Some Women May Not Want Cervical Screening

We note with concern the methodology and conclusions of Waller et al. ¹ in their article on ‘Barriers to cervical cancer screening attendance’. The authors began with a concern about falling cervical smear attendance rates and the premise that barriers exist to prevent women attending for smears. They asked women in interviews to explain their behaviour in not attending for a smear, using a set of questions comprising possible reasons for non-attendance. Yet nowhere do Waller and her colleagues consider that women may increasingly have simply decided not to have a smear. Non-attendance at smear appointments – especially when opting out is near impossible – may be due to a weighing up of the pros and cons of smear tests, and not only for the reasons of discomfort or embarrassment given by the authors. There is the low chance of avoidance of cancer as well as the risk of a false-positive, leading to unnecessary treatment with its association with premature birth^2,3 as described to the general public by the same organization that funded this research. ⁴

Adults must be treated as competent, but they cannot make decisions about screening when they are not presented with it as a choice, with the potential for harm as well as gain. The only reasons cited for smear avoidance are effectively a list of excuses such that one fears being sent to the naughty step. The authors’ conclusion that women who may be too busy both to vote and have a smear may be ‘disillusioned’ with public services negates the realistic statistical appraisal of the efficacy both of voting and of smear tests. Maybe some women are under no illusions? When it comes to screening autonomous adults, professionals have to remember that informed choice is an ethical right. We ignore this at our professional peril.