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.