Pap smears and privilege

The notion of privilege is a rubbery one. Just because someone is a wealthy, white male living in a wealthy western country, for example, that does not make him immune from experiencing violence, depression or serious illness. And someone who is living in disadvantaged circumstances, such as a family with inter-generational unemployment, may have privileges that would be denied them if they were in the same circumstances elsewhere.

Sometimes what should be a universal right is a privilege, something available to some but not others. An example of this is Britain's NHS, available to people across the socio-economic spectrum. It is not perfect, accessing certain treatments can be a postcode lottery, and every time Jeremy Hunt, the inappropriate and unqualified Health Secretary, opens his mouth, I am terrified he is going to announce its disbandment - but what it does offer is free pap smears for women aged 25 and above.

Yes, lying back on a narrow bed in a clinic, taking off your pants, spreading your legs and having an instrument that resembles a plastic duck bill inserted into your vagina so that a few cells can be gently brushed off for pathological analysis is a privilege. This is a privilege denied so many women across the world.

Women in Guinea and Burundi have the world's highest rates of death by cervical cancer, at 23.7 and 22.4 per 100,000 respectively. Women in countries such as the United Arab Emirates, where healthcare for expatriate women is dependent on the level of insurance offered by your employer, often miss out on receiving pap smear coverage, especially if you're unmarried and the insurer lumps pap smears in the same category as "fertility treatment". The rationale is that because premarital sex is illegal in the UAE, unmarried women shouldn't be having sex and thus don't need fertility treatment, even though a pap smear is not actually a fertility treatment. For local Emirati women, a lack of education and taboos surrounding the open discussion of sexual health issues, can also mean cervical cancer screening is not as common as it should be.

If only women across the world could enjoy the same access to pap smears.

I have already blogged on this a couple of days ago because it is Cervical Cancer Awareness Week - the age for your first pap smear on the NHS should be lowered from 25 to 20. The age was raised from 20 to 25 in 2003 because "only" around 3% of cervical cancer cases affect this age group and the high number of abnormal smear test results in the age group leads to more false positives. But this is cold comfort to those who have lost daughters, sisters, friends, partners and wives to cervical cancer under the age of 25. Surely it would be better to revise the raised age once the rates of teenage girls receiving the HPV vaccination reaches much higher levels?

Britain's easy availability of the HPV vaccine, which prevents many forms of the cervical cancer-causing human papillomavirus, is another privilege everyone's daughter should be enjoying.

Since 2008, the HPV vaccine has been available to girls in Year 8 of high school. But there are still issues with the uptake of this and the problem lies with the poor example many parents are setting their daughters. A University of Manchester study of 117,000 girls showed that the uptake of the vaccination was just 58% among 12-13-year-olds whose mothers had never been screened for cervical cancer. In the same age group, the uptake was almost 84% among girls whose mothers had been screened in the past five years.

Mothers who are not setting an example to their daughters by not getting regular pap smears and, presumably, not talking about it either, are the ones most likely to have un-vaccinated daughters. We don't know the circumstances behind each and every vaccination refusenik - is it a case of girls not liking needles? Are parents unconvinced by the need for the vaccination? Are parents ill-informed about the vaccinations? Are there parents out there who truly believe it is a "slut needle" in the same way Rush Limbaugh believes that birth control pills are for "sluts"?

Is it simply a matter of cervical cancer not being discussed in many British households? Well, I'm sorry, but the time has come to have those discussions, to get over yourselves, to quit being prudes, to recognise that words like "vagina" and "cervix" are not rude words, but anatomical terms every young woman needs to know about and be able to say without hiding behind the sofa and turning beetroot-red.

Add to this the fact that 20% of women eligible for pap smears on the NHS simply don't bother. My friend Jai Breitnauer blogged eloquently on this as well as the HPV vaccination uptake scandal this week and I urge you all to read it.

The women and teenage girls of Britain are in a privileged position when it comes to cervical cancer screening and prevention. Sometimes privilege doesn't come in obvious forms such as wealth and power. But a privilege that comes in the form of a needle, a speculum and a brush is one that will save lives. And one day, when every woman can receive cervical cancer screening, and every young girl can be vaccinated against HPV, that privilege may become a worldwide right.


Image courtesy of www.kozzi.com

Today I shall talk about cervical cancer...

This week is Cervical Cancer Awareness Week. But for any awareness week to actually be effective, all the awareness-raising has to translate into action.

These actions should include booking a pap smear if you are a woman (er, obviously...) and you are due for one or you've never had one before and encouraging your female friends to have a pap smear if they are due for one or have never had one before.

The good news is that with early detection, cervical cancer does not have to be a death sentence. But pap smears are essential for early detection and subsequent early treatment.

It is important for all sexually active women to know about pap smears, to know why they are important and to not be afraid of them. It is a few moments of slight discomfort and pants-off mortification in front of a doctor or nurse who has probably seen more vaginas than all of Motley Crue combined and, as such, will not find yours to be horrible or weird. But the discomfort and mortification could save your life. I'm not even being melodramatic - a pap smear probably did save my life.

My story - and why women in Britain need to lobby the government

I was very lucky. I was 21, living in Sydney, when I had an abnormal smear test. In Australia, the rule of thumb for pap smears is to start having them from the time you turn 18 or a year after you become sexually active, whatever comes first. Pap smears are generally covered by Medicare, just as they are by the NHS. But the NHS rule is that you should start having them every three years at the age of 25. This is too late for many women who have died tragically young.

My abnormal smear revealed CIN 1 cell changes - the lowest level abnormality - and it was sorted out very easily. By a gynaecologist I rather embarrassingly ran into at a party a year later when it turned out he was a friend of my landlord. To my eternal shame, I pointed to my face and asked him if he recognised me from that end. To his eternal credit, he laughed. Ahem...

For the next two years, I had a smear test every six months, and now I have one every year. Imagine if I had to wait another four years after I was 21 before my first smear test - that would have been plenty of time for the cells to develop into something far more sinister.

In Britain, Dr Chris Steele has been a leading advocate for women under 25 to receive smear tests. His Too Young To Die campaign needs more support - you can start here. And here is a link to the Facebook page for the Mercedes Curnow Foundation, which campaigns to lower the age of pap smears in the UK from 25 to 20.

But we also need to lobby the man in charge, Health Secretary, Jeremy Hunt. If you go to his webpage, whoever put it together has included a link to click on if you are not one of his constituents but you do want to contact him in his capacity as Health Secretary. Unfortunately, this will take you here, to a rather soulless online form. It only gives you the option of receiving a reply by email or post but not by telephone. How do we know Hunt will read any of the feedback that comes via this link? How do we know if anybody reads it at all? Still, if we all bombard this link with our questions about the availability of smear tests to women under 25, who knows? Maybe something will happen?

The HPV vaccination - the pearl-clutchers hate it but it will save lives

Hurrah! Medical science has advanced to the point where cervical cancer has the potential to become a thing of the past! There is now a vaccine against many forms of the Human Pappiloma Virus (HPV) but here's the thing - it has to be administered before the young woman becomes sexually active. It is too late for me but it is not too late for our daughters. The UK National HPV Immunisation Programme takes place when girls are in Year 8 of high school.

Naturally, there are people out there who panic at the thought of girls aged around 13 being given a such a shot. The moronic mentality seems to be that giving girls a vaccination that will help them when they become sexually active will cause them to automatically become sexually active. Yes. And having more fire extinguishers around will cause more fires. Anti-vaccination people generally make my piss boil. As such, I suggest everybody educate themselves here before they troll me.

More ways to take action regardless of whether you have a cervix or not...

Everyone should watch this segment from ITV's This Morning to hear Dr Dawn Harper explain more about cervical cancer and hear these real-life stories.

Making a donation to Jo's Cervical Cancer Trust is another great thing to do this week - they support women who have the disease as well as their families, and advocate for early screening and prevention.

And while you're at it, make a donation to Inspirational Friends - two women, Hannah Lawton and Jessie VanBeck, are planning to row across the Atlantic in the Talisker Whiskey Atlantic Rowing Race to raise money for Jo's Cervical Cancer Trust and Myton Hospice. This is in memory of a friend who lost her battle with cervical cancer in May last year.