With so much pressure to have a pap test to screen for cervical cancer you would assume it was a very common type of cancer. Well, that assumption would be wrong. After much digging in search of the facts, I found the raw data that outlines a simple truth:
Cervical cancer is a rare cancer. Here is what Stats Canada (2008) has to say about it – but be careful about the math – incidence of cervical cancer is given by two and five year incident rates per 100,000 women: http://www.statcan.gc.ca/pub/82-003-x/2012001/article/11616/tbl/tbla-eng.htm
I am not a mathematician but my calculations to convert into a percentage for incidence of cervical cancer works out to an incident rate of .0073%.
What is going on?
forwomenseyesonly 
I think that cervical cancer is more prevalanent than that. Most, if not all cases of cervical cancer are caused by the HPV virus, wich 83% of the population is a carrier. My mother had cervical cancer, and I have had three scares now. It is not hereditary, as it is caused by a virus. And the worse thing is, the men that carry the virus are not symptomatic. They may not even know they have it and are spreading it.
My statistics are from Stats Canada, the holy grail of statistics as the numbers are tallied and given the stamp of approval by the Canadian government. I am not surprised you think cervical cancer is more prevalent. We are given information that is misrepresented by those who have a vested interest in women’s health “care”. I had a difficult time finding the raw data.
I am sorry to hear about your mother and your own three scares. The rate of false positives is high. As well, I have heard of women who have their cervix and uterus removed, and after having a second opinion and biopsies done, discover there was no cancer in the first place. One woman sued and was successful at winning her case. There are many sites on the subject of misdiagnosis of cervical and uterine cancer. I am including one here: http://cervicaldysplasia.healthrisks.biz/unnecessary-hysterectomies-and-complications/
The stats I am looking at are from the American CDC
We do not have readily available health care like Canada so maybe that plays in to the statistics
here.
A woman (Elizabeth) from another blog site wrote this comment which I liked so much I am sharing it on this blog:
“. . . More and more women here are beginning to wind back pap tests or have given them away completely, often after a bad experience – more women are working out the test is very unreliable with so many women enduring unnecessary invasive procedures. Some women avoid doctors, hospitals and want to give birth at home . . .
I’m not surprised some women avoid doctors, hospitals and want to give birth at home. Women’s health care was based on IMO, paternalism and abuse – women were viewed as easy targets. The profession was dominated by men, the untouchables…complaints got nowhere…and some doctors took advantage …it was easy and even encouraged with no informed consent, screening targets and pap testing linked to the Pill. If a woman went to the doctor for a headache and was aggressively pushed into a pap test and breast exam a complaint was likely to be met with the woman being scolded, “well, the doctor shouldn’t have to pressure you, it’s for your own good” and you’d also get that from other women.
With this sort of history it’s not surprising that standards are poor in women’s healthcare. Consider the fact we continue to screen young women for cc and have a senior doctor stating publicly that the program shouldn’t change until they’ve completed the research into Gardasil. Now that was an article pointing out the futility of pap testing young women and the high risks…that can lead to over-treatment, cervical damage and miscarriages, premature babies etc…
I thought that comment said a lot.
I doubt you’d find a doctor prepared to make that sort of statement in any other area…”yes, we know the program doesn’t help and it will harm quite a few, but hey, we want to finish our research and need the pap test records for a few more years so keep lying to young women (and all women) and keep the guinea pigs coming…” and of course, these young women should be grateful as they’re wheeled in for unnecessary cone biopsies or laser treatments….unknowingly doing their bit in the “fight” against cc. Far from informed consent or any consent, these women are misled into testing that can only worry and harm them.
Just disgraceful…leaving the program unchanged to enable the research to be completed also condemns older women to continued serious over-screening. So much for the health, rights and well-being of individual women. What does this say about the profession and their view of women?”
Oh Sue, thank you so much for providing an antidote to the lies, bullying and paternalism that is everywhere regarding women’s health “care”. It is almost impossible to find balanced, truthful and respectful information when searching for anything to do with women’s health, you have to search hard, or be a member of the medical profession or have access to actual medical journals to find the truth. Women have been brainwashed for so long, and so well, that they even turn on each other. I have seen blogs where a girl or woman will post that she is scared of having a pap, or doesn’t feel the need as she is low risk, or for whatever reason doesn’t wish to have a pap, and instead of help and encouragement, gets told to “suck it up”, or “you’re ‘mature’ enough to have sex, you are mature enough to have a pap”, or “It’s part of being a woman”, or “So you want to get cervical cancer and die?”. Absolutely horrifying, the pap screen associations have done their jobs well, brainwashing women into this sort of behavior. I can’t imagine men falling for the bullshit to start with, but even if they did, I certainly can’t imagine them turning on each other like that. I can’t wait for the truth of this unreliable test to finally come out, so women can stop taking unnecessary risks with their health, and have access to top quality, reliable care for cancer.
You are making many good points Jacqui. It is very hard to find any raw data to provide us with the facts. I did manage to find some statistics though, and was shocked to discover pages that revealed cervical cancer is nonexistent in some northern cities in Canada. Even though incidence of other cancers was similar between northern and southern cities, the incidence of cervical cancer was recorded as 0.0! I’m not sure why – but it did make me suspicious. After much searching I did manage to find a good solid page of government approved statistics I could understand, and which I have shared above. The raw data illuminates just how rare cervical cancer actually is.
It is disheartening when some women turn on the women who have done research and have learned to question the usefulness of pap smears. It seems there is mistrust or fear of those who have chosen to trust their own instincts and knowledge? I agree with you that men probably wouldn’t fall for it in the first place, and I also cannot see them turning on each other in the same way. Hmmm . . . maybe that’s part of the reason why there is no pressure, deception or coercion geared towards men to submit to prostate exams! And a prostate exam is not as invasive (although a finger up the butt is not exactly pleasant either). If the shoe was on the other foot I cannot imagine men allowing insertion of a metal object into their penis to enable prostate viewing or scraping. I especially cannot see men allowing pieces of their prostate to be snipped off to double check results from an unreliable test. They would fight back in a strategic, cohesive mass attack!
Thank you for your comments Jacqui, much appreciated.
Obviously Merck was not familiar with statistics when launched Gardasil vaccine or they created own statistics to keep us in a state of fear.
I have not done a great deal of research on the Gardasil vaccine, but I have searched long and hard for statistics on cervical cancer. The raw data I have found all highlights the same thing – namely that cervical cancer is rare in developed countries. The little I have heard about the Gardasil vaccine is very disturbing, but most of my information has come from reading about the lived experiences of young women who have been harmed from it. I agree that women are kept in a state of fear, well put! And I also think that the statistics are not easily accessible for a reason. If women were given the facts about the rarity of cervical cancer, the unreliability of the test method to screen for it, and the high likelihood that further tests and treatments would be required, then no woman would agree to screening in the first place. What really ticks me off is when there are claims that screening has decreased the incidence of cervical cancer. Screening only detects the presence of cancer, it has nothing to do with decreasing or increasing the incidence of cancer. What has decreased the incidence of cervical cancer in the past 50 years is better hygiene, protected sex, and improved nutrition.
Thank you for your comment. I enjoyed your post on the differences and similarities between male and female brains and was discussing it with family earlier this evening. A very interesting and thought provoking posting!
“Screening only detects the presence of cancer, it has nothing to do with decreasing or increasing the incidence of cancer. What has decreased the incidence of cervical cancer in the past 50 years is better hygiene, protected sex, and improved nutrition.”
There are a number of patent falsehoods in this statement:
1. Screening detects atypical cells that have a increased risk of becoming cancerous. If those cells are removed, cancer has been prevented.
2. There is no proof that hygiene has anything to do with cervical cancer. Ditto nutrition.
3. Protected sex does reduce the risk of cervical cancer. But if everyone were having protected sex, the prevalence of HPV wouldn’t be so high.
“There is no proof that hygiene has anything to do with cervical cancer. Ditto nutrition.”
There is no proof of otherwise either!
What? Nobody’s advocating that people stop eating healthy meals and avoid bathing. But someone here is advocating that women refuse pap smears, which ARE proven to prevent cancer.
Pap smears are also proven to harm to some extent up to 77% of screened women.
All to prevent 0.65% chance of cancer? Or to keep the doctor’s cash flow?
Incidence is not “chance of cancer.” Incidence is the number of new cases of a disease in a given time period. The incidence is low because cancer is being prevented. Without screening and appropriate treatment, the risk of cancer is increased.
In the US, pap smears are relatively low-paying procedures in terms of insurance and Medicare/Medicaid reimbursement. In fact, many organizations that offer them (Planned Parenthood, nonprofit women’s health centers) do so for free or at a net loss.
I’d like to see the research you’re mentioning. I’m not trying to sound smug or anything, I really would like to see it. Do you have a link?
The fact that pap smears are very cheap (and have a corresponding reliability) is widely known. It is the main reason why governments in backward countries like USA, UK and Australia still impose pap smears on women instead of offering more reliable, less invasive and more useful primary HPV self-testing.
The research reference you asked about: Kavanagh A M, Santow G, Mitchell H, “Consequences of current patterns of Pap smear and colposcopy use”, 1996.
Thanks for sharing that article so quickly. Reading the abstract, it appears that the 77% figure you referred to was the likelihood that a hypothetical young woman would have received a colposcopic exam (kind of like a microscope used to look at the cervix through a traditional speculum) under the 1990s guidelines used in Australia. The point of the article was that colposcopy was overused in that place and at that time. The point was not to describe the overall risk of a pap smear.
It is not about the overall risk of a pap smear, but it is a good illustration of one aspect of the potential harm that pap smears lead to. If you think that colposcopy is a simple exam easily tolerated by women, you are mistaken greatly. Colposcopies are not only invasive and often lead to psychological harm and destroy the woman’s desire for any further intimate life, the are very often accompanied by cervical biopsies of which women are either not warned at all, or told that it is “minor and virtually painless”. In reality, cervical biopsies are often excruciating and leave women in pain, bleeding, and feeling violated, sometimes for many years after the procedure.
Now, given that the risk of being sent for a colposcopy for a screening woman is 77%, you, being one with “a lot of training in evaluating clinical and epidemiological research”, can estimate how much unnecessary pain and damage a pap smear cause. Especially since the life-time risk of cervical cancer for a woman who doesn’t screen at all is just over 1%.
In response to your comment below (I guess we’ve wandered too far down our own discussion thread), you seem to be missing the point that the fault (increased risk of colposcopy) was due to the guidelines used in Australia twenty years ago, not the pap smear itself. Risks and benefits should always be clearly discussed with any patient, but I’m not too sure I can get behind the idea that 1% (and as I’ve explained ad nauseum here, without screening that number is much higher) of women is too small a number when compared to anecdotal evidence of psychological harm. Guidelines are constantly under review to reduce unnecessary risk, but the bottom line is that providers want to do everything reasonable within their power to stop deaths from easily preventable illnesses.
Yes, you did explain it, “ad nauseum”, that without screening that number is much higher. But, following the “facts and numbers” we are all given by the system, you couldn’t say by how much higher.
You said you can’t get behing the idea of 1%. Let’s employ the maths to figure it out:
According to the medical officials currently about 60% of targeted women participate in pap-screening, and those 40% who don’t screen make up 3/4 of all cervical cancer cases (check any pro-pap site). If the average risk of CC, including those “saved” by pap smears is 0.65%, with basic maths it becomes clear that that the highest possible risk for those who don’t screen is 1.275%, and the lowest possible risk for those who do screen all their life is 0.283%. Therefore that is less than 1% difference in chance of getting the cancer no matter whether one screens or not. Compare if to 77% of chance being sent to colposcopy and subsequent risk of the torture called cervical biopsy, and you will see what the pap-propaganda is not telling women or the people like you.
Mike, even IF a small number of women are helped by pap testing, the end result does not justify the enormous violation of women’s rights and the damage caused to huge numbers…to our bodies, health and lives. There was never a need to do so much damage, to help so few…as Finland and the Dutch have shown with their evidence based programs. The lifetime risk of cc is 0.65%, take out false negatives and consider natural decline and it seems that fewer than 0.45% can be helped by pap testing. (population pap testing is outdated now and should be scrapped) I say “if” a small number are helped as there are no randomized controlled trials for pap testing.
Stomach cancer has fallen by a similar margin with no screening test, so we have to be careful making assumptions.
Finland has had SINCE THE 1960s, a 7 pap test program, 5 yearly from 30 to 60 and have the lowest rates of cc in the world and they refer far fewer women for potentially harmful excess biopsies/over-treatment. The Dutch have the same program, but will shortly scrap population pap testing and offer 5 hrHPV primary tests at 30,35,40,50 and 60 (or self test with the Delphi Screener) and only the roughly 5% who are HPV+ and at risk will be offered a 5 yearly pap test. Most women are not even at risk, they’re HPV- and should only be offered 5 to 10 yearly HPV primary testing. (or self-testing)
Those HPV- and no longer sexually active might choose to forget all further testing. (and those HPV- and confidently monogamous)
It’s the shocking and unethical over-use of this test that’s a scandal, IMO, heads should roll…here in Australia we have one of the highest referral rates in the world, due to serious over-screening. We do everything to maximize risk for NO additional benefit. It has created enormous profits for vested interests. Women here are still pressured to have an absurd 26 or even more pap tests, but thankfully, the screening rate is falling as more women become aware of the facts.
There is no doubt in my mind that these programs have been hijacked to maximize profits for the medical profession. (and in the States add extreme defensive medicine) It also shows a deep disrespect for our bodily privacy, legal rights, health and quality of life.
I got to the facts early and was content to accept my near zero risk of cc, the risks with testing were too high for me.
It’s time we protected women, not these program and the vested interests who live well
off the abuse of women.
Proven? Don’t think so. There are no randomized control trials that I am aware of that can help support your strong assertion, and all of the other evidence is correlational and “correlation does not equal causation”. Your use of hyperbole seems to be another example of misrepresentation of evidence designed to overestimate benefits of screening practices that are often at odds with evidence, which minimize or deny risks, and which seem to be part of a pattern of the misinformed disconsent process that so many of the voices on this blog have testified to.
A British Medical Journal article laid out some basic elements of what should be included in truly informed consent for cervical screening using . These included:
* Inform women of the absolute benefit of their participation in the cervical screening programme. THE BENEFIT TO AN INDIVIDUAL WOMAN OF ATTENDING THE NHSCSP [their national screening program] IS EXTREMELY SMALL.
* Inform women of the inaccuracy of the test and disadvantages of being tested.
* Inform women that because the Health Authority pays them to perform Pap smears that there may be a conflict of interest.
http://www.bmj.com/rapid-response/2011/10/28/women-informed-consent-and-cervical-screening
The points in this journal align very well with the points raised by numerous intelligent and well-read contributors to this blog.
* The women on this blog have provided many references to information that clearly indicates that they “get” that the benefit to them as individuals is extremely small. They’ve read the literature and are well-informed and well-aware of what their individual lifetime risks are.
* The article speaks to the inaccuracy of the test, and it is easy enough to do a google search and find other articles that speak about the challenges related to its sensitivity and specificity – Your assertion that the test is reliable is misleading, and seems another example of the sort of misinformed disconsent process that many on this blog are protesting about.
* The article also highlights the conflict of interest that seems to conspires against truly informed consent. There are various types of financial incentives that seem to contribute to the the minsinformed disconsent process that women are subjected to.
It would be progressive if physicians would “seek first to understand” and really pay close attention listened to the issues raised by women who are requesting that the principle of informed consent be truly put into practice. Your debating tactics might serve you well in your academic battles with other medical students, but the way you are conducting yourself on this site is undoubtedly doing little to change the minds of anyone you are addressing and your paternalistic comments (“we know what is best for you and are only working in your best interest”) only add to further distrust. If you really want to improve women’s health, try on an attitude of respect, stop talking down to people, and start working to get your colleagues to do the same. That might help reduce a barrier to women accessing care that is really in their best interest.
The reason the incidence of cervical cancer is so low is that health care providers have gotten so good at screening for it and preventing it. Women get their annual/biannual paps, and if premalignant cells are found, these women have the choice of having a hysterectomy or biopsy to remove the affected area or organ. Remember, premalignant and atypical cells DO NOT count as cancer, they just have a higher risk of becoming cancerous. So that’s why the incidence of cervical cancer looks so low. Other cancers like lung and pancreatic cancer cannot be screened and prevented as easily, so that’s why their incidences are higher.
Cervical cancer was one of the leading causes of cancer death among women in the early 20th century. The advent of the pap test and consequent reduction of the incidence of cervical cancer is one of public health’s greatest success stories.
Cervical cancer was already in steady decline before the massive cervical harm (i.e. cervical screening programmers) were unrolled. The medical profession used the natural decline to support their deceitful propaganda about pap smears. And you are trying to repeat the hype here again.
Alice, with all do respect, this is not true, and the idea that cervical cancer screening is a massive conspiracy is silly. Take a look at the cervical cancer rates in unindustrialized countries, most of which lack effective screening programs:
http://www.who.int/hpvcentre/statistics/en/
Mike, here is the problem: it’s another “statistics” cherry-picked and published by the people who benefit from excessive and unnecessary screening, or influenced by the people who benefit. You wouldn’t expect a butcher convincing you that it’s healthier to become a vegetarian, would you?
The WHO benefits in no way from excessive screening. They don’t sell a product, and they don’t collect dues from physicians. They are funded by UN member states with a charter to improve public health. I don’t see how your analogy applies here.
They are getting the numbers for their aggregated statistics from heath organizations and governments of individual countries, who, in turn, benefit/advised by/connected to those who do benefit from the excessive screening.
That’s an awfully long chain of people upholding such a big conspiracy.
Big money – big chain 🙂
FL, I looked back at my comments for things that were paternalistic, and didn’t find any. You went ahead and put those words in my mouth. I never claimed to know “what’s best,” that’s the choice of the patient. And I’m not talking down to anyone anymore than you are talking down to me.
I know I’m not going to change anyone’s mind here. I just came in to point out that the original article seemed to miss the point that the incidence of cervical cancer is low in the West because it’s being screened. I believe the tests are more effective than doing nothing and have confidence in the institutions that conduct this research. I understand that others have less confidence than I, and I DO understand that there a good reasons to be skeptical.
And honestly, you make a great deal of assumptions about who I am and what I do, so please don’t tell me that I’m disrespectful to patients. I work harder than most to building a trusting healing relationship with them. I’m not part of some homogenous enemy here.
I want to respond to that stuff about proof and correlation, but I’m honestly too tired now. Maybe we can comment-fight about that stuff later?
*due respect* And Mom was an English teacher, too.
Please don’t bring up that old furphy that cervical cancer deaths rates would be at the rates of unindustrialised nations if industrialised nations didn’t have cervical screening. Here is a Australian government report on cervical cancer. Note paragragh 6.11
“Invasive cervical cancer is a rare disease. The annual incidence was below 15 per 100,000
in Australia even before the National Cervical Screening Program began (see Figure 2.2),
but current screening is detecting some kind of abnormality in about 5000 women of
every 100,000 screened (AIHW 2003).”
Click to access wh39.pdf
Did you see that figure? It was LESS than 15 per 100,00 before screening was introduced! It was ALWAYS RARE.
Mike, (doctor I presume?), please read this study comparing the Netherlands screening program to that of the U.S.: http://onlinelibrary.wiley.com/doi/10.1111/j.1468-0009.2011.00652.x/abstract
You will see from the study that even though women in the Netherlands are not screened until age 30, and then only once every five years afterwards, that the incidence/prevalence of cervical cancer is comparable to rates in the U.S.
The facts are:
-cervical cancer is rare – extremely rare in women under age 30
-the pap test is highly unreliable as a screening method for cervical cancer
-drs are able to charge extra fees for pap tests
Hi, Sue. I am not a doctor, but a medical student who’s wandered in here from someone’s Facebook post. I do have a lot of training in evaluating clinical and epidemiological research.
The article you’ve posted is interesting, but it’s shifting the goal post a bit. The point is that both nations are using the test with good results, only one uses it less frequently. If you can find something that proves equal incidences of cervical cancer between a screened population and an unscreened population, then you’ll be on to something.
The starting age and timing of the pap test is pretty hotly debated (especially since American preventative service agencies have recommended screening every three years for low-risk women), but that’s a different argument from the effectiveness of the screen. There are screenings for other diseases that are only done once in a lifetime but are still shown to decrease mortality. If you were advocating for not screening women under 30, that would be one thing. But the tone of the article seems to imply that pap smears are a scam altogether, an argument to which I strongly take issue.
There is nothing in that article that claims pap smears are unreliable. There is lots of evidence that shows paps are extremely effective when performed appropriately and used in combination with other tests such as HPV testing and colposcopy if they’re needed.
Doctors (and nurse practitioners as well) often do charge fees for the exams and tests they perform. There are countries where a fee-for-service model is not used, and they still screen for cervical cancer. There are a lot of organizations that actually lose money on performing paps.
When I was a student I too believed “researches”, “science” and “statistics”. All until the real life taught me a lesson and I realized that they often come in “quotes”. The “truth” and the “facts” can be partial or cherry-picked.
I doubt there would be so many women with pap-hatred if they were told the real facts, given comprehensive information about risks and benefits of the screening and allowed to make their own decision to screen or not to screen, without being denied unrelated medical care or medications. Most women are not anti-pap as such, they are anti-bullying, anti-coercion and anti-deception. It’s just that bullying, coercion and deception often accompany the pap smears you are so fond of.
Alice, I’m sorry if you felt misled or bullied by a provider. That shouldn’t happen.
And I’m not fond of pap smears. Really. No one is. They just help prevent disease is all.
Mike, most people agree that shouldn’t happen. But it does happen, and it happens more often that you may think.
You may be not “fond” of pap smears, but for as long as the medical profession in countries like USA, UK and Australia continues insisting that it’s OK to shove tools and instruments into women’s genitals on a regular basis, scrape and tear parts of their cervixes off, perform extremely painful “treatments” that turn out to be unnecessary in most cases and deny women’s access to a more reliable, safer and less invasive HPV self-test that would do a much better job of preventing the cancer, there are going to be arguments like this. Because no woman who knows the real facts will believe that pap smears are “the best way to prevent cervical cancer”. We know it is not, we know it leads to a huge excess in invasive exams and excruciating “treatments”. And we know that there is no other logical explanation for the absence of freely available HPV self-test kits than vested interests of those who benefit from excessive screening procedures and “treatments”. If the system really cared about women and really wanted to prevent cervical cancer, they would offer all possible options, including HPV self-tests.
Mike, that is wonderful that you have training in evaluating clinical and epidemiological research. Then you will be able to understand that collecting cells from any part of the human body will result in “abnormal” cells much of the time. If a person uses soap with a high perfume content and cells are scraped from the arm or leg, the cells will test “abnormal”. The same principle applies with scraping cells from a woman’s cervix – the cells may test “abnormal” if the woman has just had sex, used a tampon, taken a bath, etc. Abnormal cells do not mean the woman has cervical cancer, or even that she is at risk of cervical cancer. As Elizabeth has said, The HPV test is a much more accurate predictor of whether a woman is at risk of cervical cancer than the highly unreliable pap smear.
I am not asking women not to screen. All I am doing on this site is raising awareness that cervical cancer is rare, that the pap test is unreliable, and that women have a choice. I am not attempting to withhold information and choice – the medical community does that. The program has worked so well that women do not even realize that they have a right to something called: Informed Consent.
I have a question that I do hope you will answer: Why are men respectfully offered information and a choice in regards to prostate cancer screening, even though prostate cancer is roughly 19 times more prevalent than cervical cancer? And please do not tell me that women are treated respectfully, offered information and a choice in regards to cervical cancer screening, because we both know that is not true.
Ok, I’ll go point by point, but then it’s off to bed for me. I really hope the timestamp on these posts don’t reflect that we’re all keeping you up at 4 am. 🙂
There is a possibility of false positives with any test. That’s why current cervical cancer screening guidelines default to reasonable, lower-risk followup to atypical results, like an HPV test or simply repeating the pap in 6 months to a year. Shame on any provider who runs to the OR after a single ASCUS result.
Pap smears are an effective test, especially in combination with HPV testing. Combined pap and HPV are superior to HPV alone, and that’s the reason why providers still do them. It’s not because they make money off them, and it’s not because they like making women uncomfortable. You could argue that they’re doing so defensively, and I could argue that they’re doing so to help people, but the truth is probably somewhere in the middle and the bottom line is that the current screening methods save lives.
I’m not going to get into an argument about the quality of information and autonomy women receive from their providers, because I understand it depends only the individual provider. I understand that a lot of people here have had negative experiences with bad providers or care for someone else who has, and for that, I’m sorry. I’m very sorry that your doctor or whoever was such a shithead. Honestly, it’s inexcusable. Please understand that there a lots of great providers out there that deeply respect their patients’ autonomy and work hard to provide information that is up to date and easy to understand.
Finally, the prostate thing: comparing prostate cancer and cervical cancer is a false equivalency. Cervical cancer screening is highly recommended for women because cervical cancer has high mortality rates and is easy to prevent. A stage III cervical cancer has a five-year survival rate of 32-35% according to the American Cancer Society. A stage III prostate cancer has a five-year survival rate of almost 100%, also according to the ACS. The other issue is that the PSA screening test has high numbers of false positives and false negatives, so much so that many providers deem it to be worthless as a screening tool. And digital rectal exams are also highly unreliable for detecting prostate cancer. The current guidelines are to neither recommend for or against the PSA, which is why most providers will leave it completely up to the patient.
Mike, you do not need to apologize as you are still a student and have not likely had the opportunity to cause harm. Although I am curious about your stance on practicing vaginal exams on anesthetized women without the women’s knowledge or consent.
You are claiming pap smears are an effective test. Please provide evidence/references to support your claim. Testing with both HPV and the pap is excessive and of no benefit. Testing alone using HPV testing is the most effective route, because a pap is pointless unless a woman is HPV positive, which is in roughly only 5% of cases. Only in HPV positive women would a pap be of any benefit, although the benefit of the pap is still dubious.
Your comparison of cervical and prostate cancer screening has not answered my original question: Why are men respectfully offered information and a choice in regards to prostate cancer screening, even though prostate cancer is roughly 19 times more prevalent than cervical cancer? You have not answered why women are NOT treated respectfully, offered information and a choice in regards to pap tests/vaginal exams, even though cervical cancer is rare, while prostate cancer is not. Also, cervical cancer is extremely slow growing, taking up to ten years to form into a higher stage cancer.
Your claim that “there a lots of great providers out there that deeply respect their patients’ autonomy and work hard to provide information that is up to date and easy to understand” might be true in others’ experiences, but I have never had the good fortune to meet a provider that fits that description – especially in regards to pap tests/vaginal exams.
Another research that exposed unethical approaches and vested interests in Cervical Screening programs: “Reaching targets in the national cervical screening programmes: are current practices unethical?”, by P. Foster and C. M. Anderson, 1998.
Link: http://jme.bmj.com/content/24/3/151.full.pdf
Mike, in defense of FL’s claim that you were being paternalistic, you referred to Alice’s “idea” that “cervical cancer screening is a massive conspiracy” (correct me if I’m wrong, but Alice did not phrase it as a “massive conspiracy”–therefore, based on your definition, you were the one putting words in her mouth) as “silly”.
To me, using the word “silly” seems a cop-out akin to name-calling. You’ve used this word rather than adequately backing up your claims with sufficient evidence–and if you doubt that the one link you provided was not sufficient evidence, let me explain one reason why it’s not (a reason that I do hope you will be able to grasp). There are many differences between unindustrialized countries and industrialized countries OTHER than the absence vs. presence of screening programs. In order to prove that screening resulted in the diminished cervical cancer rates, you would need to isolate screening as the only difference between the two. So clearly, you’re operating with some flawed logic.
Another example of your flawed logic and, in addition, your apparent disability to interpret the majority of the information presented on this site:
“And I’m not fond of pap smears. Really. No one is.”
I’ll give you the benefit of the doubt and assume you have not read many of the articles on this site. Because if you had, you would see that certain doctors ARE fond of pap smears. “The Other Side of the Speculum” is a good place to start. You can find the link if you scroll down a bit on the main page.
And finally, I’m really curious what you think you’re doing to help by coming here and arguing–and continuing to argue–even after Sue has clarified that she wants women to have a CHOICE. That’s been stated as her reason for providing information; she’s doing it so that women can make their own decision. Based on the comments that have recently been made, it’s easy to see that women are interpreting the information in different ways. Many are still interested in getting tested. But the overall attitude is one of relief that they have access to the information. Are you against the idea that women should be allowed access to information and given the opportunity to choose a course of action that suits them? Because unless you are against it, I don’t see a reason for conflict.
I have just figured out how Australian medical system is killing two birds with one stone:
1. Making cervical cancer look rampant.
2. Pretending that their “successful screening program” is saving enormous amount of women from the cancer.
The trick turned out to be very simple:
A friend of mine has just got a copy of her pap smear results. She now regrets that she agreed to do the smear and says she won’t do it ever again, but that’s not the point. The point is that my fried did the smear only because her doctor talked her into it. She had no symptoms, no family history of ANY cancers, no suspicions for HPV risk, no pain, no previous history of any female problems. She was absolutely healthy and asymptomatic. Yet she did the pap smear.
Now she received a copy of her results from the lab. All fine.
However, the results came with a payment slip, which contained Medicare Benefits Schedule item number 73055 for cervical cytology. Looks about right, isn’t it?
BUT, if we search MBS and have a look what 73055 means, we will the the following:
Cytology of a smear from cervix, not associated with item 73053,…
(a) for the management of previously detected abnormalities including precancerous or cancerous conditions; or
(b) for the investigation of women with symptoms, signs or recent history suggestive of cervical neoplasia.
Then, if we have a look ant the number 73053, we will see:
Cytology of a smear from cervix…
(a) for the detection of precancerous or cancerous changes in women with no symptoms, signs or recent history suggestive of cervical neoplasia…
In other words, 73053 is for routine pap smears for healthy asymptomatic women who have never had any abnormalities, and 73055 is for pap smear for women who have symptoms, or previously had abnormalities, precancer or cancer. And my friend should have got 73053, not 73055!
Both items 73053 and 73055 cost exactly the same and look very similar, so there isn’t much chance any patient will notice the difference, but it works wonders for the sly System.
Medicare Australia is the main power behind the cervical screening program, and now, instead of admitting in its statistics that this particular smear was useless for my healthy friend, it will add my friend to the unbelievably high number of women who, as the System claims, had, have or are likely to have cervical cancer and, because my friend will stay healthy, the System will also claim that of so-many-women with detected abnormalities so-many are now healthy.
What a simple, genius and dirty trick, isn’t it?
Oh Alice, having that information sink in felt like a punch to the stomach. It is a simple, genius and dirty trick. Great detective work, I’m impressed you figured that out. But it is just so disturbing and frustrating.
I too was so outraged when I uncovered this nifty scheme. Who knows how many women have been marked as “at risk” or even “cancer survivors” and then claimed to be “saved by screening” via this little trick!
My friend is now so happy that she refused to register for eHealth. If she did have a PCEHR/eHelth, the cancerous 73055 test would have been put into her electronic medical records for everyone to see, and a perfectly healthy woman would have been treated as high-risk or even a cancer victim for the rest of her life! And then my unsuspecting friend would be wondering why every single doctor she visits talks about her cervix and pap smears more than of anything else.