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Gold, incentives and meh

A shocking reminder of the importance of smear tests

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My triennial smear test is not something I look forward to. Once booked, I wait with grim anticipation but afterwards I leave feeling virtuous and somehow healthier. When the results drop through the letterbox, mixed in with the bank statements and bills, I always have a little butterfly of anxiety but luckily they have always been normal.

Several friends have had abnormal results and a few have been for colposcopy but I have never seriously considered the possibility that they might have cancer. Given that cervical cancer is the most common cancer in women under 35 and the fact that I have cared for several young women who have died of the disease, you would think I would take it more seriously. But I don’t think I do. Or perhaps I didn’t until last week.

A couple of weeks ago a friend went for a colposcopy. She handled this with her usual aplomb, joking on Facebook that her husband had offered to cook that evening as compensation. So when she called a few days later to say she had been diagnosed with cervical cancer I just hadn’t seen it coming. Despite previous hopes for another baby, she underwent a hysterectomy and she has been told the prognosis is good.

Since its introduction in 1988, the NHS cervical screening programme has almost halved the rate of cervical cancer in the UK and it is estimated that it saves around 5,000 lives each year. So why are so many of us becoming blasé about our smears?

When I reminded my sister she said, ‘It keeps dropping off the end of my to do list’, and I don’t think she’s alone. The tragic death of Jade Goody in 2009 bought cervical cancer back into the public’s awareness but the initial soar in numbers attending for smears is again in decline. Jade Goody’s case made a lot of young women sit up and think, ‘if it can happen to her, it could happen to me’, but once the shock had faded so did its effect.

My friend will hopefully recover quickly and soon be back looking after her husband and their children. I wonder how many other women will have been jolted into booking their smears by the ripples of shock emanating from her family and friends?

But I also wonder how we, as GPs, can build on that experience and sustain the motivation to attend for screening in years to come.

Dr Laura O’Loghlen is a GPST1 who lives in Devon and trains in Gloucestershire.

Readers' comments (3)

  • Women with irregular cycles, short cycles or who menstruate for longer than a week can find it difficult booking appointments for well woman clinics for a date when they can be reasonably certain they are not going to be menstruating. Women who are working may find well woman clinic times don't fit well with work schedules.

    Described by a Telegraph writer as like "having sex with the Tin Man," I imagine many women don't look forward to the smear procedure (or waiting on the results) and would rather just get it in there, get it done and get out again. But some well women clinics also want to do weight and BP checks at the same appointment - which makes for a longer appointment if the clinic nurse or practitioner then wants to discuss any weight or BP concerns.

    A possible solution? Smear clinics within Boots or health centers. Walk-in, or where appointments can be booked just a few days in advance, when a woman might better anticipate a window of opportunity, and ideally with shower or bidet facilities for woman coming straight from work or going straight back to work. Are women who don't attend for regular smears being surveyed for what it is that is putting them off making appointments?

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  • Or you could look at Margaret McCartney's advice!

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  • Hazel Drury

    Link to MM blog.
    which is a counterpoint to the usual spiel and thought provoking.

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