Many women are uncovering the facts regarding pelvic exams and are discovering that cervical cancer is rare, that a pap smear is an unreliable testing method, and that they face a very real risk of harm from followup procedures. Some women understand that all cancer screening is optional and are saying “No” to pelvic exams and pap smears, but some Doctors are not respecting informed decisions. What follows are excerpts written by women who have said “No” to cervical cancer screening:
Sarah, from Australia: A few days ago I’ve got this severe pain in my chest, I felt it somewhere deep and it wouldn’t let me move or breath normally. I waited for a couple of days – no improvement. Knowing that many people in my family died of heart attacks, I convinced myself to be a “responsible person, proactive about own health” and went to the medical center I was such an infrequent visitor of. That’s where the “fun” began. Here is the script.
Doctor: Hello Sarah, take a seat. What’s happened?
Me: Hi. I’ve got this chest pain and it wouldn’t let me sleep, move or breath properly.
Doctor: Ok, let’s have a look what’s in your records.
Me: I have a kind of family history…
Doctor: When was your pap last smear?
Doctor: There’s no info about your pap smears in your records.
Me: That’s about right. I’ve never provided such info.
Doctor: Why not?
Me: Because the only outcome would be that I’ll be told to have the next one.
Doctor: Are you saying you aren’t doing pap smears at all?
Me: Sorry, I came here today because…
Doctor: Don’t you know that pap smears are the most important tool for preventing cervical cancer?
Me: I heard that, but today I’d like to do something about my chest pain…
Doctor: I’m talking about cancer here; it is a very serious thing!
Me: Yep. *Cervical* carver, which I maybe possibly have a tiny-puny risk of, or maybe no risk at all!
Doctor: Have you been vaccinated against cervical cancer?
Me: No I’m not vaccinated against *HPV*? They said I’m too old for that when the vaccine was rolled out.
Doctor: Then why you think you have such a small risk?
Me: Usually I don’t discuss my private life, but to finish with this question – I’m a long-term absolutely monogamous relationship with a man who has never been in short-term relationships. And I tested HPV-negative before meeting this man.
Doctor: So what?
Me: Don’t 97% of women and 100% of men clear the virus within 2 years and become immune to it?
Doctor: The virus may not be cleared, it may just lie dormant for ages and then activate and cause cancer.
Me: If our bodies did not develop immunity against HPV, the vaccines wouldn’t work.
Doctor: It’s more complicated than that!
Me: Could you please explain then?
Doctor: It’s complicated, you won’t understand.
Me: How do you know I won’t understand?
Doctor: It will take too long and we’ll waste your consult time for an irrelevant lecture. And we’ll make the other patients wait!
Me: Well, so far you’ve been happy to waste my consult and the other patients’ time on talking about irrelevant pap smears.
Doctor: You should watch your language! Cancer prevention is not a waste of time! It’s important!!
Me: Today, for me, my current pain is important, not a chase after a rare cancer that I have 99% chance of never getting in my whole life. And since you told me to watch your language, I will tell you that I know about unreliability of pap smears, about the misinformation around this screening, about incentive payments doctors get, about reaching screening targets and I know the real statistics of this cancer. And that’s why I don’t want to discuss pap smears anymore.
Doctor: In thins case you can’t be a patient in this centre. We are committed to providing high quality comprehensive heath care. And if you resist that, we can’t help you here.
Me: Fine. In this case I want all my info to be deleted from your system, because I don’t want to a patient here anymore, and I’m not coming back ever again. Thanks for bloody nothing, you greatly helped with my chest pain.
Slam the door.
F%cking conventional medicine with its ” high quality comprehensive heath care”! http://blogcritics.org/culture/article/unnecessary-pap-smears/comments-page-174/#comments
Here is another woman’s story:
Sia: I’ve just had an unbelievable experience at the doctors today, I went in to see a random doc for a medical certificate, and he asked me when my last pap smear was, I said that I’d declined to participate in that programme, I actually really wasn’t in the mood for a debate, anyway he actually told me I was a “silly girl”, and asked “why not?”… So I told him. That should have been the end of the discussion, but he felt it was his duty to lay on the usual cc is in decline because of screening, precancerous cells are detected a lot, and save lives yadda yadda.. So I counter argued him, you all know the arguments.. Well, he started to raise is voice and talk over me, by this stage I’d figured out it was time to get the hell out of there, he wasn’t listening to me, so I said “I’m going now”. He then had the nerve to say, “No I haven’t finished talking to you yet”!! I got up and left, and got the forms to make a formal complaint with the practice manager on my way out. http://blogcritics.org/culture/article/unnecessary-pap-smears/comments-page-173/#comments
Not all Doctors would react this way. Here is one female Doctor’s views on pressuring women into pelvic exams and pap smears:
I do think it’s bad practice to cajole and occasionally frighten women into smear tests . . .
Currently, women are encouraged to have a smear. GPs are incentivised to do so. This means that when a woman comes in with a symptom that needs sorted, there is a detraction from the woman’s agenda. This presents a conflict. I can’t quote research because it, shamefully, hasn’t been done – but there are women who do not wish to have a smear and who are asked, time and again, why they are not ‘complying’ with the medical screening targets. This can cause distress and can even prevent women from coming to see the doctor about symptoms. Many doctors have seen this pattern.
I don’t expect people in general to realize this, but it cannot be ignored. There are many discussion forums on the internet where women discuss the issues they have faced when they have wished to decline a smear. Women have felt humiliated, bullied, harried. It’s not fair and it’s not right.
To me the problem is that we advertise smears as the usual. We don’t individually consent and explain screening in the same way as we would other interventions – like a prescription or an operation. We do not recognize that it is a completely valid choice not to have screening. Doctors cannot and should not force their own value judgements onto anyone else – either to have or not to have a cervical screening.
I’m happy to explain my rationale because I am concerned that a great many women are being directed into cervical screening without knowing that it’s a choice and without giving fully informed consent. I want to see better discussions of the pros and cons. This isn’t recognized well – here’s a response to some research on the uptake of cervical screening written by myself and Professor Susan Bewley. It didn’t occur to these researchers that some women may have wanted not to be screened.