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Anonymous

I think over-testing is an issue - many women find pap tests violating, uncomfortable, painful etc - it shows a lack of respect for our bodily privacy to over-screen. Also, over-screening leads to over-detection and few women are happy to leave an "abnormal" result sitting on their file. Australia has huge over-treatment rates as a direct result of over-screening and some women are left worse off with damage to the cervix that can lead to premature babies, the need for c-sections, cervical stenosis etc
Almost all of our referrals are unnecessary - lifetime risk of cc is 0.65% - take out false negatives, less than 0.45% can be helped, while our referral rates are 77% - it's higher in the States.
The Dutch and Finns have programs that provide some protection for the more than 99% who can never benefit - they offer 5 to 7 pap test programs (5 yearly from 30 to 50 or 60) and there are self-test pap and HPV kits. The Dutch are moving to 5 hrHPV PRIMARY tests offered at 30, 35, 40, 50 and 60 and only those positive will be offered 5 yearly pap tests. Those negative and in a monogamous relationship or no longer sexually active might choose to stop all testing and revisit the subject if their risk profile changes in the future.
This greatly reduce the amount of testing and over-treatment and identifies the small number at risk - only 5% by age 40.
Whereas here, a small problem has been turned into a highly lucrative industry in over-treatment - a small problem has a major negative impact on the lives of women not even "at risk" from this rare cancer.
I agree that the over-treatment of women is horrifying - when you consider this is a rare cancer and a small risk, damaging treatments should be avoided, but then women have never received decent information about this testing - most of the information we get is biased and misleading and that means we can't make informed decisions. Most women are not giving informed consent for screening, it's impossible unless you do your own research. I know some women are still having hysterectomies for pre-cancer or dysplasia or CIN 3 (mainly in the States) and that is just shocking...it should amount to professional misconduct. Also, testing women under 30 is unhelpful and harmful, they are excluded for their own protection in many countries - testing doesn't change the tiny death rate, but this group produce the most false positives. (1 in 3 for those under 25)
These women can produce highly abnormal pap tests (false positives) and can end up having damaging over-treatments. The pap picks up as abnormal, normal changes in the maturing cervix or transient and harmless infections.
The Finns have the lowest rates of cc in the world and send the fewest for biopsies etc - they offer 7 pap tests, 5 yearly from 30 to 60.
As a low risk woman, my risk of cc was near zero, it was an easy decision to pass on testing almost 30 years ago now. I did not get the information I needed from my doctor or the screening authorities, I had to do my own research. Its been hard watching friends and family being worried sick and harmed by this program over the years. There are far better ways of dealing with this rare cancer without harming the masses.
I agree - the entire focus is on rare cervical cancer, while other HPV related cancers are virtually ignored. Males were excluded from the HPV vaccination program even though more people die from head, neck and oral HPV-related cancers than rare cervical cancer. It's just that cervical cancer screening is backed by powerful cancer charities, women's groups and those with a vested and political interest in these screening programs. Bowel cancer takes far more lives, but the screening program struggles for funding. The money goes to the loudest voice...

December 4, 2011 - 6:10am

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