Suffragettes and screening

An early contender for the most annoying research publication of the year has been delivered courtesy of the Journal of Medical Screening. Entitled Barriers to cervical screening attendance in England: a population-based surveythe researchers interviewed 580 women face to face and then corrolated their voting behaviour with their attendance at cervical screening and “barriers to attendance”.

The press release clangs the alarmist bell – and aren’t all medical press releases involving cancer liable to heavy handed treatment –  ”Women who don’t vote are less likely to attend cervical screening. In the first study to test the theory that low cervical screening uptake is associated with broader social disillusionment, a paper in the  JMS has shown that women who said they rarely or never voted in elections were more likely to be overdue for screening. ”

The paper goes on to say: “The association between voting behaviour and screening uptake lends support to the hypothesis that falling screening coverage may be indicative of a broader phenomenon of disillusionment, and further research in this area is warranted”.

And then:  ”In these studies, women often cite negative attributes of the smear test (eg it is embarrassing or uncomfortable) as a way of justifying their behaviour…an alternative explaination for the finding is that both voting and attending for screening require a degree of organisation, and women who do not manage to vote because of busy and chaotic lives might also be unlikely to attend for screening. ”

What I find astonishing, first of all, is the lack of acknowledgment, anywhere in the paper, that women might just not want to have a smear. They may be CHOOSING not to have one. There seems no crack in the assessment of the situation that allows for the fact that there are many women who know they are at low risk of cervical cancer, have weighed up the pros and cons, and have decided not to be screened.

It is impossible, though, to opt out of the NHS cervical screening programme. You can write a letter and tell them you want no more invitations, but five years later you will be put back on the list and described as a defaulter if you do not to turn up.

This paper seems to ascribe women no autonomy. We must “justify” our behaviour – mustn’t we? If we don’t turn up, it’s because we are too “chaotic”.

It may be that the women involved are pretty good statisticians and have decided that their chances of benefit from screening are small and their chances of false positive testing are higher. These women may also have decided that being responsible for electing a damaging political party isn’t desirable either – but the problem is that the researchers behind this paper have made an unwritten assumption that cervical screening is good for all women all the time and that everyone must have it.

They have not acknowledged that there are problems with cervical screening and that doctors are obliged, ethically and morally, to ensure women are making an informed choice about it.

So what about the distressed older woman who does not wish a smear because she has never had intercourse, knows she is at low risk of cervical cancer, and who finds the examination uncomfortable on several levels  - but is being hounded by red-ink letters telling her she is late for the test and has to explain to a health professional yet again why she does not want to have it.

It’s simply not fair. The main reason I vote is out of respect for Emmeline Pankhurst and her peers. The reason I don’t want a smear is because I’ve made a decision not to have one. Researchers need to understand the concept of autonomy and the right of anyone to make a decision not to be screened.

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Margaret McCartney is a Glasgow-based GP and FT Weekend columnist. She started writing for the Life and Arts section in 2005 and moved to the magazine in 2008. She also has her own blog:

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