Cervical screening and the quest for informed consent
Cancer screening – a mini rant that turned into a big one.
I must declare an interest and a bias here. My father’s had prostate cancer (not found through screening, admittedly) and I had surgery to remove pre-cancerous cells on my cervix last year. My very first screening for cervical cancer found dangerous cells that, had I left them, could have meant I went the same way as Jade Goody.
Four days ago, Jo’s Cervical Cancer Trust released this press release,
side of the eye. Villa Mercedes Leading national charity calls for urgent action in approach to anniversary as ‘Jade Goody effect’ goes into reverse
Jo’s Cervical Cancer Trust is calling for urgent action in the approach to the anniversary of Jade Goody’s death as latest figures show the dramatic surge in numbers taking up a life-saving test she is said to have inspired has not been maintained.
Three years on Jo’s Cervical Cancer Trust says the so-called “Jade Goody effect”, when cervical screening rates rose for the first time in a decade, has all but disappeared.
Every three hours a woman in the UK is diagnosed with cervical cancer and every day it claims three lives – yet the disease is preventable. The UK’s NHS cervical screening programmes save around 5,000 lives every year but recent figures show one in five women overall fail to attend with figures worse for those under 35 with one in three not taking up their invitation.
So you can imagine my surprise when today I read in the Independent (after a tweet from @mgtmccartney, the writer of the piece, lead me to it) this article: http://www.independent.co.uk/life-style/health-and-families/features/why-im-saying-no-to-a-smear-7577967.html
“The NHS persists in sending me red-ink letters despite my written declaration to opt out. I’m made to feel a risk-taker in not having cervical screening – yet I’d also be taking my chances if I had it done.”
I agree with her points – the NHS shouldn’t be sending her letters if she’s decided to opt out. But really, a red ink letter? So what? To defend herself against my accusation of being irresponsible, she said
I don’t think it’s irresponsible to treat women as autonomous adults who can make evidence based choices. @Tannice_
— margaretmccartney (@mgtmccartney) March 20, 2012
I think this is over-stating things. We are autonomous beings – a letter penned in red ink can be easily shredded and forgotten about. It might annoy, but for some women, it could save their life. buy Lyrica from mexico No one is saying you have to have it.
“That potential for good has to be weighed against the risks of treatment. It’s known that having a cervical biopsy – which is done to get more information about the degree of abnormality – raises the risk of pre-term birth in later pregnancies. “
– this is also true. Women should be told the consequences of having a biopsy done and I’d NEVER argue against informed consent. Unfortunately the tweets that were sent out afterwards from the writer, including me, seemed to say that I was opposing women getting the info they need – that’s not true.
“I weighed up my personal risk factors for cervical screening (for example, smoking is a risk factor), threw in my own priorities – and decided not to have it.”
This is fine and dandy – for her. But smoking is not the only risk factor for cervical cancer. (From NHS website):
“Changes in the cells of the cervix are often caused by the Human Papilloma Virus (HPV), which also causes genital warts. There are more than 100 different types of HPV. Some types are high risk and some types are low risk. HPV-16 and HPV-18 are considered to be high risk for cervical cancer.”
Margaret McCartney goes on –
“Most information sent to us, as potential participants, doesn’t make clear that it’s a personal choice, and a balance of pros and cons.”
– Again, I absolutely agree that information should always be given, but that information should also be balanced with the risks of cervical cancer. I was given lots of information when after the results of my screening came back. In fact, the NHS website says your doctor will discuss this with you:
“If any changes are found, your GP will discuss with you whether to wait and see if the changes go away on their own or whether you need treatment […] In the UK, it is estimated that 8 out of 10 people are infected with HPV at some point during their lifetime. For most people, the virus goes away without treatment and does not cause any harm. […] If your results show abnormal cells, you will be sent for screening every six months to monitor the cells. You will only be given treatment if the cells do not go back to normal. If your results indicate more serious cell changes such as these you will have a colposcopy to investigate further. A colposcopy is a procedure where the surface of the lining of the cervix is closely examined.”
– none of these procedures cause any harm to the cervix. The colposcopy is simply an instrument to have a good look at the cervix. It’s true that a biopsy will sometimes be done during the colposcopy, but you’ll be told about this before it happens.
Many women don’t take up their invitation for cervical screening and I think the reasons they don’t are probably not because of their fears about the health impact. This article, from June 2011, says that up to a fifth of UK women don’t attend their cervical screening test at all.
“About 1,000 women die of cervical cancer in the UK annually.”
“But experts estimate screening saves at least 4,500 lives a year in England alone.”
“The research, released to mark Cervical Screening Awareness Week, appears to suggest that many of those who have missed or delayed appointments for cervical cancer screening are doing so because of inconvenience, embarrassment or worry about taking time off work.”
Encouraging people not to even go (after all, the initial screening test won’t lead to the harm that Margaret McCartney talks about) is, to my mind, irresponsible. There’s no harm in having the information available that might lead to your death. Margaret argues that we should be informed better – I agree and take this to its logical conclusion – we should be informed about the risks of NOT doing anything about the pre-cancerous cells that lurk in our lady parts. After all – if we don’t know they’re there, then we’re not informed at all!
Margaret McCartney provides no evidence that women aren’t being informed about the pros and cons of these procedures – she includes information about those who are given info on a separate test and refuse it – prostate cancer – which is another post entirely – in fact I could write a book about that (with help from my expert mother who strived to learn all she could about my Dad’s cancer and treatment). I was talked all the way through my procedure and gave my informed consent to what might mean I have a difficulty pregnancy or even pre-term birth. Obviously, my experience doesn’t speak for all patients, but there’s little evidence here that women aren’t being informed. But they can’t be informed if they don’t even go!
I agree 100% that information about the risks of a biopsy should be given, but a female doctor writing in a national paper about not even bothering to have the initial information about whether she’d even need further treatment seems to me, irresponsible.
Her very profession puts her in a position of authority – perhaps meaning that women will take her advice as read and not even look into it – it’s a sad fact that people often don’t read a whole article, especially if they’re on their way somewhere or get bored half way through (not a comment on the piece – it’s very well written!). Without seeing the nuance (which there is in the piece) the message is – doctor says not to bother.
As one of the commenters on the article says:
As a doctor you are in a very informed position and can make such decisions with more accuracy, to glibly put that responsibility on people without your training is perhaps optimistic.
It’s yet another excuse for someone who’s frightened, embarrassed or just too busy to have a smear not to bother at all. Now who’s uninformed?
I couldn’t agree with you more. I had a lletz procedure when a run of the mill smear came back with stage 1 cancer cells. I had no symptoms and didn’t smoke either. Now had I sat back and took the message of the article which was ‘don’t bother with screenings’ I could have been stage 2 or 3 before symptoms appeared. My outlook would have been very different.
I am in complete agreement, I think there’s a lot of women out there embarrassed about getting smears and mammograms who don’t want to get them. Some of whom have symptoms and who will be very pleased to see a doctor telling them
‘not to worry about screenings’.
I think it’s a worrying message, dr McCartney being a medical professional may know all the things to look out for in her own health but those without medical training putting off a smear who may have symptoms they aren’t equating with cervical cancer can see this as a message not to bother.
Really irresponsible: by all means everyone can opt out if they want, but opt out with knowledge not from relief.
Dp
X
Dawn, there is no such thing as “Stage 1 cancer cells”. You will have had CIN 1, the very first identifiable “abnormal cell” stage.
Only 1% of CIN 1 ever progress to cancer.
You had an invasive and damaging operation (LLETZ), whereby a large chunk of the muscle that enables you to carry a pregnancy, was cut out.
I really wish more girls were informed. The way you write, it is clear that you actually thought you had cancer when you did not.
Margaret is spot on. Without screening 15 per 100,000 women would die of cervical cancer. With screening 10 per 100,000 women will still die of cervical cancer.
You can do the math here, if you can bring yourself to think logically.
IR
Regretfully Informed Reader you don’t have the first clue of what you’re talking about and your ignorance is not only annoying but insulting and hurtful to those that have had to deal with the subject matter and don’t you dare presume to correct someone on a matter like this. I’ve been through this with a partner and it’s something that you learn about inside and out while you wait for your appointment and I don’t take kindly to know it alls like you correcting or skewing details to prove a point. Why don’t you consider the lives of those around you and see whether your arrogance would be comfort with them gone due to nothing more than rhetoric and a lack of screening.
I take issue with the number of women forced and bullied into having pap smears. Women who were NEVER told thet cervical cancer was rare, NEVER told that the pap smear is less than 50% reliable, NEVER told that they have a right to say no if they believe that is in their best interests.
Tens of thousands of women have had scripts for the birth control pill denied because they decline a pap smear. I’ve read and heard stories from so many women who have been refused medical treatment because they are not ‘up to date with their pap smear’.
A huge part of the reason of why I fight against pap smears is because of the way women are treated by other women and the medical community. They are NOT given the facts, they are belittled, told their stupid, reckless, uneducated and crazy when they say ‘no’ to a pap smear.
A ppa smear is a personal choice, yet it is never treated that way.
Phoenix, are you talking about the UK here? I’m guessing not, because of you using terms like Pap and birth control instead of smear and contraception..?
I can’t believe for a second that women in the UK are refused birth control or medical treatment because they decide not to have treatment. Plus I’d really like to see evidence that women are not informed enough in the UK about this. So far I have seen none. I can’t speak for the US or Australia.
This may not get seen, but I would just like to say. I am currently on birth control (but very low risk for cervical cancer as I do not have the HPV virus – don’t want to go into too much detail)
But my doctor (I live in the UK) is now refusing to give me contraception because I don’t want to have a smear test.
So it DOES happen in the UK.
I was told “you HAVE to have a smear test” by a female doctor who should probably know better.
Now, after doing some research, I realise that having a smear test is not compulsory. And I am angry that my GP is try to coerce me into doing it by refusing to supply me with contraception that I don’t use for birth control but actually use for symptoms of PCOS.
We are not being given all the information.
Hi Laura, I have not seen this comment until just now but I have to say I am appalled that you are being denied contraception because you won’t have a smear test. However I am astounded they don’t seem to have given you a reason for that and I assume there must be one.
“Informed Reader” – too shy to leave at least a first name?
What you say is a little bit of a misrepresentation. Dawn may have had CIN 1 and her terminology is wrong – CIN 1 is not cancer. That’s true. But the majority of CIN 1 cases aren’t treated – just monitored.
Even Macmillan Cancer Care are confident enough to say that the majority of CIN 1 cases go away by themselves.
I also had a LLETZ treatment. Yes, this affects my risk of late-term miscarriage. I’m fully aware of that and it scares the hell out of me. I’m not happy about it. But there’s a chance that I wouldn’t have even been around to even try for a baby had I left this alone.
I would NEVER say that information shouldn’t abound in health – the more information the better. But I can see a fundamental error in reasoning – there should be better information but you shouldn’t have a smear test – thereby not having the information to act on or not? Makes absolutely no sense whatsoever.
There is little harm in a smear test or a colposcopy – the more information you have to hand about your body the better – once you know you have CIN 1 or 2/3 then at least you know that you have them and can weigh up the risks of having a LLETZ or whatever treatment is recommended.
If you’ve already had children then obviously there’s less of a risk to having such a procedure.
When I first started working in Public Health, I was a bit conflicted about the the fact that there are cancer screening uptake targets, because I sort of wondered about the potential conflict between patient choice, informed consent, and effectively mandating an uptake level. It doesn’t quite fit together, and in some ways it’s a square I’ve never really rounded.
Also, I’m conflicted about the Independent piece. I get that Margaret doesn’t have screening, and has her own reasons for that. I tend to think that the National Screening Committee has reviewed the evidence likely in a lot more detail than Margaret, and determined that screening is in the best interests of the majority, and I wonder whether Margaret is undermining the process of helping people to access something that is ultimately in their best interests. But, at the same time, she is informed and knowledgable, and perhaps it’s not inappropriate for her to feed her own views into the mix. But her decision is based on her perception of her personal risk, and I wonder quite what the penetrance of the message is, and how equipped people are to asses their own risk in a similar way.
If Margaret had written that she ways up the benefits and risks and has decided that smoking is worth the risk for her, and she continues to have a 40-a-day habit, I think objections would obviously be appropriate. Conversely, if she admitted to weighing up the risks and deciding that it’s more beneficial for her to eat an overall balanced diet than specifically counting five-a-day. I doubt we’d object. But both approaches contravene public health messages, and neither is directly comparable to declining screening.
Basically, I’m don’t really have any straightforward solutions or crystal clear opinions on Margaret’s column… It still seems grey in my mind. I’d encourage my patients to go for screening, and I myself would go for screening (though possibly not cervical screening, given my lack of a cervix). I think screening is in the best interests of most patients. But is someone saying they’ve weighed the options and come to a different conclusion in their personal circumstances a bad thing? I guess it depends on both how and how much that influences others. I think it’s tricky.
Informedreader you’re not so informed I am well aware the differences between CIN 1/2/3 I did not have CIN 1 I had what they thought was CIN 3 and came back in biopsy as 1a1 cancer. Now whilst i don’t have to explain this to you I felt that your message was silly enough that it merited it.
Lletz wouldn’t have been done for CIN 1 mainly as the abnormal changes go away themselves.
Please do not misrepresent my comments for your own ends thanks.
Dawn, I’m so sorry to hear this. Sounds like you’ve been through a lot and I’m so glad this was picked up before it became dangerous!
It’s like you said Tannice I’m still here and im grateful for that. A lot of my family are nurses, I myself am a Dr (not the medical kind) but I did my research and I knew the risks. I know that there are complicating factors for pregnancy but I’ll worry about that as and when I need to. That’s if I can still think logically…lol
@Dave – Sorry, exactly what part of my post are you taking issue with? Your little flame attack is nothing more than that, a childish attack.
@Tannice – Would adding my name make any difference to the clarity or credibility of my post? If it makes you feel better, my name is Janet.
My point is that the evidence should be given to women, such that they can make a truly informed decision. There is plenty of scope for error, and resulting damage from unnecessary treatment (or missed cancer cases) with cervical screening. The sensitivity and specificity of the test (whilst improved with LBC) still aren’t great.
I would also like to point out an error in my post. The rates quoted are in fact incidence of cervical cancer, and not mortality rates.
@Dawn – I apologise as it would seem that I jumped to an incorrect conclusion. Sadly this is the result of many of my friends and colleagues talking about their “cancer cells”, which when I’ve probed further turn out to be simply abnormal cells, and the fact that cancer isn’t staged by the cells, but rather by the invasion and spread of the disease. I’m pleased that in your case it was caught early, and I hope you make a full recovery.
Your last line shows how our thinking has been skewed…we don’t need an excuse not to have a screening test, they are always elective. Like Dr McCartney I also decided to decline screening almost 30 years ago…as a low risk woman it was an easy decision…my risk from cc is near zero, the risks were too high for me. Women are just expected to attend and with no real information and a lot of it is misleading – it is impossible to make an informed decision without doing your own research. The facts will surprise most women…not one country has shown a benefit pap testing women under 30, but all have evidence of harm. Young women produce the most false positives. (Cervical cancer screening by Associate Professor Margaret Davy and Dr Shorne in Australian Doctor, 2006)
Lifetime risk of referral here after an “abnormal” pap test – a whopping 77%… lifetime risk of cc – 0.65%….take out false negatives and consider natural decline and pap tests help fewer than 0.45%..there was never a need to harm so many, but now there is no excuse, we should follow the Dutch and only offer pap testing to HPV positive women from age 30…we can now identify the 5% who have a small chance of benefiting from pap testing..this testing would save more lives and we’d better protect the more than 99% who can never benefit from any testing. I’m relieved a few doctors have decided to speak frankly about this testing. The lack of real information means women can’t assess their risk profiles, consider actual benefit and risk, avoid excess testing and make the best decision about over-treatment. If you can’t be honest with women, there is something very wrong. IMO, this program has been unethical from the start and operates outside the law. You see the respectful way men were treated with prostate screening, real information was released and doctors were reminded to get informed consent, yet women are still waiting for this respectful treatment. Our doctors should be ashamed of themselves, they are knowingly over-screening and seriously over-treating, basically harming women and receiving target payments for their trouble. The Delphi Screener also enables women to test themselves for HPV…women should demand smarter testing.
Now, screening authorities in America are recommending against PSA screening for men because the risks of screening are not worth the benefit. as I recall, this is a common cancer affecting 200,000 new patients a year and killing well over 30,000. Cervical cancer effects, what, 12,000 new patients a year and kills 4500? if we take into account this is with a 70% decrease, the numbers still don’t reach the height of prostate cancer. Yet men are given a choice, they are respected, and their choices aren’t ridiculed and called “dangerous”.
How DARE anyone tell a woman she must screen or she’s misinformed and deserves cancer (not that I’ve seen that on this board but believe me, its out there). Cancer screening is a choice. It is a choice because there are risks. The demanding that women MUST screen is misogyny. Dr. McCartney has every right to explain her reasons for not screening and woman are responsible for making their own decisions. How dare people come onto this board and accuse her of persuading women not to screen – as though women aren’t intelligent enough to make their own choices! Clearly prostate cancer is a very real threat to men yet no one is demanding men screen. How can you NOT see the difference in approach?
I will NOT subject my healthy body to such an imperfect test – I have read and researched and come to the conclusion that the risks of screening do not persuade me to participate. And don’t for one minute think any one of you can come on here and say “you would rather get cancer than deal with treatment of pre-cancer?” It is none of your GD business as to why I feel the treatment isn’t worth the risk. That is my decision to make. Not yours. If you want to go through it it, power on. I’m not condemning you and I respect your decision. I expect the same in return.
Not to mention, I have never once read that the drop in cervical cancer might be attributed to the high number of hysterectomies in my country (1 in 3 women over 40). Its all put to screening. over 4 million women a year are processed with abnormal paps yet 99% of these women would never get cancer – being a numbers person (college degree and working professional by the way), these numbers are NOT good to me and do NOT satisfy me that screening will protect me from unnecessary harm. That is my choice. STay out of my vagina.
Hi EJ, I’m a bit confused by your ire.
Where are you getting your figure of 99% of women who would never get cancer? I’d be interested in the methodology and ethics of determining those women who have been told they are at risk yet never develop cervical cancer. Please can you give a reference (being that you self-define as a working professional with a college degree)?
I understand not wanting to have the test and that is, of course, your choice. No one is saying that you have to go for screening. That’s really not my point. The point is I really don’t see that discouraging women is helpful, either. Discouraging women is no different to encouraging women: women should have access to the facts and the facts alone. The efficacy of any medical procedure is a delicate balance and cervical cancer screening is no different.
Having no information on the health of your cervix is not “informed” any more than being told to have the screening tests without being aware of the risks. I went for a check up recently and put the questions of Dr. McCartney to my specialist. She told me that I had had very clear carcinoma in situ and that if that had not been removed then the likelihood of it becoming full-blown cancer was so high that surgery – a LLETZ procedure – was the best course of action. Obviously this is an issue that is very important to me and so therefore perhaps I don’t have the best judgement. I am yet to read Dr. McCartney’s book on the subject, but I will. I’ll update my post if I change my mind, but for now I stand by what I wrote.
Please also note that this website is based in the UK so I am basing my post on stats, facts and procedures here, not in the US. You will also note that I have not commented specifically on the PSA screening test for prostate cancer: I am well aware of the problems with that screening and it is not currently available in the UK. My father was diagnosed from symptoms: not screening, as I did mention.
Thank you for your comments
Tannice
Agree 100% with freedom of choice and think all medical decisions should be well informed. I am lucky in the all stages of my diagnosis and treatment I was well informed of the risk and benifit of each choice of treatment. I was diagnosed with stage 1b1 cervical cancer a year ago aged 28. Quite a shock as I was a non smoker. My friend had been diagnosed with stage 3 CC just a few years before so I knew the treatment was as hystorectomy. Only three weeks into married life this was a devistating blow but I was very fortunate in that I was offered fertility saving treatment of a repeat LLETZ (first didn’t have clear margins) and laparoscopic lymph node removal. I am a year on and 9 weeks pregnant. I am a high risk pregnancy because iv had two LLETZ, if I had only had one I would not be classed high risk. From my extensive research I understand biopsy gives no additional risk unless you are pregnant at the time. I am so thankful for the smear system and the fact that advances have saved my fertility.
Elizabeth the policy, process and whole system for smears and treatment is so different in the UK from Australia it would be unfair to compare the two. Giving figures that are true in Austalia aren’t here do you are misleading people on UK sites.
‘I think this is over-stating things. We are autonomous beings – a letter penned in red ink can be easily shredded and forgotten about. It might annoy, but for some women, it could save their life. No one is saying you have to have it.’
I strongly disagree. One of the main arguments against smears is that women are being told from all sides that they do ‘have’ to have it and some women don’t even know that they can opt out! Women are even being refused the pill for it – yet you trivialize a woman’s choice to refuse and being harassed about this choice is a mere ‘annoyance’.
You say it is merely ‘annoying’ to be harassed to open your legs for a stranger -for some that is frightening, oppressive and humiliating. I doubt if anyone has ever considered that some women have been sexually abused or raped in the past and therefore don’t want an invasive procedure such as this? And why exactly should we be harassing those women with letters or forcing them to go? Why should they fear going to the GP for anything without this getting brought up? Why should those women who have overcome their abuse and chosen to have sex in a loving relationship and who want to go on the pill be forced into smears? I am not saying that this is the reasoning behind every woman who refuses – but has anyone actually ever considered this at all?
There is also a great deal of misogyny that goes on regarding smears, which you seem to ignore – women who refuse smears are treated like irresponsible children, we get harassed and refused treatment, we are told we are liars, that we are not really in monogamous relationships or that our partners *might* cheat on us and so we should be tested anyway. I have seen far too much of this attitude, mostly coming out of the mouths of men. Why can’t I make a responsible decision of my own? Why can I not be the one to judge me own partner and whether he will cheat? Are all women such poor judges of characters that we don’t know the men we are committed, and in many cases married to? Saying all women cannot ever make the correct judgement merely pushes us below men yet again, as though we are inferior. I’m too immature and irresponsible is what they say. Women have always been told that we are too stupid to make our own decisions; we had to fight for the vote, we had to fight to be allowed to work, and I’ll be damned if I will now lay down and spread my legs.
Hi Jane, I can’t say that I can comment on all of this since I have not experienced what you clearly have. I can’t imagine my doctor being so authoritarian and so I have written from my own experience. As for the misogyny you say there is surrounding being treated like a child – again, I have never heard of any of this and such underhand scare tactics are not something I support. However, I don’t think smear tests are being used to subjugate women – the smear test potentally saved my life as I had CIN 2. I fear conspiracies surrounding health as I think they are destructive (i.e. anti-vaccination).
Very sad to hear of your experience, it is awful to be refused the pill just because you won’t have a smear. Woman should be given enough respect that they can make an informed choice. Have saw it from the other side though where these reminders (and a number have been needed) have lead to friends eventually going for smears.
By way of information being in a monogamous relationship does not prevent you from getting HPV. HPV can be caught from any sexual contact such as oral sex or for play so even if you and your partner have only had sex with each other but have had any sort of sexual contact with someone else at any stage in there/your life then you are still at risk of HPV and cervical cancer as it can take up to 30 years to have any effect. Shocked drs would suggest partners would cheat, shocking to cast such accusations.
I got cervical cancer aged 28, in a monogamous relationship, having only 1 sexual partner other than my husband, non smoker and otherwise a healthy person. I am delighted to say due to early detection I gave birth to a beautiful baby girl 4 weeks ago at full term. I have extensive treatment to my cervix and lymph nodes removed yet it had no effect on my pregnancy.
Thanks for your story Michelle. Much love to you and your little girl!
I’m scared stiff….. At the age of twenty I had a suspect smear result but it cleared over the next few years this pattern was to repeat itself and recently ( I am now 60) I have recalled for another repeat test as my last one eight months ago was again suspect. I had had three reminders the last one ‘urging ‘ me to go. So this afternoon I am reluctantly attending the surgery. Well having had breast cancer twice I understand what can happen so why have I delayed? The truth of the matter is I feel so ashamed and looked down upon. Two years ago a small piece of paper fell out of my hospital notes as the nurse picked them up I read the note and kept it. I was so embarrassed to read that thirty years ago my then doctor had written to the hospital as I had had several partners and was high risk. Up to that point I had had three partners including my first and second husband. I was be bought up quite prudish so to have this said about me brought about a feeling of such embarrassment and humiliation that the idea that it is all my fault ( even the literature sent out with appointment suggests that woman are to blame as many partners can result in the virus) has made me very hesitant. The facts of my life are that at the age of four I was raped in a children’s home at the age of five I was taken to a vd clinic by my adopted mother. I am not and will not play the victim but I know the result of that encounter has left me with herpes something I only found out when it erupted while on chemo. I know I did not get it with my long term partners (this I have checked ou) I have been married second time for over twenty five years. But this information about my herpes was sent out on a general letter to a consultant who was seeing me for a knee problem. There was a potted medical history attached to all letters sent to hospital. I caught a nursing assistant reading this letter. Talk again about humiliation. I have taken steps for my notes only now to be accessed by the doctor and have had the potted history taken of general letters.
So combined with the possibility that I am a likely candidate for cervical cancer and I have herpes makes me look as if I have had a sexually colourful life. And it has been just the opposite. So I beg people to stop putting the blame of such a condition on women. It has such a
Negative effect. My betting is that many women don’t attend for the smear test because blame is heaped upon us if we are infected
Sent from my iPad
I know this is an old thread but thought I’d comment. I don’t agree with your blog – Dr McCartney is not discouraging women from attending – all she said was that women should receive ALL the information regarding all the potential positive & negative outcomes of screening and treatment. You say you haven’t seen evidence to suggest women aren’t informed but how many women are aware of the results of the Bristol University study, or the work of Archie Cochrane & Angela Raffle? The terminology used in women’s screening programmes are “you should” – this is not the approach undertaken with regards to men in countries with prostate screening. They are given charts & offered discussions on the “pros and cons”. The stats others mention are in relation to Australia & the US. In the US, 99% of women receive abnormal results at some point (because of annual testing), in Australia (bimanual testing) it’s 77% and here it’s 65% – all this with an average risk of under 1% of developing cervical cancer. The disparities reflect the higher frequency of using this testing technique not its methodology per se. For me, it puts the methodology of the test in perspective, for I find it highly unlikely that those 65-99% of women would have gone on to develop cc without intervention of the smear test, these are the sorts of figures women should be seeing.