in women’s cancer screening…I want the facts, a chance to assess my risk profile and then I’ll make an informed decision. It’s shocking the lack of respect that exists for a woman’s right to decline cancer screening.
    The complicating factor…so many women don’t realize this cancer is rare, always was and was in natural decline before testing began…but false positives are common…almost all of the women who think or were led to believe they were saved by a pap test, have in fact, been over-treated…
    The numbers say it all…lifetime risk of cc is 0.65%…lifetime risk of referral after an “abnormal” pap test…a whopping 77% in Australia.
    I wonder how many of these women were left with serious issues after over-treatment? I wonder how many believe the pap test saved their life?
    It’s unfortunate there aren’t more doctors like Dr McCartney…

  14. Michelle McKenna April 20, 2012 at 6:11 pm #

    It doesn’t really I am still left unaware of what you would have done if I had presented you. You mention that it’s rare for irregular bleeding to be a result of cervical cancer so would you still have sent me for a colposcopy given your thoughts that such proceedure gives risks of pre-term birth if you believed the chances of me having cancer were rare. I don’t actually wish you to answer as the reality is my dr did the correct thing and sent me for a smear test as well as a blood testing and requested me to return if all results were negative and symptom were to persist.

    Attending smears as well as my friends diagnosis of cervical cancer made me aware of what to watch out for. The leaflets I received at my smear and when I received my results made the symptoms and what to look out for very clear. For anyone concerned about the trauma of a smear test the trauma of cancer, I believe, is far greater.

  15. Margaret McCartney
    margaretmccartney April 20, 2012 at 9:26 pm #

    to recap:
    cervical screening is for women with no symptoms.

    diagnosis is necessary for women with symptoms, such as erratic bleeding.

    The tests you do depend on the individual women’s circumstances, but smear tests are screening tests and cannot be relied on to exclude a cervical abnormality in an women with symptoms.

    So a ‘normal’ smear would not be enough to exclude a cervical problem in a woman with symptoms. She would need further tests.

    A woman with symptoms such as erratic bleeding is far more likely to have something wrong than a woman without symptoms who is being screened.

    This means that the risk/benefit ratio is tipped vastly in favour of investigations for a woman with symptoms. This may well include colposcopy, as well as swabs, blood tests, and of course, clinical examination.

    If a woman has erratic bleeding, therefore, she has symptoms, and she needs a diagnosis; colposcopy is a better test than a smear test. See for example

    http://www.rcog.org.uk/womens-health/clinical-guidance/persistent-post-coital-bleeding-query-bank

    Cervical cancer may be an uncommon cause of erratic bleeding but it still needs to be excluded with reliable tests – a smear would not be reliable enough.

    My concern is with the information given to women who have cervical screening. I’m very keen that women who have symptoms get a proper diagnosis and appropriate treatment.

  16. steve April 21, 2012 at 11:41 am #

    I have never felt Margaret is calling for an end to cervical screening and it’s unfair to try and paint her in that light as some commentators have tried to do.
    All she is asking for is that women be allowed the right to make an informed choice and in order to do that women need to have the facts, just as men do for prostate screening (which incidentally, unlike cervical screening, does not save lives).
    So here are some facts:
    In order to prevent one death from cervical cancer we need to screen 57,000 women. Of these, 2000 will have some degree of abnormailty. We have no way of knowing which of these women will go on to develop cancer if left alone and consequently we expose all these 2000 women to the possibility of further distressing and sometimes disfiguring intervention. One Australian study has suggested that an average 15 year old Australian girl who under goes the full Australian cervical screening programme has a 75% chance of having such intervention at some stage which can cause fertility problems and which ultimately, in extreme cases, may lead to hysterectomy and the complete loss of child-bearing capacity despite no guarantee that these women would have developed cervical cancer if left alone. We know, for instance, that even the most extreme pre-cancer change in a smear, so-called CIN 3, may only progress to cancer if untreated in about 30% of cases – we just don’t know which 30%.
    The incidence of cervical cancer peaked in the UK in 1950 with 11 deaths per 100,000. By 1964 it had already declined to 9 per 100,000. In 1964 rudimentary screening was introduced. But it was not until 1987 that a national programme of call-and-recall screening was introduced. By then mortality had already fallen to 6 per 100,000. Since then it has fallen to just above 3 per 100,000. The degree of decline between 1950 and 1964 (before any screening was introduced) was effectively the same as the degree of decline after the introduction of rudimentary screening which, in turn, was the same as the degree of decline after 1987 when the national screening programme commenced.
    The rate of death from cervical cancer has fallen by nearly 80% since 1950 and screening is often cited as the cause of this decline. But the reality is more subtle. The decline began long before widespread screening was introduced – it had already fallen by 50% by 1987 – and other factors such as improved hygiene, reduced levels of STDs, increased use of condoms, less smoking, etc. have undoubtedly had a significant role. The incidence of diagnosis and death from stomach cancer has declined even more dramatically over the same time period yet we have never screened for that.
    Cervical screening DOES save lives BUT at best the national screening programme has reduced your risk of death from cervical cancer from a tiny 0.006% to an even tinier 0.003% – a relative reduction of 50% but an actual reduction of less than 0.003% – yet we continue to hassle women about smears. This doesn’t seem right to me.
    I think sexually active women SHOULD go fo a smear test on a regular basis but far better to do that from a position of knowledge and understanding than from a position of ignorance and, in some cases, preceived coercion.

    • Anna April 11, 2014 at 2:40 pm #

      ” think sexually active women SHOULD go fo a smear test on a regular basis”.. .. but why SHOULD they? You list all the faults with the test- why SHOULD not someone arrive to the conclusion that they are fine without this test? “In order to prevent one death from cervical cancer we need to screen 57,000 women. Of these, 2000 will have some degree of abnormailty. We have no way of knowing which of these women will go on to develop cancer if left alone and consequently we expose all these 2000 women to the possibility of further distressing and sometimes disfiguring intervention.” Why SHOULD I… and how come a man wants to tell me I SHOULD, excuse me?

  17. G Higgins April 21, 2012 at 10:31 pm #

    Thank you so much for the blog and for your book which I have just finished and really enjoyed. I’m also really really happy to finally read the comments of other people with similar opinions to me and am
    so relieved that there are actually people out there with the same views. I’m sick of being told I am wrong and should go for a smear, without people realising that they have been totally brainwashed by the media. I am mad that women seem unwilling to take their own personal risk factors into account and instead just churn out what they have read, but I’m also mad that balanced info is not made available. The standard line in favour of smears still is ‘Just look at what happened to Jade Goody’ . What I remind them is that Jade Goody had countless smears which found nothing and she also had a variety of other cc symptoms. How her name has come to be used to encourage women to go for smears is beyond me, as surely it should be the opposite??

    I know so many women who have ‘needed’ follow up treatment following a smear and after having various bits cut out or lasered off have believed they’ve been ‘cured’ of cancer and do not question that there may be a problem with the test or that they have been subject to needless, painful and harmful treatment. I find this so so worrying.

    I’m 29 and have never been for a smear test, nor do I plan to. The last time I got called for one (multiple unrequested letters and a ‘reminder’ from my GP when attending an appointment for an entirely unrelated issue) I wrote to my GP explaining that I had assessed my own risk (with no help from the pathetic propaganda leaflet sent with the reminder) and decided that the risk of the test far outweighed my personal risk of cc. I was then made to ‘opt out’ of the test (Even though I can’t recall ‘opting in’). I also find it worrying that gp’s receive bonuses for % of smear tests administered.

    It makes me so mad that women’s bodies are routinely violated in this way without informed consent, and that women are their own worst enemies by not questioning the shoddy NHS leaflets or the biased articles in women’s magazines. The only time I will go to my GP is when i am ill and require medical treatment.

    Thank you Dr McCartney. I wish you were my GP.

  18. Jane April 22, 2012 at 12:45 am #

    G Higgins – I wish Dr McCartney was my GP too.

    This blog is the subject of great discussion at my office. I am always amazed at how vocal and angry my colleagues get when I state that I refuse cervical screening. Why the anger? It’s my body and my choice.

    I only go to my GP when I am ill. At every visit the subject of smear tests comes up. I have asked to opt out of the scheme. It appears that I need counselling before I can do this! I am a grown up people!

  19. Elizabeth (Aust) April 23, 2012 at 5:30 pm #

    Steve, you lost me in the last paragraph…
    “I think sexually active women SHOULD go fo a smear test on a regular basis but far better to do that from a position of knowledge and understanding than from a position of ignorance and, in some cases, perceived coercion.”

    It is not for others to say women “should” test – we should be provided with all of the information, good and bad, and the decision left to us. I think many women are sick and tired of being ordered about and being told what to do…
    According to your assessment, I should be having regular pap tests, but as a low risk woman, my risk from cc is near zero…the risks were too high for me and I made an informed decision not to test almost 30 years ago. I’m not interested, especially as a low risk woman, in an intrinsically unreliable test for a rare cancer. If I’d followed the recommendations here, there is a high chance I would have lost some of my cervix by now. MOST women will be referred here after an “abnormal” pap test – we have very high referral and over-treatment rates. (lifetime risk is about 76%)
    I had to go looking for the facts, that should not be necessary…we should receive a balanced overview of the evidence, similar to the breast screening information sheet produced by the Nordic Cochrane Institute.

  20. Elizabeth (Aust) April 24, 2012 at 8:24 am #

    Jane,
    Challenge the system – they rely on women giving in to their demands or certainly not challenging them. Doctors cannot remove you from their patient list, demand you have counseling or refuse to treat you simply because you decline an elective screening test – make a complaint and even take it higher to the General Medical Council. Can you imagine a man being treated in this way?
    I made it clear to my GP that I did not want to waste my valuable 15 minutes with her discussing screening tests I’ve decided not to have…I would not tolerate having my file flagged and being hassled at every consult, receiving letters or phone calls – it amazes me what many women put up with…
    If women do their reading and make an informed decision not to test…there is no need to avoid doctors or face a battle at every visit – you make your position clear and ask that a note be made in your file. If you can’t work with your doctor, find a new one. If a call and recall system is introduced here, I’ll ask for permanent removal and if they have a problem with that, my lawyer can sort it out with them, I suspect one letter from her will solve that problem. Continuing to send women who’ve chosen to opt out of cancer screening….red letter demands every 4 years is IMO, harassment. It might be easy just to throw the letters in the bin, but I feel there is a principle at stake here, my right as an independent adult to make my own decisions about cancer screening and have that decision respected and accepted by the medical profession. (and government)

  21. steve April 24, 2012 at 8:16 pm #

    Hi Elizabeth – “I think women should” is just my opinion – that’s all. Just like I think people should wear seat belts or should not smoke or whatever. I just want people to make decisions based on knowledge and not ignorance because an opinion based on ignorance is no opinion at all.
    Cheers
    Steve

  22. G Higgins April 25, 2012 at 1:37 pm #

    Steve – if you have read any of the views above at all, then you should see that ‘ignorance’ is the last thing any of the people who have posted can be accused of. Ignorance is going along to a test because you have been told to, and because thats the way it is, without questioning the reliability and usefulness of the test, or without considering what the implications of a false positive/false negative results are!

  23. steve April 25, 2012 at 3:13 pm #

    Hi G Higgins – oh gosh – I didn’t intend to upset or offend or accuse anyone above of being ignorant and I am sorry if that is how I come across. This is the fundamental problem with web posts as opposed to good, old-fashioned, face-to-face conversation – things are open to mis-interpretation. Anyway…
    The problem I have with modern medicine, and I speak as a GP, is that people are not always given all the facts about anything. Instead they are often given one sided, paternalistic views and not allowed to make an informed choice and this has consequences. So, for example, I believe we have far too many people on far too many drugs that are doing them little or no real good.
    I thought the professor who debated with Margaret on Radio Scotland recently was terribly paternalistic when he accused her of putting women off having smears by giving them the full picture.
    Or, to give another example, millions of people with no history of heart disease or strokes are taking statins to lower their cholesterol with a view to preventing these events. Yet, in reality, if you take a statin in such circumstances over 5 years it reduces you risk of a heart attack or stroke by less than 2% and it doesn’t improve your mortality at all. But most doctors don’t tell their patients this.
    Conversely, people are sometimes given a lot of information but all of it is given equal weighting when that is not justified by the evidence but patients are not told this and are thus prevented from making a proper informed choice. Such tactics, which I deplore, are widespread in the world of alternative medicine and amount to little more than deception.
    In the end of the day the most important aspect of any treatment in my view is the so-called “number needed to treat”. In otherwords, how many people need to be subjected to a particular treatment for one person to benefit. In the case of statins above it’s about 1 in 50. In the case of cervical smears, as I said in my initial post, it’s 57,000 women smeared with 2000 receiving further treatment to prevent one woman from dying from cervical cancer (assuming that that is the ultimate goal of the cervical screening programme).
    I will respect and support any decision any competent adult makes about their health provided they ARE making an informed choice and provided they take responsibility for that choice, come what may.
    To give you an example that applies to myself, I would not have chemotherapy unless it offfered a chance of cure (e.g. certain blood cancers and, in my case, certain testicular cancers). I have spent 20 years looking after people receiving chemotherapy, including my own late wife, and I have read all the information I can about it and I have come to the conclusion that, as far as I am concerned, if there is no prospect of cure or significant longevity (measured in years) then I will not have it. And I hope, if that time ever comes, my own doctor, family and friends will respect and support that choice as best they can.

  24. B. B. April 26, 2012 at 9:07 am #

    Gosh, listening to all of the above, you intelligent and informed ladies could all have convinced me not to go for smear tests under the guise of informed choice just to avoid an uncomfortable procedure once every 3 years.
    Just as well I did bow to pressure and follow the heard so that (after always having clear regular screens) when I attended screening with absolutely no symptoms and in seemingly perfect health I had my 2b cervical cancer picked up and, as the tumour winked at the nurse, she was able to book me an immediate colposcopy. I still lost my fertility and ended up having procedures that would have you ladies screaming in the night and begging to turn back time in order to go for screening. It saved my life and there is nothing ambiguous about it Dr McM. As I did not have symptoms, it is likely that by the time that I did, it may well have been too late. You can tell yourself that I’m rare if you like, it makes no difference if I am and will hopefully will make you think about how irresponsible it is to say that screening isn’t necessary.
    And as for statistics, I’m was definitely worth saving, as are all the women that have gone along to screening and subsequently had their cancer detected (and yes, I do know that screening is not a test for cancer it is to detect cell changes so that you hopefully never have to face cancer).
    When you’re looking at the prospect of kissing your loved ones goodbye and knowing that you could have done something to prevent it, clever statistics and excuses just become redundant.
    Good luck with dodging the 1 in 3 bullet. Low risk doesn’t mean no risk.

  25. Elizabeth (Aust) April 26, 2012 at 11:19 am #

    BB, who is saying women shouldn’t go for smears? The point being made which seems to get lost all the time with cervical screening…women should be provided with ALL of the information and left to make up their own minds – no target payments to doctors, no scare campaigns, no misleading and incomplete brochures and programs should be independently assessed on a regular basis so they move with the evidence.
    If women make an informed choice to screen, that’s their business, but the evidence is clear now that only HPV positive women aged 30 and over can benefit from pap tests…about 5% of women. hrHPV primary triage testing and the Delphi Screener not only better protects the vast majority of women who are not currently at risk from cervical cancer – these women might choose to test infrequently for HPV and HPV primary testing is more likely to prevent these rare cancers. If women are worried about cervical cancer, they should be lobbying the government for smarter testing, not population pap testing. The Dutch are the ones to watch here…
    Pap testing may have helped you, but what about the false negative women or the women left with cervical stenosis or an incompetent cervix after an unnecessary cone biopsy or the women who lose a premature baby. Their life stories are so often dismissed…collateral damage, that’s unfair.
    Screening is a gamble…we all make decisions every day and accept full responsibility for those decisions.
    Whether women have pap tests or not is their decision and the same applies to colonoscopies and other screening…strangely, we don’t see the same sort of emotion when people choose not to have colonoscopies, even though bowel cancer is far more likely…but so often there is near hysteria and even personal attacks when women choose not to have cervical screening. It seems the most concern and emotion is reserved for the rarest cancer. I wonder if it’s a reflection of the very high profile given to this rare cancer…possibly because these expensive programs knew they were looking for a few needles in a huge haystack and had to test very large numbers to stand a chance of bringing down the already small death rate.

    My gripe – it is impossible to make an informed decision without honest, balanced and complete information…men got it in prostate screening in this country and women should be treated the same respectful way…the Australian cervical screening program is excessive, harmful and more than a decade behind the evidence, we’re harming women unnecessarily…but with NO scrutiny of the program, no one is acting in the interests of women.
    Hope all continues to go well for you.

  26. Michelle McKenna April 26, 2012 at 5:52 pm #

    Elizabeth I am lost on why screening can only help the over 30′s? I had this ‘rare’ cancer at 28, the best man at our weddings girlfriend had it at 29 (stage 3 requiring hystorectomy), my sister in laws gran died of cervical cancer. My cousin works in a team of 8, two of the woman in the team had cervical cancer and required hystorectomy another’s sister is battling it just now through chemo. With regards to false positives, if a smear gives a false positive reading then the colposcopy will not show up any area of abnormal cells so no treatment will be given. I appreciate that woman will have the inconvenience of the trip for the test but that’s all. If during the colposcopy cells are found it is then no longer a false positive. Jade Goodie did have abnormal smears, did attend a colposcopy and did chose not to be treated this I know to be fact from a friend of the family she did ignore letters asking her to attend – maybe it was her informed choice. I have looked up many stats on prem labour and it does show an increase in chance but from around 5% in the general population to those treated to around 12% which includes woman who have been treated for cancer and who have required repeat LLETZ. Of the 12% no indication is give on how early or if the woman waited the reccommended 6 months before conceiving. What a gift I have been given, not only did I have cancer but I also have the chance of a baby. I am well aware of the risk but like with any medical proceedure I make myself aware of the risks as it is my health and my responsibility. I would not like any woman to be pushed into a smear through fear or anything else but I would not want wish the pain, suffering or harm of cancer on anyone either.

  27. Elizabeth (Aust) April 26, 2012 at 9:57 pm #

    Michelle, I can understand your feelings, but cervical cancer has always been rare. Before screening started a GP might have seen one case over their entire career. It is HIGHLY unusual to know so many women who’ve had actual cervical cancer, I’m not doubting you, but many women believe they’ve had cancer for instance with a diagnosis of CIN 3 when most of those women will not progress to invasive cervical cancer, so that can lead to lots of women believing they’ve had cc.
    The false positive/colposcopy position is not so clearcut…many things can cause a false positive, my younger sister had a highly abnormal pap test, colposcopy and then a cone biopsy which showed normal tissue. It was a very bad experience…it appears using a new brand of tampons had caused an inflammatory reaction. As I understand it and as explained to my sister FAR too late, other things can lead to a false positive…infection (transient and harmless) trauma (childbirth) hormonal changes (pregnancy, menopause) inflammation from condoms, tampons etc and perfectly normal changes that occur in young women, the maturing cervix, and older women.

    I have always been shocked and angered at the lack of research into the harms of over-treatment…my sister was told by her specialist that more than 50 cone biopsies are performed for every one that turns out to be necessary. What ARE the figures? I know one study showed the lifetime risk of referral here was a whopping 77%…most women are unaware of this figure. You’d think this would have prompted a lot more research and changes to our program, but no, that certainly didn’t happen, but if you want a study into why some women choose not to have an elective screening test, take your pick, there are lots of study. I know which research I regard as more important.
    Damage to the cervix…how many women are left with damage that can lead to all sorts of problems? I’ve been unable to find much research over the years, it’s like no one really cares about this large group of women…for many years I’d read the treatments after an abnormal pap test were “minor” in nature – I think that’s a question best left to individual women, my sister certainly wouldn’t agree with that assessment.
    I recently read about a woman with a prolapse who wondered whether a cone biopsy performed many years ago (a false positive) might have had something to do with it…I couldn’t find any research, but watching the procedure on line, was shocked at how roughly the cervix is yanked out for treatment…it made me wonder whether prolapse might indeed be another issue?
    I say testing doesn’t help those under 30 because…after decades of testing no country in the world has shown a benefit pap testing those under 30, it doesn’t change the tiny death or incidence rate (“Cervical cancer screening” in Australian Doctor by Associate Prof Margaret Davy and D Shorne, July 2006) BUT this group produce the most “abnormal” pap tests/false positives. Dr Raffle says 1 in 3 pap tests will be “abnormal” in the under 25s and concludes it is unethical to test those under 25. Countries that don’t test women before 30 don’t have more young women with cervical cancer..like Finland and the Netherlands.
    I understand the very rare cases that occur in young women are usually adenocarcinoma, an even rarer form of cc and the pap test is bad at picking up this type of cancer. I know these women tend to get false negative pap tests and may end up ignoring symptoms after being reassured by a “normal” pap test…that’s why young women are advised in those countries that don’t test them to see a doctor if they develop persistent and unusual symptoms like bleeding after sex and between periods. (All women should respond to symptoms regardless of a normal pap test result.)
    I’ve read of pap tests picking up actual cervical cancers in young women (not CIN) and have wondered whether it changed much in the long run…the pap test didn’t pick up an early issue, so was the woman about to develop symptoms anyway? Then there is the issue of false negatives…
    The youngest woman here to get cervical cancer was 21…we pap test young women here and over-screen, she apparently had a false negative pap test, returned to the GP six months later, I assume with symptoms, and a pap test was performed again which was abnormal…of course, she should have been referred to a gyn…what would have happened had the test been normal (false negative) again? This woman was used to promote pap testing in young women when it could be argued pap testing cost her six months, delayed her diagnosis and may have changed her prognosis. It’s this sort of dishonesty I resent, using a false negative case to promote pap tests and by a system that is intending to remove young women from pap testing. In my opinion, the only reason we’re still testing young women in this country is to complete some research into the effectiveness of Gardasil. I think this is unethical without first obtaining informed consent from young women for the pap testing and the research. No one else appears to be concerned though…I feel sure we’ll continue to test those 25 to 29 though, similar to the UK.
    HPV testing is not recommended for those under 30 as I’ve read around 40% would test positive…and in almost all cases these women will clear the virus naturally within a year or two. By age 30 the number of HPV positive women drops to 5%…
    I’ve found over the decades the quality and accuracy of information provided to women with this screening has been shameful…and that continues in this country with no advocates for informed consent. With no real information and misleading and inaccurate information we cannot
    provide informed consent nor can we make the best decisions, we have no idea what we’re agreeing to…
    Anyway, nice chatting to you…I think we can learn a lot by just opening up frank discussion. As I say, I believe more women could be saved with hrHPV primary triage testing and the Delphi Screener and just as importantly, we’d spare a lot of healthy women the ordeal of and risks with over-treatment.

  28. Michelle McKenna April 26, 2012 at 10:32 pm #

    I do appreciate the discussion and how it challenges thinking which is always a good think. I think in the end we have to agree to disagree. I respect your choice and decision and it is a subject I am never going to be impartial on given my history. To avoid doubt as to the people around me who have suffered, I was stage one and only required surgery, I have 3 monthly check ups at the Beatson, my friend (best mans gf) was stage 3 and required hystorectomy followed by chemo and radio, sister in laws grab found after death and the two at my cousins work attended I know received a hystorectomy so I doubt they really had that proceedure for abnormal cells and were mislead into thinking it was cancer. Just to ensure your figures for quoting are correct 7 young woman under 20 in Scotland have had cancer –
    http://www.isdscotland.org/Health-Topics/Cancer/Cancer-Statistics/Female-Genital-Organ/i_cancer_female_genital_organs.xls?1
    Over 100 20-24 and I lost count on those 25-30. I do hope your sister recovered okay and did not suffer any challenges if she went on to have children. I read on a couple of different studies the life time treatment rate was 16% so just show stats may show a different story depending on what you read.

  29. Michelle McKenna April 26, 2012 at 10:56 pm #

    Sorry just realised the link relates to all female genatile cancers not just those of the cervix, have read so many studies over the past 6 months my head is swimming with them!

  30. Elizabeth (Aust) April 26, 2012 at 11:33 pm #

    It is confusing, years ago cervical cancer stats were lumped in with other gyn cancers including uterine, so that often inflated the stats for cc, adding to the confusion.
    Sure, those things will change your perspective. I’m 54 and don’t know a single woman who’s had actual cc, but know many who’ve had abnormal pap tests and over-treatment. My sister did not have children, but it might have been difficult for her having lost a fair bit of her cervix…this was a few years ago now and I “hope” the procedure occurs less often these days or doctors are more careful not to remove too much tissue, I haven’t been able to find any stats though….a friend who works in a hospital tells me the day procedure lists are still busy with women having cone biopsies, many very young, that fills me with concern when the cancer has a 0.65% lifetime risk AND here in Australia, we only test women for HPV after these treatments, if we tested them before we could rule out treatment/biopsies for most of these poor women. So much of it makes no sense to me.

  31. Michelle McKenna April 27, 2012 at 12:23 am #

    I see I have been talking from a UK statistical point of view I am quite unaware of Australia’s figures. I think (in the UK) we have come a long way. From what I have read and my experience from friends is CIN 1 is left for a wait and see with repeat smear in 6 months, CIN 11 and CIN 111 has colposcopy with treatment depending on level of abnormal cells. The amazing thing for me is that if I was diagnosed 8 years ago I would have received a hystorectomy. I was diagnosed 3 weeks after my wedding so this would’ve been devistating at this stage of my life. The standard of care is still a hystorectomy but since I wanted children and was stage 1 I was offered fertility saving surgery. Iv received two LLETZ and had pelvic lymph nodes removed so my treatment and harm has been kept to a minimum to allow me to retain my fertility but my chance of re-occurrence and death have increased by 1% all of which was fully discussed with my consultant. I believe progression has been made in treatment overall but again that opinion all comes from a positive experience.

  32. Eline April 27, 2012 at 7:03 pm #

    Michelle, Re: With regards to false positives, if a smear gives a false positive reading then the colposcopy will not show up any area of abnormal cells so no treatment will be given. I appreciate that woman will have the inconvenience of the trip for the test but that’s all. If during the colposcopy cells are found it is then no longer a false positive.

    Only 12% of high grade lesions (CIN3 and CIS) progress to invasive cervical cancer but all (100%) need to be treated because noone can identify these 12%. That means 88% is overtreatment, and that is what I understand of the term “false positives” – if left alone, these women would be perfectly fine.
    http://www.bmj.com/content/326/7395/901.full?ijkey=kndK1dePPBERM
    http://www.cme.hu/dlObject.php?aid=515&/CME%20V12N2%20C40%20Atilade.pdf

  33. Michelle April 28, 2012 at 12:41 am #

    Eline, if you put 100 woman in a room and said if untreated 12 of you will develop cancer but 88 will be fine, 6 of you will die and 5 will require a hystorectomy, 1 may qualify for surgery which will allow fertility. Out of those who are of child bearing age you will have a 12% chance of a pre-term labour rather than a 5 % chance of pre-term labour. I wonder out of those 100 who would take the chance on treatment. I would do anything to have been treated pre-cancer stage.

  34. Eline April 28, 2012 at 1:10 pm #

    I see where you are coming from Michelle, getting cancer is a very sad thing. But losing bits and pieces of my healthy cervix or even my uterus for nothing is unacceptable for me.

    The fact is the lifetime risk of invasive cervical cancer is less than 1% and this test carries a 65% lifetime risk of referral (with 3 yearly testing). 1000 women need to be screened for 35 years to prevent one death. For each death prevented, over 150 women have an abnormal result, over 80 are referred for investigation, and over 50 have treatment. (http://www.bmj.com/content/326/7395/901.full?ijkey=kndK1dePPBERM)
    Also, women die from cervical cancer despite being screened. Angela Raffle says that “we do not know what proportion of cervical-cancer deaths are preventable by screening – it may be 50% (…) The public have no idea that most deaths among women who have been screened are unaffected by screening programmes that are promoted as “simple and effective”.” (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2805%2978229-5/fulltext)

    Some women may choose to screen, some may not. Why not giving women the facts so that they understand what they are agreeing to and let them decide? That is what an “informed decision” is all about…

  35. Margaret McCartney
    margaretmccartney April 28, 2012 at 11:41 pm #

    hello
    I actually don’t think that there is a massive difference, in the end. My job involves seeing women who may well have had their deaths delayed or fertility preserved by cervical screening, but I also see the problems, especially potential overtreatment and anxiety, and of course babies born preterm. We have to be fair to everyone, and I do think that’s what we all want. I’d like to see more honesty in the information women are given, and more discretion when it comes to making choices. If women knew better the risks of overdiagnosis and treatment, I do think it would actually make for easier decision making and treatment later on – a recall would be less of a nasty surprise and more of an anticipated reality.

  36. Eline April 29, 2012 at 1:39 am #

    I see where you are coming from Michelle, getting cancer is a very sad thing. But losing bits and pieces of my healthy cervix or even my uterus for nothing is unacceptable for me.

    The fact is the lifetime risk of invasive cervical cancer is less than 1% and this test carries a 65% lifetime risk of referral (with 3 yearly testing). 1000 women need to be screened for 35 years to prevent one death. For each death prevented, over 150 women have an abnormal result, over 80 are referred for investigation, and over 50 have treatment. (http://www.bmj.com/content/326/7395/901.full?ijkey=kndK1dePPBERM)
    Also, women die from cervical cancer despite being screened. Angela Raffle says that “we do not know what proportion of cervical-cancer deaths are preventable by screening – it may be 50%. (…) The public have no idea that most deaths among women who have been screened are unaffected by screening programmes that are promoted as “simple and effective”.” (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2805%2978229-5/fulltext)

    Some women may choose to screen, some may not. Why not giving women the facts so that they understand what they are agreeing to and let them decide? That is what an “informed decision” is all about…

  37. Elizabeth (Aust) April 30, 2012 at 6:39 am #

    Dr McCartney,
    There is endless concern about the rare cases of cervical cancer, but no one seems to give a damn about the women over-treated – there is very little research into over-treatment – how many women end up with health or obstetric problems as a result of over-treatment/excess biopsies? Is anyone counting or doing any research at all?
    They may argue serious harms are rare, but so is invasive cervical cancer, so why is it…one is very important, the other dismissed…ignored. When you consider the amount of over-treatment in this country, the number of women left with serious issues must outnumber the number of women helped by testing.
    I was reading on the Mamamia site – a poster “Kathy” bled uncontrollably after a cone biopsy (normal biopsy) and ended up having a hysterectomy. Another woman (Prue) was left with damage to the cervix, lost a baby and then had a premature baby that had issues, but is doing better now…another post on the Blogcritics site – a young woman left with severe scarring that prevented the release of menstrual fluid, she had cramping, spotting, odour, pain – had a procedure (or two) to open the cervix and ended up with endometriosis – sex was difficult for her and her relationship fell apart…this young woman’s health, body and life have been damaged by over-treatment…and her problems are far from over…she will no doubt have issues if she wants to have children…yet these women get NO consideration at all.
    Papscreen and the Cancer Council etc mention the rare cases of cancer, but have nothing to say about these women….they don’t exist as far as they’re concerned.
    I just can’t understand how it can be fine to ignore informed consent when there is risk and especially serious risk, no matter how small that risk – and in this case, probably a greater risk than invasive cervical cancer.

  38. Sarah hill May 7, 2012 at 11:17 am #

    Niki

    Treatment was radical trachelectomy for stage 1 cervical cancer. I had no symptoms, abnormalities were discovered through the smear which resulted in a colposcopy leading to disgnosis. I do believe without the smear I may have went on to have symptoms, I then may have went to the dr but I am sure by which point I would have been passed the stage for fertility saving treatment. Yes I do believe the smear saved at the very least my fertility.

  39. Elizabeth (Aust) May 13, 2012 at 3:58 am #

    http://www.telegraph.co.uk/health/women_shealth/9231478/The-dangers-of-missing-a-smear-test.html
    I think this sort of article is a large part of the problem.
    What is the likelihood this young woman was destined to get actual cervical cancer?
    What is the likelihood she was over-treated?
    It annoys me that women get so much of this hype – scaring young women into pap testing (often over-screening) is irresponsible, IMO…these women are also then more likely to agree to over-treatment – often making decisions based on fear and misinformation.
    http://www.telegraph.co.uk/health/women_shealth/9231478/The-dangers-of-missing-a-smear-test.html
    Cancer charities and support groups are super sensitive to the facts – who are they trying to protect? Why is providing real information viewed as insensitive or irresponsible? These attitudes are IMO, not in the best interests of women. The damage this program causes is awful and now most of it is completely unnecessary with HPV primary triage testing. (for those who wish to test) BUT, there was never a need to harm so many, to help so few.

  40. Hannah November 26, 2012 at 9:56 am #

    Every time I go to the doctors about an ongoing health condition, I am harassed about cervical smear tests. Today the nurse said “you’ll be having the smear test won’t you” while she had a needle in my arm drawing blood! I was shocked to see on the screen that 2/3 of my notes are about my refusal to take part in smear testing, with only 1/3 about the actual health problem that is making my life unlivable. I have read all the literature, analysed the statistics, and come to the informed decision that I would rather live with a small risk of developing cancer than subject myself to invasive procedures every 3 years. How can I make a complaint about this continued harassment and have it recorded on my notes that I do not want testing so that I am not asked again? I have already complained to my doctors surgery because they send me smear test requests in the post without paying postage, so I have to pay RM fines just to get the letters in the first place.

  41. Elizabeth (Aust) December 13, 2012 at 3:12 am #

    I know this is an old thread, but just wanted to say it’s good news that Scotland will stop screening women under 25, (and Wales are also, likely to make the change) but unfortunate this long overdue change will not take effect until 2015. Sadly, Australian women are still being tested from 18 or 20 and every 2 years, and one recent study showed some doctors are even testing teenagers under the age of 17…horrible over-screening.

  42. Sabine January 4, 2013 at 12:53 am #

    OMG… I can believe what I am reading!!!
    I run a support group online for girls with CC which I started in may 2012. I have now 1700+ members now and the girls which ages differs between 21 till (I don’t even know) r going through the horror of treatment. Lots of our earlier stage girls got picked up by a smear (which is 5 seconds of having to take your pans of) but most of our later stage girls ended where they r because they didn’t see the importance of screening (my self included)
    I watch girls suffer daily from the effect if the cancer treatment and the stigma attached to CC and the serious long term effects of the radio and chemo therapy you receive for CC is far worse then u can ever imagine as the doctors/oncologist don’t emphasise how sever they can be (not that you have a choice)
    It hurts deep in my heart to read your misguided and goggled opinions.. And to the GP.. It is because one GP with opinions like u mine got to where it was….
    I came down to him some after time again with classic symptoms of cc but was told not to be silly and that I was to young for cc… Now I use I wheel chair mostly when I am out.. Live on a bowel of pills from morphine to muscle relaxers to bowel meds etc etc etc due to radio damage to my spine, pelvis, sacrum, nerves in legs, hips and back, lymph system.. I also got multiple areas of multiple fractures all over my pelvis (basically my pelvis is shattered) from the radio destroying the bone. I got colitis to my whole bowel due to radio and a twist on my vowel.. I currently have a kidney infection due to all the bladder damage AGAIN from radio.. I got damage to my hearing from the chemo and lost my sense if smell/taste.. I have serious short term memory problems and problems with concentration (just writing this is hard and I know I now sound like a child when I write)
    I live with a good 4-6 pain level on a normal day.. Every day!!!!!

    I try to get on with my life and take care of my husband and two little girls 2 and 4 years (my youngest was 4 months when I got really ill)
    I am disabled for life but all this could have been prevented if I had just been screened!!!!

    I am not alone.. My case is one of the milder ones… Remember I have 1700 girls in 8 months joining (this is a closed group where u have to be approved by admin to join)

    The girls looses their fight all the time and there is nothing I can do but to be there to support them with my team of admin… U u come on the group.. Meet those girls.. Look them in the eyes and say again that screening is not worth it!!!!
    I don’t know if to shout at u or to cry for u.. Because u could have it right and not know about it.. 3 years is to long.. It need to be every year when u r sexually active.

    Maybe if there was a little attention on cc instead of everything is bloody pink (no disrespect to breast cancer as my half sister is a breast cancer survivor)
    But all we ask is a little awareness as it us CC awareness month this month!
    CC survivor!

  43. Sabine January 4, 2013 at 2:45 am #

    A link was posted on our group and that was how I found u… There is a very long thread going right now in outrage over that your numbers and statistics r not even correct!
    Please stop using google and blogs to “educate” your self and hope u can take responsibility for your choices if u r gonna be one if the 500.000 women who get diagnosed with invasive CC every year.. Where 270.000 did because it didn’t get caught early enough!

  44. Margaret McCartney
    margaretmccartney January 4, 2013 at 11:37 pm #

    dear Sabine
    I’m sorry you’ve been ill. You describe having symptoms suggesting cervical cancer that weren’t promptly investigated. Screening is only for people without symptoms. If a woman has symptoms which may be from cervical cancer, in the absence of other explainations, a negative cervical screen wouldn’t be enough to reassure me -in general she needs referral for further investigations. Please look at the evidence on cervical screening and the risk of overtreatment it generates. Some women will want to have screening after having all the information, and that is their choice. Some women won’t. Each woman should be allowed to make an autonomous decision in conjunction with her healthcare professionals. In the UK this organisation is recommending properly informed choice for people considering screening tests, with which I very much agree. http://www.kingshealthpartners.org/info/informed-choice-about

  45. Teresa June 26, 2013 at 11:52 am #

    I’m horrified that men and women are approached in a different way when it comes to prostrate cancer screening on the one hand where they are expected to opt in rather than opt out and are given the facts objectively and breast and cervical cancer screening on the other hand where women are being obviously nudged by paid actresses appearing to look like the woman next door but also woman you want to admire. Men are more stubborn (can be a good thing though) and less likely to take advice from authorities so the nudging is aimed at women in the hope they would persuade their menfolk to have prostrate cancer screenings as well as attend cancer screenings themselves and tell all their female friends to do so. Men also consider cancer screenings to be a private issue so will not be urging their male friends so much. Search for Downing Street nudge unit and behaviourial change unit on the internet.

    Opting out of breast and cervical cancer screenings is a difficult process and not unlike changing utility companies at first but gets more complicated. Women do not get a letter back as proof they have opted out and sent the form back. A woman who opts out of cervical cancer screening gets a letter after five years. This is what I call harassment.

  46. Dora December 14, 2013 at 2:25 pm #

    Please don’t use this to promote the HPV vaccine. It is a poorly tested and highly dangerous vaccine that protects (if it actually works) against only 3 strains of HPV. The marketing campaign is disgusting. Most young girls believe that it is a universal protection against cancer. Others use it as an excuse not to use condoms.
    At no point are they, or we, told that 90% of all HPV infections resolve spontaneously after 2 years.
    The mainstream media in the UK and USA don’t even report on the girls left paralysed or dead after receiving the vaccine. Thankfully Japan have kept proper records of the serious side effects and are now banning the vaccine.

  47. Elizabeth (Aust) September 11, 2014 at 1:32 am #

    I just read an interesting post by an American woman who has declined pap tests, her insurance company has sent her a card offering her a $50 gift voucher if she has a pap test by a certain date. The wording is just astonishing.
    “According to our records you still need a cervical screening test”…and they try everything, you might have cc and not know it, do it for your family, be responsible…all the usual stuff.
    The timing of the card may be significant as well, according to the writer, it arrived just before school goes back and the gift voucher is from a department store that sells books, clothing, shoes etc.
    The manipulation and coercion of women to get them screened is just disgraceful, yet not many seem to care, many/some seem to think this is how a “non-screener” should be “managed”…hopefully, some of these women will challenge this unacceptable practice. What next? Throw in a free lunch with every mammogram!

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