Wednesday, September 26, 2012

Questioning the need for pap smears

About pap smears (or cervical screenings)

 Someone shared in Yahoo Answers:

"Abnormal pap tests are VERY common, almost all are false positives. False positives are even more common in women under 30 (1 in 3 for those under 25)...in fact, in many countries pap tests are only offered from age 30. The UK doesn't test before 25 and after reviewing all of the evidence a couple of years ago declined to lower the testing age to 20...Dr Angela Raffle, world expert on screening, concluded it was unethical to screen women under 25. No country in the world has shown a benefit pap testing women under 30# but young women produce the most false positives.

Cervical cancer is rare, very rare in young women...women need to be careful agreeing to pap tests during pregnancy or for 6 months to a year after delivery - you are even more likely to get a false positive at these times due to birth trauma and hormonal changes.

Pap testing is a screening test, if you're symptomatic you don't need pap tests, you need a proper assessment by a specialist...bleeding for 5 months after delivery is not normal, you may have some retained placenta...also, bleeding can produce a false positive pap test.

So, don't panic...the lifetime risk of cervical cancer is 0.65% (LESS than 1%)...keep things in perspective and see a decent doctor.

Don't feel you have to apologize to doctors - pap tests, colonoscopies, mammograms, PSA testing are all "elective" cancer screening tests, they can never be anything other than elective. As a low risk woman I made an informed decision not to have pap tests about 30 years ago, my risk of cc is near zero, I was not prepared to accept a 77% lifetime risk of colposcopy/biopsy, almost all false positives and the high risk of over-treatment...that can damage the cervix and lead to premature babies, c-sections, miscarriages etc

Now we know that only 5% (roughly) of women benefit from pap tests, those women who test positive for HPV at age 30 or older - this is the new Dutch program - women will be offered 5 hrHPV primary triage tests at ages 30,35,40,50 and 60 and ONLY the roughly 5% who are positive and at risk from cc will be offered a 5 yearly pap test (until they clear the virus)....those HPV negative will be offered the HPV primary testing program and there is also a reliable self-test option, the Delphi Screener. Those HPV negative and confidently monogamous or no longer sexually active can forget all further testing. This program will save more lives by identifying those women at risk and spare HUGE numbers of not-at-risk women from a lifetime of unnecessary pap tests and the fairly high risk of false positives and potentially harmful over-treatment. (about 95% of women aged 30 and older)
Sadly, in most countries the programs are not based on the evidence and that means women suffer...from lots of unnecessary pap testing, excess biopsies and over-treatment and some lose their lives...pap testing is less reliable than HPV primary testing.

You might want to get a second opinion before allowing a biopsy..."
I agree with the answerer that there are lots of unnecessary pap testing in most countries, and this Natural News health website also notes that the medical industry and pharmaceutical industry nowadays are mostly motivated by politics and profits.

Someone shared in this website:
"I think only  women in the west  are the only women who believe they need routine annual gynaecological exams.
I'm 51 and have had one pelvic exam in my life - when I was symptomatic - it turned out to be nothing....
The medical journals have lots of research and articles to show that these exams are unnecessary in asymptomatic women and can be harmful"
 Alternative tests for cervical cancer

CSA Blood Test

I learnt that there is a new and better alternative way of testing called the CSA (Cervical Specific Antigen) Test, which is non-invasive and much more accurate..

I googled about Cervical Specific Antigen, and came across some similar testimonies of how women decided not to do pap smears - they are in the comments section of this website http://dodomar.hubpages.com/hub/For-any-woman-fearing-an-OB-GYN (need to ignore the article on top and scroll down instead to read these testimonies). Here's sharing some of the testimonies below.
"
Loren 23 months ago
After doing my research I don't do pap smears anymore. I'm not scared of getting cervical cancer. I hated having pap smears and I think all the anxiety I used to have over them harmed my health. My blood pressure used to always be sky high when I would have a pap smear. They're degrading and I refuse to let myself feel so violated anymore. I feel so happy and free thinking about not ever subjecting myself to the discomfort and humiliation again. It was depressing.

Sienna 
2 years ago
Young women beware...pap tests cause more harm than good!
Here in Australia teenagers and early 20's women are still screened even though the evidence of enormous harm has been clear for years. There are no benefits for women under 25 so it's a futile and risky exercise.
Don't put yourself through it and end up with cervical damage and emotional problems, these biopsies are nasty.
This was in the paper last year:
Pretty clear isn't it?
Yet now we have ads on TV calling for young women to screen and a scary campaign featuring a 21 year old woman, a rare, rare case and she had a normal pap smear 6 months before she was diagnosed so the pap test didn't help her, it might have delayed the diagnosis. Naturally they didn't mention that fact...it was all praise the pap smear nonsense once again.
This is what happens when you screen young women - every 2nd or 3rd pap is "abnormal" and these poor girls are referred...false positives...scary stuff - and the one or 2 with a real problem are missed.
The Government is about to change our program FINALLY protecting young women from harm, but astonishingly they're investing AT THIS STAGE half a million tax funded dollars on a scary campaign to get young women to do what they absolutely should not do if they value their health and their ability to have babies one day.
This is beyond negligent and irresponsible.
It's like...let's harm as many young women as possible before the change is made.
I'm sure lots of young women will get screened and end up damaged...I hope they all take legal action.
They didn't need to suffer...."
"Also, there is a simple blood test which is almost 100% accurate that tests for cervical cancer - it's called the CSA Test (cervical specific antigen) and was patented about 4 years ago in the States. Women should demand access asap - write to your politicians and womens action groups. There are many vested interests in the lucrative business of cervical cancer screening that will not give up their market and control easily...
You'll find information on line at the Cervuis and Onconix websites."

From what I read in the CSA blood test website http://onconix.net/pap_smear_limitations.htm the CSA blood test is much more accurate test than pap smear (which is found to be unreliable, according to the many testimonies I have read so far), and is also convenient.

Delphi Screener Self Test

I have checked out the website http://www.asexuality.org/en/index.php?/topic/70367-byebye-pap-smear-pelvic-exam/ as well as a few other related websites. I agree with the first post that says:
"If you hate traditional pap smear and pelvic exam and want an alternative: Do the research first on your options. After the research, I would go to your GYN doctor and say "NO to traditional pap smear & pelvic exam AND say I want my CSA blood test and delphi screener instead."
CT scan

I think that if a CT scan showed no sign of abnormalities in the pelvic and abdomen regions, it would also indicate strongly there is nothing wrong with these areas. As for women in the East, we seem to hardly hear about cervical cancer and they don't do cervical test pap smears too. I think only in modern cities, where western medical practices have an increasing influence, the GPs are starting to advocate (or rather propagate/advertise) pap smear tests to women - I think it's part of the medical propaganda from the West.

DR-70 blood test

I also learnt from this petition website that there are alternative non-invasive tests, besides CSA blood test, such as DR-70 blood test and urine sample tests that can be used for pelvic exam screening. http://www.thepetitionsite.com/18/the-right-to-pelvic-exam-alternatives/

"In other countries such as China use a CSA blood test that some believe to be even more effective that a pelvic exam. DR-70 is a simple blood test that can also detect it. Verbal questionnaires can eliminate the need to look for skin cancer, which can often hide in the nether regions. Urine samples can be used to test for cervical cancer and HPV. There are also personal vaginal swabs or a Self Pap that can be used in the bathroom and then given to the doctor to replace the PAP smear. Some places offer lessons in self pelvic exams,"
I googled about DR-70, and came across this website. http://www.mnwelldir.org/docs/cancer1/dr-70.htm
"In June 2000 the FDA approved a new cancer screening test called DR-70. It is a simple blood test the screens for 13 different cancers all at the same time. Clinical studies have been conducted all over the world and the results showed that it detected cancers of the lung, colon, stomach, liver, pancreas, rectum, ovaries, esophagus, cervix, uterus, thyroid, breast and even malignant lymphoma. The test is simple, non invasive, and costs right around $100.
You will have to ask your doctor for this. Odds are s/he might not have heard of it. If s/he hasn't heard of it, the phone number to AMDL, Inc., the company that developed it, is  714-505-4460 , or you can go to their web site atwww.amdl.com."
It is good to know there are safer, more convenient and non-invasive screenings available, and I hope these options are available in more clinics.

Why a GP is saying no to pap smear

I also read this article, which I find quite balanced. http://www.independent.co.uk/life-style/health-and-families/features/why-im-saying-no-to-a-smear-7577967.html I think the GP who wrote this article has made a strong case on why she's saying no to a pap smear, since it's optional and it often carries more risks than any potential benefit, and she considers herself having low risk for having cervical cancer (since she doesn't smoke, for example). Besides, it is noted that cervical cancer is indeed very rare, and therefore not worth the risk of pap smear too.

I agree with Michaela's view at the bottom of this website http://dodomar.hubpages.com/hub/For-any-woman-fearing-an-OB-GYN that women have every right to be given risk information on cervical screening by the GP, and they are free to decline any and all medical examinations.

Awareness about alternatives to gynecological exams

I think it is good to be part of this Facebook community "Against Gyn Exams" as they are here to "exchange articles and websites on the subject to increase awareness of the many existing alternatives and scientific facts about gynecology, its history and unravel the real motivations behind gynecology", according to the profile description. It is also good that we have such useful information and testimonies available online, which enable us to make informed decisions, especially when it comes to certain medical exams that may affect our health and well-being.

Even though some women may think that the peace of mind is well worth taking pap smear, I find that in many other cases, women prefer to have other alternatives to pap smears because they find pap smears unreliable and a bit risky, if not humiliating or embarrassing.

I agree with the following comment I read at the bottom of this website http://feministsforchoice.com/why-must-a-pap-smear-be-so-awkward.htm that people need to be given a choice on whether to accept a screening test.

"Elizabeth says:
Sandra,
An appropriate screening test must meet a few criteria, one being the test must be acceptable to men or women. Yet I have always felt women were told they must find it acceptable, no one really asked women how they felt about this test. Self- test options have been blocked or discouraged in many countries, many countries screen too often or too early worrying and harming huge numbers of women unnecessarily…in ethical and evidence based hands, most of this damage was avoidable. Now there is no excuse…"

Profit-oriented nature of medical screenings

I have come to see that GPs in western (and westernised) societies seem to follow (perhaps blindly) their medical procedures, when it comes to recommending cervical screening, for example, - and part of their motivation could also be that their practice gets paid a bonus for achieving certain levels of screening, as shared by this person below. 
http://www.independent.co.uk/life-style/health-and-families/features/why-im-saying-no-to-a-smear-7577967.html

scotslass6 months ago
"As far as I can see, noone has pointed out one of the main reasons for GPs pressurising women into screening. Their practice gets paid a bonus for acheiving certain levels of screening, just as they do for childhood immunisation.
I'm all for people being allowed a chouce to opt out, but when they do their GP and the health authority should accept this" 
 Patriarchal influence on medical exams

I have come across a few observations online about the unfair or unequal treatment of women in medical examination matters, partly due to the male-dominated patriarchal mindset. Here's an example.
http://againstallevidence.wordpress.com/2010/12/30/cervical-screening-lies-part-1/
"Lishra,
Exactly, and we don’t see that sort of attitude in male cancer screening – there IS a double standard in medicine. My husband was “offered” prostate screening when he turned 50 and I was astonished to see he was handed a long sheet listing the pros and cons of testing – his doctor stressed cancer screening is elective and entirely his decision.
Women are treated SO differently – ordered, pressured, coerced or scared into screening with IMO, misleading and even incorrect information. Zero respect for informed consent and our doctors even get paid behind our backs for numbers screening…counted like sheep being run through dip!
Yet prostate cancer is common, cervical cancer has always been rare and that’s the difference, you MUST screen very large numbers if the disease/cancer is rare and with an unreliable test that means a BIG and negative impact on healthy women – the more than 99% who’d never have an issue with this cancer.
It means this program is only viable IF unethical measures are used and informed consent is ignored – IMO, that makes the program unethical and illegal…it violates our legal rights and ethical standards.
I guess keeping women ignorant has protected the Govt and doctors from law suits from women harmed by over-treatment – most women walk away relieved they don’t have cancer or assume they were “treated” for cancer. When women don’t have basic information about this testing, it means legal action is unlikely as few women will put 2 and 2 together and realize they didn’t give informed consent in the first place: How many women even receive the pros and cons of testing from their doctor? Most women tell me they’re basically told by their doctor that all women MUST test, it’s part of being a woman…doctors have been getting away with this for decades.
Time to challenge them…I’d urge every woman to speak up and stand firm when her rights are violated – ask doctors about false positive rates, the rareness of the cancer, the evidence that testing helps women under 30….when you have the correct answers, you’re better able to assess your doctor’s answers."

Conclusion about cervical screenings

Much of the medical profession in modern societies is partly influenced by patriarchal mindset, and partly influenced by the profit nature of the medical industry. Even in clinics here in Singapore, I see posters advertising about cervical cancer vaccines to women. When I googled about pap smears earlier on, I see a number of websites of hospitals and polyclinics in Singapore propagating about women above 30 to take pap smears every 3 years, and not much information was given about the possible risks of the pap smear test. One thing I noticed also is that it seems most people in Singapore are not outspoken about this either, unlike in the West. It is only through internet research have I begun to realise the dubious motivations of the medical industry behind their propaganda about cervical screening.

What about mid cycle spotting if one doesn't want to go through cervical screening?

I googled to find out more about mid cycle spotting, and some websites say "Fortunately, mid-cycle spotting is usually nothing to worry about." as it could be due to hormonal changes, for example, which is normal/common. http://answers.yahoo.com/question/index?qid=20100904112118AAdvb76
You could consider taking alternative screen tests, such as the CSA blood test, just to put your heart at rest.

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