Doctors need to stop pushing pap tests, especially in light of new findings. Some doctors have been getting away with the practice of withholding informed consent for a long time. Women rarely get offered a choice about whether or not to have a pap test; they are simply expected to comply. In fact, the withholding of informed consent has been standard practice for such a long time, and has been done so cleverly, that some women are not even aware that they have a right to choose.
The unethical practice of withholding informed consent has largely been ignored, partly because of the assumption that pap tests are for a woman’s own good. Coercing women into unwanted pap tests has been considered by some to be an acceptable way to practice due to the belief that screening saves lives. However,the belief that pap tests “save lives” has never been scientifically proven, no randomized control trials have been done that support this belief, and now there are new findings that highlight this.
A recent article in the British Medical Journal titled “Why cancer screening has never been shown to ‘save lives’-and what we can do about it” illuminates the lack of scientific evidence in relation to cancer screening. The authors state that cancer screening might identify site specific cancers, such as breast or prostate cancer, but that even when cancer is found early, it has not been shown to benefit overall survival.
Overall mortality is what people care about. Healthy people want to live longer, and this is usually the motivation for undergoing cancer screening. But, as the authors highlight, important pieces are missing from the bigger picture of cancer screening. For example, while there may be some gains in avoiding deaths from site specific cancers (e.g. breast or colon cancer), these gains may be offset by slight increases in treatment related deaths.
Basically, cancer screening has not been shown to reduce a person’s risk of dying. The authors also suggest that the harms of cancer screening, such as over-diagnosis and unnecessary follow up interventions such as biopsy, radiation, and chemotherapy, have largely been ignored and undocumented. In some cases, cancer screening may increase a person’s risk of dying.
Pap test coercion needs to stop. The mantra that coercion is for a “woman’s own good” doesn’t ring true, and doesn’t excuse it. Some doctors don’t tell women the facts, such as the fact that cervical cancer is rare or the fact that they stand to benefit financially from testing women. Some doctors don’t tell women about the inaccuracies of test results or the risk of over-diagnosis, unnecessary surgeries and other potential harms. Some usually don’t tell women much of anything; the propaganda has already done the talking.
Media coverage and women’s own shared experiences continue to reveal a disturbing reality where women are being exploited and harmed by unethical medical practices. When you strip away the context of so called health care and look at what is happening to many women you are left with coercion, bullying, abuse, rape, mutilation, and in some instances, physical and psychological torture. It’s time to stop pushing pap tests, time to start paying attention to the harms, time to start telling women the facts, and time to let women know they are free to make up their own minds.