Melissa, I agree with most of your points, but not about screening.
"Don't put off having your cancer screening tests."
It is inappropriate to present screening as mandatory - it is legally and ethically an "offer" that requires our informed consent. After reviewing the evidence and considering my risk profile, I have always rejected pap testing and more recently declined mammograms. It is more appropriate to say, "you might consider cancer screening" - of course, the problem in this country has always been accessing "real" information that can help you make an informed decision. Women's cancer screening IMO, is paternalistic and there is an absence of balanced information on the risks and actual benefits of testing. I had to go to overseas sources for my information.
I'm sorry to say that any woman following the Aussie pap testing program is seriously over-screening and that leads straight to over-detection and potentially harmful over-treatment. LOTS of worrying and frightening false positives. Cervical damage from unnecessary biopsies and treatments can damage the cervix and lead to infertility, premature babies, more c-ections, cervical stenosis etc.
We have huge over-treatment rates. No woman needs 26+ pap tests. That also shows IMO a deep disrespect for the bodily privacy of women - many women find this test difficult for lots of reasons. No country in the world has shown a benefit pap testing women under 30, but all have evidence of harm - they produce the most false positives. Many countries exclude them from screening for their own protection.
Two yearly screening is over-screening and greatly increases the risk of over-detection for no additional benefit over 3 yearly or only marginal benefits over 5 yearly. Fortunately more women are walking away from our outdated program and if they choose to screen are adopting a more conservative program that offers better protection from false positives - like the Finnish or Dutch program of 5 to 7 pap tests, 5 yearly from age 30 to 50 or 60. The Delphi Screener, the self-sample HPV device, is already being used by Dutch women. Many women would welcome a self-test option. The Dutch are also planning a move from their 5-7 pap test program to 5 hrHPV "primary" triage tests offered at 30, 35, 40, 50 and 60 and only those positive will be offered a 5 yearly pap test - only 5% of women are positive by age 40. Those negative may choose to follow the HPV program or if monogamous or no longer sexually active might choose to stop all testing and revisit the subject if their risk profile changes in the future.
This will greatly reduce invasive pap testing and potentially harmful over-treatment and they stand a better chance of picking up the rare cases by identifying those "at risk" from this cancer. Our program maximizes risk and results in awful over-treatment for NO additional benefit and there is NO benefit for those under 30.
I'm not sure why our program has been allowed to fall so far behind the evidence and a review is only now just starting so change is still years away, but it is crystal clear our program is not in the best interests of women - it's excessive and harmful.
There are far better ways of dealing with this rare cancer, you don't have to harm and worry the masses - and the Dutch HPV primary triage program is also more likely to help those women who develop the even rarer form of cervical cancer, adenocarcinoma, pap testing misses at least 50% of these cancers. So our program IMO, probably means some women die unnecessarily and lots are harmed unnecessarily.
I obtained accurate information from the Nordic Cochrane Institute and from the UK on the actual benefits and risks of breast screening - the Breast Screen brochure IMO is grossly inadequate and that's unfair to women. Over-diagnosis is a serious concern and the so-called benefits now seem debatable.
I believe every woman has the right to ALL of the information, good and bad and to make an informed decision about screening. It may sound harsh, but our health appears to be treated like a game in this country - tell them whatever we think they want to hear and push them through the screening machine with a very paternalistic "do as you're told" or "WE say it's in your best interests or WE say the benefits exceed the risks."
We don't see this attitude displayed in prostate screening.
It is disappointing that so many of our doctors are over-screening women rather than warning them and advising them properly. I don't believe target payments to GPs are appropriate for something elective like cancer screening, unless it's made clear to women the doctor has a financial interest in screening. I hasten to add though that more and more of our doctors are concerned at the over-screening situation.
Here's hoping for a change in the attitudes that promote screening and that women in the future, like men, will be afforded the same respectful treatment - risk information, actual benefits and respect for their informed decision to pass or accept screening.
The Cancer Council does some great work, but I believe a major review is needed in the way you promote screening to women - that is IMO, letting your performance down badly. When you recommend over-screening to women, it makes me question the rest of your advice. We should not keep urging women to over-screen simply because our program has been allowed to fall way behind the evidence - women and their health and rights are more important than the program.
We have seen a fall in the incidence rate and death rate from cervical cancer and screening may "partly" account for those benefits, but we didn't need to over-screen and massively over-treat to achieve that result - look at Finland. The word "massive" is not mine (although I agree with it) but used by Dr Alex Barrett in the ABC Radio National series, "The Health Report" with Norman Swan to describe our over-treatment rates.
Otherwise, some sound advice.