For years women have been presented with only one side of the story when it comes to pap tests to screen for cervical cancer. The ways in which pap tests are presented have led many women to believe that they are harmless, necessary, and life saving. This type of messaging has been so well promoted that women usually don’t think to ask any questions when it comes to pap tests. Unfortunately there is another side to the story that reveals there is significant potential for harm as a result of pap testing. Increased access to information, recommendations to increase the age to begin pap smears, recommendations to lengthen the interval between pap smears, and the discovery of alternative and better methods to screen for cervical cancer have recently encouraged women to start asking questions. As a result, women are uncovering the facts and the potential for harm that can result from screening. In other words, some women are discovering that there are many good reasons that support the choice to opt out of Pap tests. Here are the top five:
1. The harms of pap tests exceed the potential benefits by a significant margin. Despite intensive screening in countries such as the United States, there is no corresponding reduction in mortality from the disease in comparison to countries that screen far less often (Habbema, Inge, & Brown, 2012). However, there is evidence of morbidity caused by pap testing (McCormick, 1989). According to Raffle, et al. (1995), in a study of women after a screening round in Bristol, England: “over 15,000 healthy women are being incorrectly told that they are ‘at risk'; over 5,500 women are being investigated, with many also treated, for a disease that would never have troubled them, and are being left with problems that include lasting worries about cancer, difficulties in obtaining life insurance, and worries concerning the effect of their treatment on their subsequent reproductive ability” (p. 1472).
2. Pap testing programs are not based on scientific evidence that validates their effectiveness. No randomized controlled trials have ever been done to substantiate the oft repeated refrain that pap testing can save lives. Pap test propaganda rarely reveals the facts; such as the fact that in developed countries cervical cancer is a rare type of cancer. Unfortunately, the people in control of research funding are often the same people who benefit from the substantial business that pap testing generates, and therefore it is unlikely there will ever be studies done that could shed light on the facts: “If somebody suggested in 2003 we [should] introduce cervical cytology, no randomized trial would ever show it was worthwhile” admits Dr. Anne Szarewski, clinical consultant for Cancer Research UK.
3. Pap tests increase a woman’s risk of exposure to HPV infection. Research reveals that vaginal specula can harbor HPV16. HPV16 is a type of HPV that is associated with most premalignant and malignant disease of the cervix. In one study, 29 specula after use on different women were examined post-cleaning. In four cases, HPV16 DNA was detected. The authors of the study concluded that “HPV infected cells can be found on instruments inserted into the vagina of women with HPV infection, and if these instruments are not cleaned and sterilized properly they will be a potential source of infection for subsequent patients” (McCance, Campion, Baram, & Singer, 1986, p. 817). In addition, HPV DNA has been found on surgical gloves, biopsy forceps, and cryoprobe tips. Biopsy forceps and cryoprobe tips can harbor HPV even after sterilization (Watson, 2005).
4. Pap testing exposes women to risk of psychological harm. There is a great deal of anecdotal evidence that reveals the extent of the psychological harm caused by pap tests. Women’s comments reveal many different aspects of the psychological damage, such as this one by FerretGirl01 on Psychological Harms of Pelvic Exams: I have a terrible fear of the OB/GYN mainly because my very first pelvic exam was so traumatic. I was a virgin and it hurt so much that I cried. And even after I told the doctor to stop, she kept trying to collect the sample after telling me she would stop any time. I felt violated…scared…and I hurt so bad I had to take pain relievers. I was bleeding when I got home and discovered my “cherry” had been popped because the doctor was too rough and rushed with the exam. That made me terrified of ever getting one again . . via Fear of Gynecological Exam – Women’s Health – MedHelp. The psychological harm can include trauma, fear, dehumanization, loss of control, invalidation, distrust, and despair. Pap tests can have a significantly negative impact on women’s lives, and yet this issue remains largely unaddressed and/or unacknowledged by the medical community.
5. For women who wish to screen for cervical cancer, the HPV test is more accurate. Research is revealing that HPV testing is able to detect cellular changes at an earlier stage, thus allowing women who wish to screen to go for much longer intervals between tests. In addition, self-testing is possible with HPV testing.
Habbema, D., Inge, M., & Brown, M. (2012). Cervical cancer screening in the United States and the Netherlands: A tale of two countries. The Milbank Quarterly, 90(1).
McCance, D. J., Campion, M. J., Baram, A., & Singer, A. (1986). Risk of transmission of human papillomavirus by vaginal specula. The Lancet, Oct. 4.
McCormick, J. S. (1989). Cervical smears: A questionable practice? The Lancet, July 22.
Raffle, A., Alden, B., MacKenzie, E. (1995). Detection rates for abnormal cervical smears: What are we screening for? The Lancet.
Watson, R. (2005). Human papillomavirus: Confronting the epidemic – a urologist’s perspective. Reviews in Urology, 7(3).