91av

THAT cancer screening is a double-edged sword should come as no surprise by now. Screening programmes undoubtedly save some lives; but they are blunt instruments, often producing false positive results that lead to emotional distress, unnecessary surgery and debilitating side-effects. It is a dilemma already much discussed with breast cancer screening in women, and prostate cancer screening in men.

Now it is the turn of cervical smear tests (also known as pap tests), as new research reveals that surgery following a positive result increases the risk of miscarriage or premature birth in subsequent pregnancies (see “Women aren’t being told real risks of cervical cancer screening“).

As in previous cases, more clarity over risks and benefits surely helps individuals and their doctors make informed decisions. But this instance raises additional concerns. Many women feel pressured into the screening, thinking it is a direct test for cancer. It isn’t: the tests check for abnormal changes in cervical cells that can go away by themselves.

This fits into a worrying pattern of instances in which women’s health problems have been trivialised and their autonomy dismissed. Women’s choices during childbirth are frequently ignored. Those with symptoms of endometriosis – a common condition that can cause excruciatingly painful periods – can still wait years for diagnosis. More recently it has emerged that a common treatment for incontinence – insertion of a mesh strip into the vaginal wall – has a worse rate of complications than we thought. Women’s reports of being left in agony were dismissed for years.

We are increasingly recognising the pervasion of unconscious sexism into all aspects of society. Perhaps that goes as far as the doctor’s surgery. Is it time for medicine to have its own #MeToo moment?

This article appeared in print under the headline “Medicine’s #MeToo”