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Readers Respond: Reasons women avoid Pap smears: Is it fair to require them for birth control?

Responses: 181

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Updated October 14, 2010

Educate and protect yourself

I don't understand how BC got tied up with cancer screening. Our doctors certainly don't require it, but they do seriously pressure women. I find it amazing that a refusal means a waiver is produced for the woman's signature. She is also told the risk she's taking not having screening YET never told of the uncommon nature of this cancer OR the risks OF testing. All one-sided and designed to scare women into testing. No greater fuss is made about anything, but money is a powerful incentive for doctors. I've always known this concern was about bank account balances and not cancer. My husband didn't want prostate cancer screening and no waiver was produced even though that cancer is very common, but doctors don't get money for testing and hitting targets. No money = no pressure = doctors couldn't care less. More women need to stop being docile ignorant lambs - get online, get the facts and take charge. At least test sensibly, if you want to test at all. Storm in a teacup if you ask me.
—Guest Joan

It doesn't work for every woman

I lost faith in this test. I know it saves some lives and that's a great thing for those women. It is imperfect though and causes lots of misery. I have never had a normal pap test, never. The first when I was a virgin at 18 was highly abnormal and I had a colposcopy and biopsy. It went on for a few years ending in a conization. That was major and really a scary and bad time of my life. I could see my entire life was going to be spent being tested and retested, more colposcopies and biopsies. No cancer, pre-cancer or dysplasia was found in my biopsies, all normal tissue. You kind of wonder what it's all about after a while. My doctor wanted me to keep going but what was the point when it all felt like a futile painful exercise. I don't test anymore. I've tested enough and don't think it is helpful for every woman. Anyway, I don't think for me it was worth the misery. There are many things that don't make sense to me with this test.
—Guest Confused

Do you know enough about this test?

It is only fair to require something for the Pill if it is necessary for the safety of the woman or clinically required. My doctor told me paps are not required for the Pill. I don't avoid paps, I have chosen not to have them. It is very hard for women to get a real overview of this test. Most of the articles that give you the facts are hard for an ordinary woman to access. Now we have the Internet it is easier, but many of the important facts are found in medical journals and unless you subscribe, you're locked out and its doctors talking about the risks of testing amongst themselves. I don't accept that women should be locked out of discussions about risk. This is my body after all. My research was prompted after my closest friend had a breakdown after repeated LEEP. Why? She was 21 and a virgin. It shouldn't be hard for women to get the facts and doctors must be forced to accept that not every woman will want to screen, why should that mean they can't get the Pill?
—Guest Carly

Paying for smears!

We've hit rock bottom when it comes to unethical conduct by doctors here in New Zealand. The Hamilton district is paying women $10 for a smear. I kid you not. The payments apply for smears and not PSA blood tests/mammograms, just testing for quite a rare cancer. Talking about informed consent and then paying for smears shows the level of disrespect for women in this country. Our doctors receive performance bonuses for smear-taking and paying women still means a healthy profit. The shattering thing is that everyone seems to accept this conduct without a peep of protest. If women MUST test to bring down the already small death rate, this is an unsuitable screening test. We don't press on and coerce, pay, scare or pressure women to test. Tests are imperfect and carry risks and not every woman will want to have a Pap, just as not every man will want PSA testing. This is not about health, this is about money and trying to make a bad taxpayer-funded screening test work.
—Guest Jacqueline, NZ

Test ethically & minimize the harm

I resent the order we get to have pap tests without telling us the facts and allowing us to consider how we feel about the test and risks. Many women are not happy to have invasive treatments to cover a tiny risk, others are prepared to go through anything if it provides even a tiny benefit. Why aren't women given an opportunity to decide for themselves? When the cancer is rare and the test causes unnecessary treatments, doesn't that make it important that we are part of the decision-making? I question the sense of testing before mid 30's. I know this testing in the UK was originally for women mid 30's to mid 50's. I know alarming numbers of women who've already had multiple treatments in their teens and 20's, some are left with major damage - we KNOW these women have a tiny risk of getting this cancer. We urgently need some professional and ethical supervision of this test to protect healthy and young women. 21 is still TOO young and condemns more women to useless harmful treatments.
—Guest Jacinta

Don't you like young women?

I won't think about smears until I'm 30 in line with our guidelines. I feel very afraid for American women though. I was reading a US site and lots of young women were talking about their abnormal pap tests. One 28 year old had LEEP at 19, 2 more LEEP in her early 20's & then "cold knife excision" and now the abnormal cells are back and she might need a hysterectomy! She said, "I have HPV so need a hysterectomy to get rid of the risk of cervical cancer". I want to save all these women from your doctors. If she lived here, she would not have been tested before 30 and none of these bad things would have happened to her. She could have enjoyed her young life. What are you doing to your women? The evidence says testing young women is harmful and of no benefit. Most HPV clear on its own within 2 years. The risk of cancer is very low. I read many tragic cases - these women are not getting the help and information they need and are not being protected from harm by anyone in your country.
—Guest Sanneke

Stand up and change things

I always wondered why my doctor gave me a free choice about the rectal and PSA testing while my wife gets told what she WILL be having. There's not an equal relationship. It's more like master and servant. I am more the client of my doctor and what I say matters. I even notice the information sheets given to men are worded differently. The one given to my wife recently after the guidelines changed sounded more like a notice from the school principal. "This is what you will be doing now". Too many women are accepting of this and until you make clear that you're running the show, nothing will change. I don't think anything in your health care can be fair while the power imbalance and rudeness remains. You could say I avoid screening but I'd say I've decided not to have it and so would my doctor. Even using the word avoid suggests women are being naughty children.
—Guest Brian

What happened to the normal woman?

I think pills should be sold at pharmacies with no script. The awful part of all this testing is the loss of normality. Women are never normal, we're either tested and a bit safer or unscreened and unsafe. I link sex with cancer and death, other women link being female with cancer and death. It depends when the frenzy starts about paps, when you first have sex or when you hit 18 whether you've had sex or not. Our doctor still tests ALL women at 16 or 18, forget the guidelines! When your privates are scrutinized, probed, scrapped and treated from teens, you start to feel negative about being female. I think it's sad. Why should the small risk from this cancer mean we must all live in this way? Women are not pre-cancerous, unless all men are pre-cancerous. It's like women are punished for being female and certainly for having sex. You had sex at 16, you'll get cancer, YOUR fault! Men get no judgment. Men get testicular cancer just as often, but their lives are not lived around that risk
—Guest Maddy

Don't panic, get the risk in context

I think all cancer screening is supposed to be voluntary although most women feel pressure to have breast and cervical screening and even guilty if they don't screen. I've noticed the fear of cervical cancer is out of whack. Dr's exaggerate the risk to scare women into screening. In fact, if you fear cervical cancer, you should also fear non-Hodgkin lymphoma, melanoma, lung, bowel, ovarian and uterine cancer because they all occur more frequently than cervical. When we screen for a cancer, we increase the fear level for that cancer. I know women who smoke heavily, yet worry about cervical cancer. The link between lung cancer and smoking is well known and lung cancer is very common. It is surprising that vast sums are spent searching for a small number of cases, money would be better spent educating people on prevention and getting a HPV test for men on the market. Like others here, the risks are too high. I had one at 40 and that will be it for me. My Dr has accepted my decision.
—Guest Annette

Once a healthy girl

Lucy, me too, your post made me cry. I'm still a virgin at 46 and because of pap tests, will never experience sex. The negligent use of this test means many virgins get pressured into this testing and many lives have been wrecked, including mine. My sex life was destroyed before it even started. When you take a 19 year old girl in for laser conization, you change her forever, emotionally and physically. (even if the physical damage to your cervix repairs itself) My treatment was futile, virgins shouldn't even be offered pap tests. Responsible countries protect all women and screen keeping in mind that the aim is to help a few women while minimizing the damage to the healthy population of women. Their job is not to destroy the lives of as many women as possible. Our doctors are recklessly indifferent to the harm they cause and have no respect for women and as a result, we all suffer. I was too young to defend myself, but the system should have done that for me.
—Guest Sharee

First exam and VERY upset

It upsets me that I am being FORCED to go through with this exam in order to get the BC pill. If I don't go through with the exam, I will no longer have access to the pill and then my husband and I will most likely have a little bundle of joy in the next year or so. I do not want someone looking at me down there, that is for my husband only, and it should be my choice on whether I want to screen for cervical cancer or not. If I get cancer then fine, I will treat it when we figure it out, but is it really necessary to look at my lady parts for the next 30+ years to find that there is NOTHING wrong down there? It infuriates me, but I don't want a child just yet...I think I will resort to the good old condom...and pray that I don't get pregnant just because the freakin' doctor thinks that looking at me down there justifies giving me a pill that I as a woman have every right to have!!!!!!!!
—Guest Dkhan

I'm not satisfied

I'm a lawyer and need to satisfy myself about most things. Often public health objectives conflict with individual risk & autonomy. We are supposed to react to guidelines even when they come from doctors with a conflict of interest. Doctors are rewarded for numbers screened and not penalized for women harmed by screening. (false positives & excess treatment & false negatives) I have no issue with the nature of the test. I have a great female Dr who delivered my son last year. However, I won't do something demanded of me, if I'm unsatisfied of the risks, need and value of the test. When the risk of false positives is vastly higher than the risk from cervical cancer, then I'll make prevention of HPV and maintaining good health and a healthy lifestyle my top priority. The broad, high pressure & not entirely honest campaigns are inappropriate - ethically you can't pressure women to accept risk. However well-meaning, it oversteps the mark to do more than inform and extend an offer to us.
—Guest Libby (Sydney)

Maybe encourage high risk women

My issue with smears is their unreliability. Once you get an abnormal pap, you can't ignore it and end up referred to a colposcopy clinic. Paps are awful, but nothing compared to ablative/cryotherapy & conizations. I don't look at paps in isolation, but where they can lead. If I had a high risk of exposure to HPV, then I'd probably have a smear every 3 or 5 years. I have been careful though, mainly because I see the drama this test can cause in your life. I have high risk friends who enjoy one night stands and sometimes are stupid enough to forget condoms because they take the Pill. Some get paps, some don't and some are haphazard, but some get abnormal results and don't follow up because they've been there before and have lost faith in testing. If we adopted a practical approach and directed it to high risk women, I think this would be a better screening program. I don't think the threat can justify treating lots of low risk women. The Q: No, a baby or abortion won't help the situation. ***From Your Guide: I just wanted to say that I agree that the follow-up rigor is often far more of a problem than the test.***
—Guest Prue

Don't hamper access to BC!

Paps are probably a good idea for some women. I don't really worry about this cancer, more bowel cancer which took two family members. I put paps with mammograms, rectal exams and PSA tests. I don't see why tests for women should carry "extra" practices to almost force screening. Why should that be done to women and not men? I also find it hard to understand because cervical cancer is not all that common while prostate is a very common cancer. It is unfair to link it to something as important as BC. Unplanned pregnancies and abortions are serious threats to your health. There should be free access to BC. If you want to save more lives, it would make more sense to force prostate testing on men, yet that would never happen. Ask yourself why that would be unacceptable, yet we have doctors forcing women to have pap smears. Why the difference in attitude & thinking?
—Guest Rosalie

How do you feel about risk?

Well, it shouldn't be happening; it's unethical. It comes down to risk, how much risk are you happy to carry in your life and what sort of risk? Is the risk of an unnecessary biopsy or LEEP a bigger worry or the very small risk of cancer? I'm low risk and found the answer easy, but had to reach that decision without the help of doctors. Dr's will test you without individual assessment, it's the safest option for them. Although I've never understood why informed consent doesn't offer them even more protection. I'm unconcerned about my tiny risk from this cancer and don't like the idea of paps and shudder to think of excessive procedures. If I were higher risk, and I never will be, I'll make sure of that, then I'd have to think about a slightly higher risk along with the fairly high risk of procedures. I could choose no screening and watch for bleeding etc (which you should do anyway) or screen less often protecting myself from cancer AND biopsies. Only "you" can answer that question.
—Guest Jennifer D
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