Way Too Many Unnecessary Pap Tests

stockings_hands2Doctors’ overuse of pap tests has recently been put under closer inspection. Up to now there has been no concerted effort to quantify the extent of doctors’ overuse of unnecessary tests, but a U.S. task force has devised a method to tally up the numbers in the state of Washington.  The task force researched 3.3 million Washington residents’ Medicaid records and insurance claims between 2011 and 2012.  The numbers were surprising.  Here is what they found:

• 57 percent of Washington female patients (almost 97,000 women) received too many Pap tests.  http://seattletimes.com/html/health/2024655331_tabchoosewiselyxml.html

That number deserves a second look: 97,000 women received unnecessary pap tests.  That’s a lot of women getting an invasive test they didn’t need, and probably didn’t want.  And that’s only in one State, in one year.

Pap tests are often presented as a mandate, rather than as a choice.  Many women may not know they have the right to refuse pap tests.  Some doctors are not informing women that they have the right to say “no” to pap smears and other tests.  Some doctors are also not informing women about the potential harms of pap testing.  Ethical treatment and respect for women’s right to informed consent in all areas of health care is long overdue.

More on this topic:

Informed Consent Missing:http://www.kevinmd.com/blog/2009/11/informed-consent-missing-pap-smears-cervical-cancer-screening.html
Why Doctor Does Not Have Smears:http://www.goodreads.com/author_blog_posts/2234123-why-i-don-t-have-smears
Top five reasons for opting out of pap tests: https://forwomenseyesonly.com/2014/04/19/top-five-reasons-for-opting-of-pap-tests/
Male doctors honest opinion on pap tests: https://forwomenseyesonly.com/2012/09/09/the-other-side-of-the-speculum-a-male-doctors-point-of-view/


  1. Ladies from the UK on this website may be interested to know that target payments for pap tests to GPs in the UK have changed. Instead of a modest bonus to reach a 50% screening target and a substantial bonus to reach an 80% screening target, this has now been changed to a stepped range of bonuses which go up in increments of 5% reaching a maximum of 80%. With UK national averages staying well below the 80% screening target figure, there is little incentive now for GPs to screen more than 50% of female patients, so the government has brought in the stepped bonuses to ensure that the bullying doesn’t let up.

    In the same response from the UK government, to whom I had written about informed consent in cervical screening, I received the following statement:
    The National programme encourages informed choice and provides leaflets and advice to help aid the decision to undertake screening and we would never condone women to be persuaded or bullied into being screened.

    So there we have it.

  2. Hi Ada
    Actions speak louder than words, their actions say they have little respect for informed consent, but need to “appear” like supporters of informed choice. (your programs are being watched by your advocates for informed consent) The crickets are chirping here, they can do what they like, just get to that target. I see BreastScreen here are screening their insulting ads again, celebrities urging us to just do it, it’s free and with a woman, great but what about over-diagnosis, the risks of screening exceed any benefit etc.? it’s shocking that if I make a false or biased claim about a product, I might be in trouble, but these programs can pretty much do and say as they like.
    If they respected informed choice, they’d ditch the insulting and unethical campaigns (“My mother missed her smear test and now I miss my mother” etc)…AND target payments for a start. We’ll never see informed choice in women’s cancer screening, these very expensive programs need to be fed…that’s why I’ve always believed it’s a question of reaching as many women as possible.
    They can do and say as they please, it has no effect on an informed woman.

  3. So they just “tongue-painted” a different picture over the situation?

    If they’re “aiding” the decision to undertake screening, isn’t that them trying to get someone to make this one decision? I wouldn’t say all decisions are equal, being as the situations consist of different things- but they certainly do not endorse someone not getting dangerous & inaccurate tests done on them.

    You know something? I figure in an argument where, let’s say, someone was arguing against medicalized childbirth- the opponent would probably accuse them of being the same as what they’re arguing against. It’s like they’d have prefered someone to say something else, so they just act like that is the situation.

  4. Those stats won’t change until they do something about the annual well-woman exam, the Pill and medical coercion. No. 1 and 2 on the list are part of the well woman exam, the routine pelvic exam leads to unnecessary investigation, including normal/harmless ovarian cysts, while the routine breast exam leads to excess biopsies. Also, many women are still forced to submit to a pelvic and breast exam and a pap test to get the Pill or even non-emergency medical care, and the exam may even include a recto-vaginal exam.
    The hysterectomy numbers would also, fall, IMO, if they do more to stop routine pelvic exams and also, adopt evidence based cervical screening. Coercion should be addressed once and for all, it’s an assault. HPV primary testing or HPV self-testing used the right way (and only for those who want it) would take most women out of harms way, the pap test/biopsy/treatment merry-go-round created by early and frequent pap testing IMO, often leads to an unnecessary hysterectomy, Over the years I’ve been dismayed to read accounts by mainly American women who’ve endured decades of biopsies and treatments for “abnormal” pap tests, some were having 6 monthly pap tests. I’ll bet most of them were HPV-
    Eventually some of them opted for a hysterectomy to be rid of the problem, many continued to have pap tests though because they, “had a history of abnormal pap tests”.
    That’s the cruel thing about this “healthcare”, it’s about as far away from healthcare as you can get, it destroys lives, that includes our health, peace of mind, sense of dignity and self-worth etc. and may literally take your life. It certainly destroys quality of life for many women.
    Thankfully, more of your doctors have stopped testing those under 21, it’s still happening here, we worry and harm so many teenagers and young women. Some research even showed some girls under the age of 17 were pap tested, that should amount to medical misconduct. I’ve heard doctors say it was necessary because the girl was sexually active or was abused as a child, the fact is pap testing doesn’t help those under 30, you just end up worrying and harming a lot of teenagers and young women. It says to me these doctors are incompetent, more needs to be done to address these issues, these doctors do a lot of damage.

    • These routine pelvic and breast exams do lead to overtreatment and unneccessary surgeries. Look at the algorithms that doctors use and the “risk” assessments they use. Endometrial cells reported for paps in women over 40 lead to biopsies and hysterectomies. Cervical polyps are biopsied even when less than 1% are cancerous. A woman complaining of a breast lump was told to get a mammogram which lead to diagnosis of DCIS and a masectomy in the other breast. Women miscarrying within 72 hours of a Pap test at around 10 weeks pregnancy when the manufacturer recommends the endocervical brush not be used past a certain time in the first trimester. If it is not ok to use after 10 weeks then is using it at 9 1/2 weeks ok?

      • I took a child development class in high school. we leared about the mucus plug. I cant belive a doctor whould do a pap on a pregnant woman much less that in the us it is standard to do paps as prenatal care. diging in the cervix is crazy.

  5. 30% of unnecessary pap tests for “evaluation of suspected appendicitis in children”???
    This just blew my brain out: pap tests in children!!!

    That is in addition to all other unnecessary medical rapes and tortures they disguise under the name of “pap smear”: pap smears for sinusitis, headaches, back pain and fainting! It really looks like one the prehistoric quack recipe books, when they tried to cure every illness with a concoction made of genitals of some exotic animal. These days the society much more “modern”: it can cure everything with a pap smear!

    Good that they are finally starting to investigate this widespread criminal practice. However, reading that “the task force researched 3.3 million Washington residents’ Medicaid records” is quite disturbing. What about the promised patient privacy, what about not disclosing the sensitive medical information without the patient’s consent? I guess every promise of privacy is a lie this days, especially in the medical world.

    • What are you referecing, Alice? I didn’t see anything on that. I DID see a thing about Stroudburg, Pennsylvania- that they had ambushed somewhere around 50 eleven-year-old girls with pelvic exams in school! This was in 1995 or 1996 & they’ve gotten increasingly dictatorial in schools, with an attitude that’s basically competitive with parents & is sometimes outright combative with children.

      I don’t care if the kid’s rude to the faculty or doesn’t focus on the nonsense that they try to teach or whether they do their schoolwork, I care about them not being attacked by the staff or whatever personnel the staff calls to go after them. I don’t want them to be put on pills that’ll make them go crazy on people or to get snatched away from their parents & put in some abusive environment that’s deemed “fine” by the government.

      Not to demonize the victim, but there is the possible result of these people growing up to take it out on everyone else. Assuredly, some would deserve it- but it’s possible for them to just go after someone because it would be easy for them. Wonder where they might have learned that from?

      • I seem to have misread the picture attached to the article. It displays very fuzzy on my monitor. As Elizabeth noted, it meant to show CT scans for appendicitis.
        Doesn’t excuse the medical system for performing the unnecessary test anyway though.

  6. Alice, I think the chart means unnecessary CAT scans for appendicitis, not pap tests, although I wouldn’t be surprised by anything the medical profession did or recommended at this point.
    Pap tests for 8 year olds…well, she “might” be sexually active, better to be safe than sorry, it can’t hurt etc.
    I know a few of our doctors have tested women under the age of 17, no idea how many doctors have tested the very young or how many teenagers were put through testing…or how young these teenagers were, 13, 14, 15? But the research highlighted this outrageous conduct and thankfully, there was a comment that girls under 18 should not be tested. You have to wonder whether this is incompetence or perversion.
    Few women would have seen the article anyway, from memory it was locked away for medical eyes only.

    • You are right Elizabeth. The attached picture picture displays very blurry on my screen, so I couldn’t read it properly.
      And you are right about the pap tests for children. I knew doctor do force pelvic exams on very young girls, that’s why I thought I got the meaning of the illustration right.

  7. Here’s an article that looks promising, written by a family medicine resident: http://www.medpagetoday.com/Blogs/QuestioningMedicine/50598
    Excerpt from the article:
    “If a woman could buy an HPV self swab or urine kit at the store for $10 and receive results in the mail saying “contact your doctor” or “you are HPV negative,” why not allow them to do so? Having the ability to screen yourself for cancer in the privacy of your own home, instead of the “privacy” yielded while in stirrups, will produce higher rates of screening.

    Letting patients take control of their health and screening will be fought with vigor as it will hurt the paychecks of many of my colleagues. However, it will help the most important person, the patient.”

    There’s no mention of opting out of screening altogether as a reasonable choice, but it’s going in the right direction.

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