An inconspicuous-looking white envelope dropped through my letterbox last week. Inside it contained an invitation to participate in the NHS's cervical screening programme. Do you know what I did next? I put it in the bin.
I'm aware that the previous statement will prompt many of you to look at your computer screen in utter disbelief, and in your minds you're probably labelling me as 'foolish' and 'idiotic' amongst other things, but hear me out - you might think again.
It's worth emphasising here that i'm not against screening. Screening is proven to prevent cases of cancer, however, at the same time, the benefit is often small when you consider the risks of screening - and yes, screening does have its risks. The problem I have is that patients aren't given enough information about the benefits and risks of screening in order to make a balanced judgement for themselves on whether to participate in a screening programme or not.
The information leaflet that accompanies the invitation to cervical screening does not provide women with all of the facts. First and foremost, it does not communicate that there are around 2,500 cases of cervical cancer per year (source: Cancer Research). Based on the UK female population of 32m (source: ONS), this means that there is 1 case of cervical cancer for every 13,000 women. In comparison to other cancers, cervical cancer isn't that prevalent. What the leaflet does focus on though, is the fact that 750 women die of cervical cancer each year - that's 1 death for every 42,000 women, folks - and wrongly, it's the use of this statistic in that manner that acts as the motivator for many women to participate in screening.
Secondly, whilst the leaflet states that screening will detect minor abnormalities for 1 in 20 women, it does not state that for all cases of abnormality, further testing is required. The simple reason for this is that scientists and doctors are still not clear on which abnormalities will develop into cervical cancer. The further testing that is required - often a colposcopy or cervical biopsy - comes with its own set of risks: premature labour in pregnancy is the most significant, besides the obvious anxiety with comes with waiting for further tests and results. Significantly, most of these minor abnormalities will go away by themselves, which for many women, means that the intervention they received was futile. But is this mentioned in the literature? No.
Thirdly, the figures in the literature are not set in context: the leaflet states that cervical screening saves 4,500 lives per year, however, it's not mentioned that in order to save one life from cervical cancer, you have to screen 1000 women for 35 years. 80 of those women will require further testing, whilst 50 of those women will go on to have unnecessary intervention to their cervix such as a colposcopy. Set that in a wider context and to prevent a few thousand deaths you'd need to regularly screen millions of women, whilst hundreds of thousands will unnecessarily have further treatment.
Screening is never communicated as being a choice. The letters from the NHS and the accompanying literature focus heavily on the worse case scenario if you aren't screened, whilst for the cervical screening programme in particular, women are labelled as 'risk takers' if they don't participate. If you choose not to participate, the NHS hound you with reminder letters... even if you officially opt-out in writing. I'm not a risk-taker. I'm an intelligent woman with a university education who has made a choice based on weighing up the pros and cons of screening. Based on the risk factors of cervical cancer, i've ascertained that my risk is currently low and I have educated myself of the symptoms of cervical cancer so that I can quickly spot any changes that might warrant further investigation.
The fact is, medical literature needs to be clearer and provide more information so people can make an informed choice about whether to participate in a screening programme. I'm not saying that we should stop screening programmes - far from it - but I'm willing to bet that fewer people would choose to go for screening if they were in possession of all the facts, the risks and the benefits... and i'm also willing to bet that cases of cervical cancer wouldn't skyrocket, either. The current culture which focuses too heavily on the benefits rather than the risks needs to end, and the failure to provide all of the facts - good and bad - goes against the very foundation of medicine and patient care. After all, you should never believe everything you read.