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A little awkward for a lot of peace of mind

Monday 7 November, 2011 by Amy

You may have seen the good news recently about cervical cancer. According to the Australian Institute of Health and Welfare (AIHW), cervical cancer rates in Australia are at an all-time low thanks to our fantastic National Cervical Screen Program (NCSP). In fact, since the Pap test initiative was implemented in 1991, the incidence and mortality rates of the disease have halved.

So what does this actually mean? Well in Victoria alone, if incidence rates had remained the same as they were in 1990 - the year before the screening program was introduced - an additional 2,277 women would have been diagnosed with cervical cancer. That equates to saving two Victorian women from being diagnosed with the disease every week.

I think we can all agree this is a pretty incredible result, particularly in such a relatively short time frame. Based on these figures, it's safe to assume most women would be jumping over themselves to get regular Pap tests, right?

Wrong. Less than two thirds of Australian women participate in regular cervical screening as recommended under the NCSP. The guidelines state that all women between the ages of 18 and 70, who have ever been sexually active, have a Pap test every two years, yet only 62% of us are listening. Why?

In 2009, PapScreen Victoria commissioned a survey to find out the common barriers to screening for the average Victorian woman. The most common response was ‘embarrassment' with ‘feeling awkward' and ‘uncomfortable' not far behind.

Come on ladies - harden up!! Are one in three of us really willing to risk developing cervical cancer just to get out of a few minutes of minor awkwardness? I think it's time for some of us to reassess our priorities.

Nine out of ten Victorian women who are diagnosed with cervical cancer have never had a Pap test, or have not undergone two-yearly screening as recommended. In other words, 90% of cervical cancer diagnoses could be avoided if all women had regular Pap tests as instructed.

So come on girls, what's a little awkwardness for a lot of peace of mind!!


I think you may find more women are getting to the truth - our program is excessive, inefficient, harmful and more than a decade behind the evidence. No woman needs an absurd 26+ pap tests, it just produces huge numbers of false positives and potentially harmful over-treatment. Women should look to The Netherlands and Finland who have evidence backed programs - there is no additional benefit with 2 yearly pap tests over 5 yearly....you just produce more false positives. Our program IMO, also shows a deep disrespect for the bodily privacy of women - recommending serious and harmful over-screening. There has also IMO, never been any respect for informed consent in this country, with women given poor and misleading information and basically ordered to screen. I think it's a disgraceful way to treat women - men are not treated this way, they got risk information quickly for prostate screening and doctors were reminded to obtain informed consent. Women are still waiting for this same respectful treatment. The Finns have a 7 pap test program, 5 yearly from 30 to 60 and have the lowest rates of cc in the world and send FAR fewer women for colposcopy/biopsy - our lifetime risk of referral after an "abnormal" pap test is a whopping 77% - thanks to over-screening, now this is to screen for a cancer with a 0.65% lifetime risk. So, we just worry and over-treat huge numbers of women for NO additional benefit. The risks of over-treatment are well known - cervical stenosis, cervical incompetence, premature babies, c-sections etc The Dutch have the same program as the Finns, but they are once again moving with the evidence - they have managed to keep their program focused on what's best for women. (Is our program for the benefit of vested and political interests?) The new Dutch program is 5 hrHPV primary triage tests offered at 30, 35, 40, 50 and 60 and ONLY the roughly 5% who are HPV positive and at risk will be offered a 5 yearly pap test...they have a small chance of benefiting. Those HPV negative will be offered the HPV program and those negative and no longer sexually active or monogamous can forget all testing. This program will further reduce pap testing, false positives, over-treatment and is more likely to prevent these rare cancers. Our program makes no attempt to protect the vast majority of women, HPV negative, who cannot benefit from pap testing. It's also inefficient and misses too many of these rare cancers. So, it's a relief to find more women are getting to the truth and protecting themselves from our seriously outdated program. The Delphi Screener is also being used by Dutch women, it's also available in Singapore, Italy and elsewhere, so women can test themselves for HPV in the privacy of their own bathroom. We're light years behind these countries. I simply don't understand what's going on in this country, but it fills me with concern. I think we need an "independent" enquiry to effect urgent change - women need to be protected and should finally be provided with a program that is in their interests.

From: Elizabeth, 15/04/2013

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