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← Why I'm saying no to a smear

Why I'm saying no to a smear - Comments

Schrodinger's Cat's Avatar Comment 1 by Schrodinger's Cat

My wife declined cervical smears for much the same reasons. The doctor's surgery then wanted a signed declaration of withdrawal, along with proof of identity.....even though she'd only just seen the doctor.

Tue, 20 Mar 2012 20:04:58 UTC | #929081

Rawhard Dickins's Avatar Comment 2 by Rawhard Dickins

I read through this waiting for the punch line like "..but what would Jesus do" and it didn't happen, maybe I've been listening to too much BBC radio.

On a serious note, "all clear" tests can lead to somewhat more reckless behaviour, I think I've fallen for this to some degree.

Tue, 20 Mar 2012 22:12:25 UTC | #929105

mmurray's Avatar Comment 3 by mmurray

I have two concerns about this article.

Firstly many (most ?) people are irrational about this kind of testing even doctors I know. They would rather not do it as it reminds them of their own mortality. "If I don't do the test I won't find out anything bad." That's the reason I keep forgetting to go and do my PSA test.

Secondly she glosses over bowel cancer screening without making an argument for or against it. I know there are many false positives with the faecal blood tests and possible side-effects of the follow up colonoscopies but I thought the evidence was clear that they save lives.

Michael

Tue, 20 Mar 2012 22:15:01 UTC | #929106

alaskansee's Avatar Comment 4 by alaskansee

@ mmurray

I think the principle here is that they do save lives but at what cost? If you can save 1 in 600,000, as the Swedish prostrate cancer study showed, but you operate on 50,000 unnecessarily and scare the shit out of 200,000 it looks like there is little point to the exercise, unless you're Mr 1 in 600,000.

These are good arguments for governments looking at allocation of limited funds, they are not for people who actually have medical problems. They are also good arguments for people who will get a false positive and spend much time and effort until they are given the okay, they are not good arguments for profit driven healthcare providers either.

No right answer but some significant statistical evidence that not screening benefits the community. The lives that could be saved with the funds currently used in screening, false positives, unnecessary operations and support is perhaps a better argument.

Tue, 20 Mar 2012 23:21:08 UTC | #929121

xmaseveeve's Avatar Comment 5 by xmaseveeve

''Clearly, most of these "abnormalities" mean very little – 10 per cent of the population don't die of these "problems".''

Only 1 in 10 does NOT die?

''Screening can throw up all sorts of unanticipated problems; shouldn't we know this before stepping into a scanner?''

What? Oh, she's selling a book... If this woman is a GP, then I despair. As another doctor commented on their thread, she is putting lives at risk.

Comment 1, Shrody,

''The doctor's surgery then wanted a signed declaration of withdrawal, along with proof of identity''

They may be held responsible for her death ('God' forbid) unless they can prove that she was warned. (It's their duty of care to warn us.)

Comment 2, I don't understand what you mean. More accidents involving the happy?

Comment 3, Mike,

I too noticed the shifty reference to bowel cancer screening. The woman is scaremongering. She is under a duty of care. Hasn't she heard of 'First, do no harm'? She does not represent medical opinion, and she knows that people trust her opinion. Shameful.

Comment 4, Alaskansee,

''there is little point to the exercise, unless you're Mr 1 in 600,000.'

We are all Mr. 1 in 600,000.

''No right answer but some significant statistical evidence that not screening benefits the community.''

Not true - back in a minute.

Wed, 21 Mar 2012 00:14:57 UTC | #929132

xmaseveeve's Avatar Comment 6 by xmaseveeve

This is the post I referred to from The Independent thread:

''Cervical cancer is caused by the Human Papilloma Virus.

This virus is endemic so the chances are that if you have been sexually active you have been exposed to the virus. To think that smoking is a major factor in this disease in the cervix is quaint.

Most people defeat HPV but about 5% do not. If the HPV is a cancer forming strain (16 and 18 common in Europe) then you may get this cancer. There are over 40 HPV strains and about half cause cancer.

The real screening test of value would be one for persistent HPV infection (it exists). In the absence of that the smear test is all the UK use but HPV testing is more effective.

For you as a doctor to suggest that no testing is ok is I think irresponsible and perhaps many thousands of women that take your advice will be at risk. I agree that testing should be improved. I also agree that mass screening is inefficient but that is the best we have. We also vaccinate young women to prevent HPV 16 and 18 but that is not good either. What we need to know is who cannot defeat the HPV virus naturally. That is the test we need. The HPV Vaccine is treating over 95% of healthy young women that are naturally immune and massive cost (£350 per patient) We need a treatment that kills the virus in persistently infected people, that would be far cheaper and less burdensome but it does not make as much profit for Pharmaceutical companies hence they prefer a scatter gun vaccine.

My wife is recovering from HPV cancer, the treatment for her head and neck cancer was very tough but she has come through it so far. HPV kills women much younger than 60 (our age).

To be clear the risk factors for contracting HPV are: The number of sexual partners you have had. The sexual habits of you and your sexual partners. The genetic propensity of your family to cancer.

HPV can cause cancer of the cervix, the vulva, the anus, the head and neck. It is implicated in breast , oesophagal and skin cancer.

Men are more than 6 times more likely than women to get head and neck cancer. Head and neck cancer is on the increase. In the third world cervical cancer is a major killer partly due to the lack of smear tests and other screening.

As a doctor you are in a very informed position and can make such decisions with more accuracy, to glibly put that responsibility on people without your training is perhaps optimistic.''

Wed, 21 Mar 2012 00:26:15 UTC | #929135

QuestioningKat's Avatar Comment 7 by QuestioningKat

These types of articles are very troubling to me. I rationally understand the comment "found that 1,000 women have to be screened for 35 years to prevent one death from cervical cancer; and to prevent that death, 80 women have to have further investigation, with 50 women having treatment to their cervices." is a low number. I also understand how this information can be used by insurance agencies to prevent women from being tested. Mammograms are frequently under scrutiny because of statistics show that X number of women need to be screened for x years to prevent one death.

Here is the thing. When I get a mammogram I'm not considering the thousands of other women in the statistics. I'm wondering if that one mammogram out of say 35 mammograms, that I will have in my entire life, is positive or not. My guess is that everyone knows someone or many who have had breast cancer, maybe even a family member. Imagine being a woman restricted by her insurance agency to one mammogram every two years, or maybe every three years. What if you would have to wait one or two years before finding out you have cancer?

The author also has not had her cholesterol tested. I had mine first tested in my mid twenties. It was bordering on high ( and is now high.) It should not have been taken so nonchalantly. Considering my family history and my lack of awareness that I had a heart issue at that time. I lost about 25 years of taking better care of my heart health.

Again a very troubling issue.

Wed, 21 Mar 2012 00:30:48 UTC | #929136

B33b13br0x's Avatar Comment 8 by B33b13br0x

I'm kind of at a loss to understand why this piece is reproduced here. Doesn't seem normal rd net material.

Wed, 21 Mar 2012 00:36:18 UTC | #929137

Agrajag's Avatar Comment 9 by Agrajag

...screening tests are for people who are well and who have no symptoms for disease.

They are also for well people who have a family history of disease.
My mother and maternal grandmother both died of colon cancer. I probably won't. I'm getting a colonoscopy every 6 years, and so far have had nothing more than a polyp or two.

One of my professional colleagues turned 50 and presented himself for a routine "screening" colonoscopy. He had no family history, signs or symptoms, had been negative for occult blood... but was found to have a tumor almost big enough to obstruct his colon. Fortunately, after chemotherapy and surgery he is looking at a favorable prognosis.I think we could agree the test saved his life.

The colonoscopy is not a difficult test. The "prep" is a bit unsavory, but once given a clean bill of health, most people won't need another test for 10 years. Colon cancer is one of the MOST PREVENTABLE cancers.


It sounds to me like this particular MD does not need a colonoscopy, because she has her head far enough up her ass to see for herself. Steve

Wed, 21 Mar 2012 01:14:53 UTC | #929141

78rpm's Avatar Comment 10 by 78rpm

In agreement with Comment 8. The moderators exfoliate comments that are off topic or otherwise not appropriate to RD Net. This piece seems extremely peripheral to what we are here for, and the moderators could have rejected it with no loss to the forum.

Wed, 21 Mar 2012 01:17:14 UTC | #929142

Ignorant Amos's Avatar Comment 11 by Ignorant Amos

Excuse my simpleness, correct me if I've got this up the left.

I'm taking it from the OP that the risk in not getting an NHS screening is deemed preferable compared with the risk of a misdiagnosis from a ropey NHS screening, and therefore undergoing unnecessary permanent surgical procedures and the associated stress of that misdiagnosis, making it the lesser of two evils? The better option instead, is to go to your GP as soon as any symptoms present themselves, and in doing so, get the more preferred and in-depth diagnostic examination required. Which is more likely to find something that might have been missed at a screening, and because it is missed, will now be overlooked by the patient because having been given they have been given a clean bill of health at the screening and no longer has any concern. Seems like a game of probabilities to me. A bit of a gamble to be sure. I'd like to see more figures.

Wed, 21 Mar 2012 01:49:37 UTC | #929147

Ignorant Amos's Avatar Comment 12 by Ignorant Amos

Comment 10 by 78rpm

In agreement with Comment 8. The moderators exfoliate comments that are off topic or otherwise not appropriate to RD Net. This piece seems extremely peripheral to what we are here for, and the moderators could have rejected it with no loss to the forum.

Well that is evident by the interest being taken, that's for sure, but it was enough to ignite world war three between me and my partner culminating in me on the settee for the night I fear.

That said, the topic fits okay within the parameters of the mission statement. Not that the mods care either way, just saying.

Wed, 21 Mar 2012 01:56:53 UTC | #929151

helena!'s Avatar Comment 13 by helena!

Strange piece indeed coming from a doctor? Proves there are no bounds for cognitive dissonance I would say. Ah well. Anyway here in Canada you can go all you want for all the tests you want so I suggest everyone at least go for their yearly physicals. Take advantage of the wonders of modern medical science. I know people who avoided the doctor but now are dead.

Wed, 21 Mar 2012 02:02:39 UTC | #929155

xmaseveeve's Avatar Comment 14 by xmaseveeve

I think we should urge our loved ones to be tested, if they say they don't want bad news. I never get tested for anything, but I know I should. 'Don't die of ignorance'. I can't understand the point of the OP at all. Sleep tight, Amos!

Wed, 21 Mar 2012 02:12:26 UTC | #929157

mmurray's Avatar Comment 15 by mmurray

Comment 4 by alaskansee :

@ mmurray

I think the principle here is that they do save lives but at what cost? If you can save 1 in 600,000, as the Swedish prostrate cancer study showed, but you operate on 50,000 unnecessarily and scare the shit out of 200,000 it looks like there is little point to the exercise, unless you're Mr 1 in 600,000.

Sure but the PSA test is a particularly bad example of a screening process as an elevated PSA is fairly lowly correlated with prostate cancer (40% ??) and even "unusual" cells in a prostate biopsy I think are not always indicative of cancer or of cancer that is fast enough growing that it is going to kill you before something else does. Coupled with that the side effects of intervention can be unpleasant if you become impotent or incontinent. On the other hand I have had two colleagues retire from work and die a couple of years later from prostate cancer. So if you really have got it it's bad news as well.

I don't think she should mix all these tests together. Each should be considered on it's merits.

No right answer but some significant statistical evidence that not screening benefits the community. The lives that could be saved with the funds currently used in screening, false positives, unnecessary operations and support is perhaps a better argument.

Agreed but she seemed to be giving an individuals perspective rather than a best use of funds argument.

Michael

Wed, 21 Mar 2012 02:15:08 UTC | #929158

mmurray's Avatar Comment 16 by mmurray

Comment 9 by Agrajag :

The colonoscopy is not a difficult test. The "prep" is a bit unsavory,

Yeh great isn't it. But trivial in the grand scheme of things we are talking about.

once given a clean bill of health, most people won't need another test for 10 years. Colon cancer is one of the MOST PREVENTABLE cancers. It sounds to me like this particular MD does not need a colonoscopy, because she has her head far enough up her ass to see for herself.

LOL

Michael

Wed, 21 Mar 2012 02:21:02 UTC | #929160

Ignorant Amos's Avatar Comment 17 by Ignorant Amos

Comment 15 by mmurray

So if you really have got it it's bad news as well.

It matters not. If the man in the sky has prostrate cancer against yer name in his great big book, all the screening in the world will make no difference }80)~

Wed, 21 Mar 2012 02:26:42 UTC | #929162

green and dying's Avatar Comment 18 by green and dying

They stopped offering smear tests to women under 25 in England because that group of people are so unlikely to benefit from it but are more likely to get false positives which cause damage. People got upset because a few people do get cervical cancer under 25 but I think it's completely reasonable. If the same argument applies to ALL smear tests on women with no symptoms (although it's less clear cut than in the under 25s group) then I don't think this GP is being irrational or unreasonable. It's not all about how many people end up dead when they could have been saved. Death is not the only negative outcome here.

We could screen everyone for everything constantly and we'd save a few extra lives when a few people got something extremely rare for their demographic, but unless all of the tests were 100% reliable that would put a lot of other people through unnecessary treatment and worry.

On the other hand I think in general people should trust their doctors about these things because most people aren't good at interpreting statistics properly. So I'm not sure I think writing this article was the best idea.

Wed, 21 Mar 2012 02:40:16 UTC | #929166

Agrajag's Avatar Comment 19 by Agrajag

Comment 17 by Ignorant Amos

It matters not. If the man in the sky has prostrate cancer against yer name in his great big book, all the screening in the world will make no difference }80)~

I just learned today that a highschool classmate who turned out to be a Greek Orthodox priest died a few days ago of oropharyngeal cancer less than two years after diagnosis. His church had this to say:

Christ is in our midst!

Dear Brothers and Sisters in Christ,

I am very saddened to inform you that the Reverend Protopresbyter Kornelios Papadopoulos, fell asleep in the Lord at his home Saturday afternoon.

He endured a long struggle with cancer, and courageously faced all difficulties with faith and hope in our merciful and compassionate Lord, Jesus Christ.

Rather shabby treatment by his employer, I'd say.
Why "saddened"? Isn't he in the lord now? Steve

Wed, 21 Mar 2012 03:10:25 UTC | #929176

smitemeifudare's Avatar Comment 20 by smitemeifudare

This woman is saying she wishes to be wilfully ignorant of any possible condition ,probably up to the point where she might develop cancer past the point where it could be treated, The old addage of prevention being better than cure rings true, especialy when large of money have been invested in screening programmes.She is of course free to do as she wishes, but if i could prevent a disease, or find it at a treatable stage, i would prefer that to being told "you have X months to live".

Wed, 21 Mar 2012 03:30:49 UTC | #929181

jmacarth's Avatar Comment 21 by jmacarth

I wish I had a G P like Margaret. I've studied Public Health and have a good understanding of screening the pros and cons. Trouble is most people don't, therefore they are herded into these programs believing they're doing something positive for their health which may not be the case. ( especially if they're unfortunate enough to be one of the many false positives)! I recently had a smear after a 4 year gap, I haven't had a mammogram and don't want my breasts X-rayed. I do have a good diet and would seek medical assistance if I was worried about changes. Personal responsibility and good information not just one size fits all advice is best way- and a good GP,

Wed, 21 Mar 2012 03:32:50 UTC | #929183

AtheistButt's Avatar Comment 22 by AtheistButt

Hey folks - can we get the name of the disease right? It's 'prostate', not 'prostrate'. The latter must be the one for when you just want to lie down all the time.

Wed, 21 Mar 2012 04:30:32 UTC | #929194

xmaseveeve's Avatar Comment 23 by xmaseveeve

Is this GP a Christian, by any chance? Is she saying leave it in the lap of the gods? Or 'God'? I cannot work out the subtext, the agenda. Ultimately, wouldn't you rather have a false positive than die a preventable death? I think I'll go for my tests now.

Wed, 21 Mar 2012 04:55:37 UTC | #929200

jmacarth's Avatar Comment 24 by jmacarth

It's not really issue either to die or endure the anxiety of a false positive. It's fine to go ahead and have the screens just be clear about the limitations of their indicators of health. If you do get a positive be prepared to feel pretty anxious for a while. There's no leaving things to the gods, I think she suggests we are vigilant about changes and get diagnostics tests if concerned

Wed, 21 Mar 2012 05:31:43 UTC | #929205

mmurray's Avatar Comment 25 by mmurray

Comment 17 by Ignorant Amos :

Comment 15 by mmurray

So if you really have got it it's bad news as well.

It matters not. If the man in the sky has prostrate cancer against yer name in his great big book, all the screening in the world will make no difference }80)~

This kind of brings us back to the gender of God issue. Does God have a prostate and who in heaven has the job of giving it a check!

Michael

Wed, 21 Mar 2012 06:32:53 UTC | #929212

mmurray's Avatar Comment 26 by mmurray

Comment 24 by jmacarth :

It's not really issue either to die or endure the anxiety of a false positive. It's fine to go ahead and have the screens just be clear about the limitations of their indicators of health. If you do get a positive be prepared to feel pretty anxious for a while. There's no leaving things to the gods, I think she suggests we are vigilant about changes and get diagnostics tests if concerned

But there is more to good health than being vigilant about changes and going to the doctor when you have a concern. If you take this approach there are lots of things that you won't discover until it is too late because the early stages are non-symptomatic. Such as high blood pressure leading to stroke, glaucoma leading to blindness, faecal blood which you can't see but which might indicate pre-cancerous polyps, ...

Michael

Wed, 21 Mar 2012 06:37:01 UTC | #929213

strangebrew's Avatar Comment 27 by strangebrew

i always was under the impression that early intervention was the key to survival rates?

How is that achieved without a biological MOT...would have thought that family medical history was the deciding indicator whether scans or smear tests was prudent ...very peculiar rant by an apparent GP?

Wed, 21 Mar 2012 08:17:45 UTC | #929222

mmurray's Avatar Comment 28 by mmurray

She has a blog

http://www.margaretmccartney.com/blog/

and a book.

Michael

Wed, 21 Mar 2012 08:40:05 UTC | #929225

This Is Not A Meme's Avatar Comment 29 by This Is Not A Meme

This smacks people as distasteful and stupid, and some comments are at a loss to explain that feeling.

I think of the horror stories of a recent era where women were taught to be so ashamed of their bodies that cancers would fester for years. They didn't look for lumps. If one grew so big it was felt in passing, they might not act on it and only went to the doctor when the cancer was debilitating them. By then it may have spread to the bones, and no amount of horror ever seemed sufficient to cause the needed social change. I grew up learning that things began to shift when Betty Ford (the wife of a powerful man) developed breast cancer. As far as celebrity-driven frenzies are concerned, mass testing was a pretty good one. Aside from the lives saved, we have a healthier culture where women's bodies are more normalized (which probably improves medical practice too). There is a herd advantage.

The author is not saying "no" to anything. I don't say "no" to syphilis testing, I just live in ignorance of my syphilis status. The author opts for ignorance, which is totally fine but I do question the morality of promoting such ignorance as an enlightened choice. Not every single thought she has deserves printing. The stats on smoking can be represented the same way, but no one says they smoke cuz they're so damn clever.

It's a stupid, needless risk taken for mild convenience. It's nothing to be smug about.

Wed, 21 Mar 2012 10:14:35 UTC | #929230

njwong's Avatar Comment 30 by njwong

I think Dr McCartney has clearly indicated that she is "not against screening, but am against unthinking screening".

Besides, there have been quite a number of reports recommending the same advice that Dr McCartney had given. Screening is performed on "healthy" people without symptoms, and merely identifies people at an increased risk who are then recommended to go for follow up diagnostic testing. However, the majority of those who do the follow up diagnostic test do not show any cancer at all - because these people are the "healthy people without symptoms" in the first place. It is precisely because the efficacy of such screening tests are not very high that we should really ask whether we should spent such a huge amount of money on screening in the first place.

For example, according to this article:

Percentage of eligible females screened for cervical cancer:
USA - 86%     OECD average - 61%

Cervical cancer 5-year survival rate:
USA - 64%     OECD average - 66%

Although the USA had significantly more screening than the OECD countries, the survival rates in both the USA and the OECD countries were about the same. From the data, I would think that the increased screening rate in the USA offered no benefit whatsoever as compared to the lower screening rate in the OECD countries.

Ultimately, everything must be weighed against the benefits and the costs.

And I don't buy the reason that it is better to go for a screening (despite its dubious efficacy) than to not go for a screening. That sounds exactly like a Pascal Wager cop-out.

Wed, 21 Mar 2012 10:45:49 UTC | #929235