Educating my 'stupid' self about smear tests

23rd January 2018

I’m one of the third of women who hasn’t had a smear test when they were contacted by their GP, as smear test rates have fallen to a 20-year low.

After the survey by Jo’s Cervical Cancer Trust, which showed that women avoided their smear tests because of “trivial” concerns like the appearance of their vulva, I’m one of the young women who has been branded “irresponsible”, “naive”, “uneducated” and even “stupid” by news columnists for putting off these potentially life-saving tests.

I’ve been getting letters for more than a year but haven’t managed to get the test booked. I moved house and changed doctors, I work very long hours, I’ve got immediate medical concerns that need addressing first — you just pick an excuse. While they all sound like total bullshit, they’re legitimate reasons.

Anyone who has tried to book a smear test will have had the following conversation:

“Hello, can I book a smear test?”

“No problem. How about 3.10pm on Wednesday?”

“I work office hours, is there a more convenient time?”

“9.40am on Friday?”

“Do you do early or late appointments?”

“We can do until 6.30pm every other Tuesday.”

“I don’t normally get back from work in time. I finish early on a Monday though.”

“No, the nurse doesn’t work Mondays. Oh, hold on… I have actually got five weeks on Thursday at 8am”

“I’m usually at my desk by- it doesn’t matter, I’ll call back.”

If you manage to make an appointment, you’re likely forced to proceed to take time off work, probably not explaining to your boss that you have a smear test, for fear of them thinking that you didn’t make enough effort to organise it outside of work time or that you’re using “women’s issues” as a reason to come in late.

This can be hugely compounded if you have a medical condition that you routinely already need to see a doctor for. In my case, I have an underactive thyroid which takes regular doctors appointments and blood tests and I’ve been putting off an X-ray and physio on my knee, after a sports injury.

It’s easy for these more urgent problems to take priority when you struggle to get anything resembling a convenient appointment.

A third of local healthcare providers and councils haven’t made any action in the past year to increase uptake of smear tests. So while women are blamed for not booking those appointments, sometimes it’s as simple as the letter going to an old address or being forgotten about, and healthcare providers not attempting another means of communication.

While some women cite fear of the results or the unpleasant or painful experience of having the test done as the reason they put it off, I cannot say I am particularly afraid.

I mean, I didn’t love getting my vag out for a complete stranger (obligatory joke about buying me a drink first) the first time I had a smear test but I can get over the idea of that unpleasant five-minute interaction and the worry that something horrible might come out of the results — after all, it’s better to know sooner rather than later.

In fact, even the people who are most afraid would be unlikely to skip a test that they genuinely thought could save their lives. The truth is, it feels unlikely that I’ll be one of the 3,224 new cases a year.

But how unlikely is it? I did a bit of digging.

Risk

Cervical cancer argh

The first worrying stat is that at nearly 29, I’m in the age bracket that is most affected by cervical cancer. I’m also at an age where I was considered too old for the human papillomavirus (HPV) jab. The otherwise symptomless HPV infection is the biggest risk factor for cervical cancer.

I’m not a smoker, which is linked to 7% of cases, or a user of oral contraceptives, which is linked to 10%, according to Cancer Research UK.

But some studies have cited obesity as a factor and, while I’m not obese, my weight fluctuates into the “overweight” category very regularly.

Other factors that studies have shown to be linked to an increase in cervical cancer are having multiple full-term pregnancies, having a family history of cervical cancer and being HIV positive.

Survival

While I knew cervical cancer takes lives, I always had it down as one of the more “survivable” types of cancer — so the fact that survival rates in the UK are 63% is a bit of a shock.

Looking more closely at the data is reassuring though. Nearly nine out of 10 women aged 15-39 survive cervical cancer.

Diagnosis

Fast diagnosis is crucial too. Survival rates five years later plummet from 96% when diagnosed at the earliest stage, compared with 5% for late-stage cervical cancer.

This, for me, is the most compelling reason to not put off my smear test any longer. Of the 890 deaths, Cancer Research UK considers 100% preventable. And the best way of preventing those is by having a smear test.

23rd January 2018