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  1. The Staggers
27 January 2023

The NHS’s patronising cervical screening campaigns have missed the point

It’s time to start addressing the very real reasons that people are reluctant to attend smear test appointments.

By Isabeau van Halm

Almost a third of people eligible for cervical screening in England haven’t attended their latest smear test – around 4.6 million people. It’s the lowest level in a decade, despite years of campaigns urging people to book an appointment.

This week, during Cervical Cancer Prevention Week, the NHS and other organisations are urging those who haven’t done so to take up the invitation for a test. Public awareness campaigns tend to highlight how these screenings are “just a few minutes of being uncomfortable”. “It didn’t hurt,” reads a tweet from NHS England.

While this will be the experience for many, these patronising campaigns often fail to acknowledge pain as a valid reason that stops people from attending appointments. Whether it’s because of medical conditions (such as vaginismus, a common but underdiagnosed condition), female genital mutilation, or trauma from sexual violence, the reality is that a smear test can be more than just uncomfortable.

Women’s pain is often dismissed by the medical establishment and these tone-deaf messages are a case in point. In response, many people are sharing on social media how pain and trauma have made them hesitant to attend screenings.

When I received my first invitation for a screening, I imagined it would be little different to a dentist appointment or check-up at the hospital. I was not prepared for the agony I felt during the test. I left the doctor’s office dazed, and bled for several days after. When I got the inevitable invitation for a second screening, I couldn’t help but panic.

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“Embarrassment” and “keep putting it off” are the most common reasons for missed appointments, according to a survey commissioned by the Department of Health and Social Care. But the same survey showed that almost a third of people who didn’t show up, representing over a million people in England, were concerned about pain.

Instead of running the same campaigns year after year, the focus should be on more tangible solutions targeting those who are least likely to attend appointments, such as offering self-testing as soon as possible. This would not only help those with pain and trauma from getting the care they need, it could make tests more accessible for all. The self-test uses a swab to collect a sample without the need for a speculum, and can be done at home. Other countries have already run national programmes with self-sampling. During the pandemic Sweden sent out testing kits to all eligible people in the country – and there was a dramatic increase in screenings.

The potential for these kits is promising in the UK as well. In a 2022 study 79 per cent of people who said they did not intend to get a cervical screening in the future were open to the option of self-sampling. The NHS is currently running trials for self-sampling – one in London began in 2021 – but progress has been painfully slow. If the NHS wants to improve coverage it needs to step up. Sweden has shown it’s possible. With such a successful alternative at hand that makes screenings less painful and more accessible, why do we continue to force people to choose between often agonising pain and missing an important cervical screening?

[See also: How to save the NHS]

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