[Trigger warning for medical coercion and abuse.]
Women, particularly in the U.S., have been conned into believing that pap smears are a necessary, frequent screening that they must endure, either so they can have access to oral contraceptives or so they feel “proactive” and “responsible” for their health. This is a bunch of rubbish.
I have gone through two pap smears, both before age 20, because guidelines at the time said it was necessary and I believed I was required to submit in order to get birth control pills. In my case, and surely the case of millions of other women, informed consent was absent when I made the decision to get cervical cancer screening.
I have compiled a great number of links so that every woman may educate herself about this procedure and the lies we are told so we will not resist having this done to us. Know that you are not alone in questioning this screening.
Dr. Joel Sherman argues that informed consent is missing from cervical cancer screening.
The facts are that cervical cancer is a rare disease in the US, a point which is never made. The American Cancer Society (ACS) predicts that there will be just over 11,000 cases in 2009. There will be nearly as many cases of testicular cancer, 8,400. In comparison both breast and prostate cancer are just under 200,000. Most women have been led to believe that cervical cancer is rampant and they need yearly screening to prevent it. Testicular cancer however, is rarely mentioned. Most physicians don’t even bother to recommend that young men self-examine. [. . .]
Informed consent on cervical cancer screening is completely lacking in this country. Women are told that they need Pap tests, but rarely told if they might not need them or asked if they want them. The ratio of negative biopsies and colposcopies to cases of cervical cancer is very high given the rarity of cervical cancer. If women are given brochures, they are for the sole purpose of convincing them to get regular testing.
From the comments section of the above article, many women share their experiences of being pressured into getting screening:
“No one can say the benefits far outweigh the risks FOR ME. It is unacceptable to suggest that others can make that call for me.”
“Almost all of my friends have had abnormal smears that all turned out to be clear….nothing to worry about at all. Of course, in the meanwhile, I had friends writing their Wills, in floods of tears, unable to sleep or eat, worried sick…this is unfair and very bad for your health.”
“I had a bad asthma attack recently and decided to see the family doctor first thing in the morning. I had the day off work. I barely sat down when the doctor said, “when was your last pap smear?…we can take care of it right now”…. I explained that I was more concerned about my asthma. The back and forth continued – all about smears. It was only when I got up to leave that the Dr finally moved on to my asthma. There was no giving up though….at the end of the consult it was mentioned again. I almost shouted, “I don’t feel well and don’t want a pap smear!” I felt the consult did not really deal with my asthma as that topic was rushed. I was spoken to like a stubborn child. [. . .] I feel pursued by doctors about smears…like a fugitive on the run.”
“I have felt pursued, insulted, over-whelmed, embarrassed and anxious as a result of the attitude of our doctors.”
Anna Sayburn writes in The Guardian in 2003, “Why I’ll never have another smear test”.
Last month, the British Medical Journal published research that suggests that I, and millions of other women, may have been wasting our time. In order to save one life from cervical cancer, the research found, 1,000 women would need to be screened for 35 years. [. . .]
So it comes down to the level of risk with which we are happy to live. And now that I know my likelihood of an abnormal smear is so much higher than ever having cervical cancer, I think I’ll take my chances until the test improves. What does [emeritus professor of surgery at University College London and cancer screening expert] Michael Baum think of my decision?
“You are not being irresponsible or reckless. You are making a serious, thoroughly well-informed choice and I would like to extend that choice to all women,” he says. I wonder how long it will take the rest of the medical profession to come round to his point of view.
From Reuters, “Women seeking birth control get unneeded pelvic exams”.
In a survey of 1,200 U.S. doctors and advanced practice nurses, researchers found that one-third said they always required women to have a pelvic exam before they would write a prescription for birth control pills.
An even higher percentage — 44 percent — said they “usually” required one, according to findings published in the journal Obstetrics & Gynecology.
The number of practitioners requiring a pelvic exam is disappointingly high, researchers say, considering the fact that the World Health Organization and the American College of Obstetricians and Gynecologists (ACOG) advise that birth control pills can safely be prescribed without the exam.
A study published this spring in Annals of Family Medicine found that 60% of men and 49% of women had gotten at least one false positive during three years of routine screenings for ovarian, prostate, lung and colorectal cancer. As a result, 22% of those women and 29% of those men had an invasive diagnostic procedure, the study found.
The educational intervention was designed to lower anxiety by providing information and diagrams to give both knowledge and a sense of perspective. “An abnormal smear test does not mean cancer. It is just a risk factor. Likewise, smoking does not mean you’ll get lung cancer. It just increases your risk of it.” [. . .]
Two hundred and forty women with mildly abnormal smears were randomised into two groups, one receiving the educational package, one not. On the plus side, those women who had the package were found to have more knowledge about mildly abnormal smears, and were glad of it. But, alas, they were no less anxious than the package- free women.
“We want women to give their informed consent to having a smear test, at the moment the system we have leads to a lot of women being worried unnecessarily by propaganda.”
One in three women under the age 25 will have an abnormal result compared with one in 14 for older women, meaning there would be many false positives.
On cervical cancer screening in Australia (article from 2004):
More than 95% of infections are thought to clear naturally within three years, but on average it takes at least five years for persistent infection to lead to cancer.
Financial Times (UK) Blog: “Health and Cervical Screening: Emotion vs Evidence”, on the UK’s guidelines of screening women above age 25.
The chances of any women benefiting from cervical smears between 20-24 are minimal, as a study in the BMJ shows: Effectiveness of cervical screening with age: population based case-control study of prospectively recorded data.
In fact, there has been no clear evidence for benefit up till now. Why is this important? Women in this age group are at risk of “false positives”, ie the smear detecting an abnormality when the cellular changes are not dangerous and would not have led to invasive cancer. They might receive treatments for these changes – but treatments they will not benefit from, because these changes would never have led to a life-threatening cancer.
“Cervical Cancer Screening: When to Begin?” (New Zealand, 2007).
A recent World Health Organisation guide on cervical cancer control recommends:
• new programmes should start screening women aged 30 years or more
• existing programmes should not include women less than 25 years of age
• a five-year screening interval is appropriate for women over 50 years
• a three-year interval is considered appropriate in the age group 25-49 years
• annual screening is not recommended at any age
• screening is not necessary for women over 65 years provided the last two previous smears were negative.
European guidelines recommend screening for cervical abnormalities “starting at the age of 30 and definitely not before the age of 20”.
“Smear test ‘no benefit’ in early 20s”, discusses results of an NHS (UK) study.
Here’s a very long, very informative (very triggering!) thread with women sharing experiences in which their wishes as patients were not taken seriously, particularly with regard to pap tests. Lots of discussion about informed consent.
Harvard Women’s Law Journal: “Pelvic exam prerequisite to hormonal contraceptives: Unjustified infringement on constitutional rights, governmental coercion, and bad public policy” by Heather S. Dixon (PDF)
The Guardian: Clare Allan, “Why I’m never going to have another smear test: For women with mental health problems, learning disabilities or a history of sexual abuse, smear tests can be especially traumatic. Why doesn’t the medical profession know this?” [Trigger warning for a stock image of 'woman at the gynecologist'. Damn I hate those.]
Fabulous thesis by Natalie Armstrong, “Cervical Screening: Women’s Resistance to the Official Discourse” (opens as PDF). It’s almost 300 pages, but completely useful. She brings in Foucaudian stuff about domination and control (biopower) through the medical establishment, regulation of women’s bodies, and lots more. It’s just awesome and totally validates my existing ideas about what these “preventative measures” and other procedures are actually doing to women.
More academic/theory articles about the medical surveillance of women will be included in part two.
[Update 1/4/11: The articles in this post and many others can be found at Violet-to-Blue, a site which has compiled and categorized tons of information on this topic.]