The Importance of Pap Smears in the Fight Against Cervical Cancer
I was asked to write a piece for All for Women about Pap tests (or Pap smears) and the role they play in preventing cervical cancer.
I was halfway through writing a stat-laden article when I thought back to an event PapScreen held last year, and a beautiful speech given by a man who had recently lost his wife – and mother of his two young children – to cervical cancer.
I think it illustrates why Pap tests are so important, better than a thousand statistics, so with his permission we’ve reproduced his story here.
Helen Marsden
papscreen.org.au
In January 2010 a beautiful amazing woman and mother of two lost the fight against cervical cancer. The fight was short yet inspirational and courageous. This beautiful woman was only 34 and was in the prime of her life, enjoying spending time with her children and a husband who cherished each day with her. This amazing woman was my wife Melissa Jane Ellis.
How life can change so quickly. One day we were your typical family of four, looking forward to seeing our children grow up and develop into fine adults. Yet Tayla (age 12) and Hudson (age 4) have now had to endure what no child of that age ever should – the loss of their mother.
After returning from a family holiday in Queensland, with Melissa exhibiting unusual symptoms, we went to our local emergency department. Two weeks later after an appointment with a specialist, we found ourselves travelling to Melbourne for tests and an operation to examine the symptoms.
Until cancer touched our family we didn’t fully appreciate how devastating this disease could be. One afternoon in October 2009, our lives would be changed dramatically forever: we were given a diagnosis of cervical cancer. It was only three short months later that the disease would claim Melissa’s life.
On the day we were diagnosed we experienced an array of emotions, from devastation and determination, to anger and frustration, to fear and concern for our two beautiful children. Melissa found amazing inner strength: her main concern was for the wellbeing of family members around her. Her positive and unselfish outlook continued throughout her treatment, right up until her passing.
At no point did Melissa ever question why her: her only question was ‘How can my experience help others?’
With the number of women having regular Pap tests still well down on where they should be, I find myself continuing the battle of awareness and prevention of this hideous disease, with the clear and distinct goal in my mind that children should not have to experience what our children have had to.
It may seem strange to have a man raising awareness about the importance of Pap tests, and their role in preventing cervical cancer, yet it’s a passion I hold close to my heart. I strongly believe that husbands, fathers, sons and brothers can play a bigger role in the fight against this disease.
Throughout this story, I’ve made references to ‘our story’, ‘we’ and ‘us’ – because although my wife Melissa was the patient, at no point in time was she travelling this road alone. It was a road that we travelled together. Unfortunately, that road is now a little lonelier with Melissa gone.
I’m sure there’s a reason for Melissa being taken away from us – someday that message may be a little clearer. It may be to help someone else, which would make sense, because she was the most selfless person I’ve ever had the pleasure of knowing.
Since Melissa’s passing I’ve obviously reflected about a lot of things, and there’s one particular event that’s hard to erase from my mind. It was one night when Tayla and Hudson were in bed, Melissa and I were watching TV and an advertisement about Pap tests came on.
The advert prompted me to ask Melissa about the last time she had a test. Melissa was dismissive and spoke of the awkwardness of the test. Her reaction was understandable, and it stopped me from taking it further.
For the sake of a moment of awkwardness, I wish I’d been more supportive and pushed a little harder. I’ll never get that chance again.
- We know that regular Pap tests (or Pap smears) can prevent around 90% of cervical cancers.
- However around a third of women in Australia don’t have regular Pap tests.
- Around 9 in 10 women diagnosed with cervical cancer haven’t had regular Pap tests.
- PapScreen recommend that all women aged 18–70 who have ever been sexually active have a Pap test every two years, even if they’ve had the cervical cancer vaccine (or HPV vaccine).
- GPs and some specially trained nurses can take Pap tests. To find your nearest clinic providing Pap tests call 13 15 56.
- For more information about Pap tests and how they can prevent cervical cancer go to papscreen.org.au or call the Cancer Council Helpline on 13 11 20.
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Filed Under: Featured • Health & beauty
Sometimes i find it hard to even say the C word I have lost a special friend & SIL to cervical cancer & her fight never ended until that last breath & i will never forget her last breath :(
Pap tests are awkward but dying is much worse .
Pap smears saved my life. A little uncomfortable now saves a lot more uncomfortable later
I don’t agree this is the best way to convey information at all, in fact, I regard it as basically trying to scare women into cancer screening and that’s inappropriate – we’re adults.
Women are not children or idiots and we’re entitled to the facts. These sad and rare cases should not be used to promote screening – we have no idea of another woman’s risk profile, or what type of cancer she had – adenocarcinoma for example, is an even rarer form of cervical cancer, which is usually missed by pap tests. False negatives account for around a third (and in some countries up to a half) of all women who get cervical cancer.
Few women benefit from pap tests and there are real risks with this testing – it’s a rare cancer, in decline before screening started, with a lifetime risk of 0.65%, taking out the false negative cases, only around 0.45% are helped by testing and that’s being generous – we know other factors aside from screening are also responsible for the decline, things like fewer women smoking, more hysterectomies, better condoms, some include better hygiene and fewer STD’s. (the last two are from Gilbert Welch’s book, “Over-diagnosis”.)
Men got risk information very quickly and doctors were reminded to obtain informed consent – they were treated respectfully – women get an order to screen, a scare campaign or scolded for choosing not to have an optional cancer screening test. Men and women are entitled to the facts and have a choice – with all cancer screening including pap tests.
The other hidden downside with this testing is its unreliability – 77% of Aussie women will be referred (usually worried sick) at some stage after an “abnormal” pap test – 77% will have a colposcopy at some stage (and usually a biopsy) that’s huge over-detection for a lifetime risk of 0.65% and to help fewer than that – 0.45% at most. Many women have been left with cervical damage after unnecessary treatments and that can mean infertility, miscarriages, high risk pregnancy, cervical stenosis, infections, premature babies, more c-sections and psych issues. LEEP and cone biopsies carry the most risk. These poor women are never even acknowledged – just collateral damage.
The changed guidelines for referral are not working according to my GP – women still panic when they get an “abnormal” test and either ask for immediate referral or are left to worry for 6 or 12 months. Almost all referrals are unnecessary and caused by false positives. The damage is greater than it needs to be – we also over-screen – 2 yearly testing causes even more false positives for no additional benefit. Finland has the lowest rates of cc in the world and JUST as importantly sends the fewest women for colposcopy (still high at 35%-55% lifetime risk, but the best you’ll with this test) Finland offers 5 to 7 tests in total, 5 yearly from age 30.
(The 77% figure is from research by Kavanagh and others cited in an article by Dr Laura Koutsky, Cancer Prevention, Fall 2004, Issue 4) See also: “Time to Chneg the Policy” Dr James Dickinson
We also test women under 30 even though it doesn’t change the tiny death rate in that age group, but produces LOTS of false positives. In “Cervical Cancer Screening” a pull-out guide for doctors in the “Australian Doctor” 2006: Assoc Prof Margaret Davy, Director, Gyn-Oncology, Royal Adelaide Hospital and Dr Shorne, GP tell us,
“No country has ever reported a decline in the incidence of or the mortality from cervical cancer in women under 30, irrespective of cervical cancer screening. Many countries do not perform cervical screening in women under 30″.
So, why do we screen women under 30? High risk for no benefit…the AMA even scolds young women for failing to screen, when they’re making the best decision for their health.
It’s time Papscreen and others stopped treating women like objects to be counted, we’re all entitled to the facts and an opportunity to make the right decision for our bodies and protect ourselves from harm – it’s our choice – it is never “shocking” or anything else that some women choose not to screen – that is our right, just as a man might reject PSA testing or a colonoscopy.
I’d urge all women to do their reading – don’t respond to disrespectful campaigns – get to the facts.
As a low risk woman, I made the decision not to screen more than 25 years ago – I didn’t get the information I needed from a brochure or Dr – last time I checked Papscreen did not even mention false positives, which will affect 77% of women. Is that right or fair?
I also strongly disapprove of the Govt paying doctors financial incentives for reaching targets for pap tests – this is unethical – it places our doctors in a potential conflict of interest situation. These payments should be disclosed to women – yet another example of the disrespectful way women are viewed by the Govt and doctors.(Financial Incentives Legislation and PIP scheme)
Dr Joel Sherman’s medical privacy forum is an exception – he wrote, “Informed consent is missing from cervical screening” – at his forum, in the section on women’s privacy issues, in the side bar you’ll find the facts – see research by Dr Angela Raffle, UK screening expert, “1000 women need regular smears for 35 years to save one woman from cervical cancer”. (BMJ:2003)
Beware of anyone who tries to use the third world as an example of risk – those women have unique risk factors that do not apply to Australia or other developed countries. Be careful of statistics – they are often fashioned to mislead – in the UK there was a campaign saying 1 in 8 women will get breast cancer – this was calculated assuming all women will reach advanced old age – going back to a normal life span, it was 1 in 68. It’s that sort of dishonesty we MUST challenge. There are many references at the Violet to Blue site as well – put together by a concerned woman.
I believe very few women are giving informed consent for cervical or breast cancer screening in this country and that must change.
I’m terribly sorry for men and women who get cancer, but I don’t act on fear and misinformation, I’ll act on facts and my risk profile.