Women's Health on the Cheap — Again: Inadequate Screening for Cervical Cancer

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This is a summary of a talk presented at a meeting of Melbourne Radical Women held on 9 March  1988. Evelyn is a socialist feminist and lesbian activist. 

Women’s health issues are given a low priority by governments in all capitalist countries, especially when it comes to funding. This is blatantly obvious when we look at the statistics stating the number of women who die from cervical cancer. In Australia 340 women died of cervical cancer in 1987 and 7,171 women have died of this treatable cancer over the last two decades. In the United Kingdom 2,500 women die of cervical cancer every year and in the US the annual figure is 7,000.

In Australia 1000 women develop invasive cervical cancer per year: a stage of malignancy  where surgery is required in an attempt to control the disease.

Cancer of the cervix is a preventable disease if early cell changes are detected by means of a pap smear test; and yet hundreds of women are dying from it. The Pap test, named after George Papanicolaou, who developed it in the 1920s involves smearing cells taken from the cervix onto a glass slide. The slides are analysed; each slide being individually visually examined through a microscope. 

So why, after twenty years of pap smear screening in Australia are women still dying from cervical cancer? In Australia there are no consistent, co-ordinated government screening programs. There is no overall national educational program to inform women of the importance of having regular pap smears, nor are there accessible women’s health centres that have preventative health care as their central focus. On top of all this different doctors have conflicting information about how often pap smear tests should be done which just adds to confusion surrounding the issue.

All women who are sexually active and have not had hysterectomies are targets for cervical cancer. There appears to be lower numbers of lesbians developing cervical cancer but lesbians are not exempt. Therefore all women who are sexually active require regular pap smears. 

The cancer is detected when abnormal cells are found on smear slides. To be able to conclusively detect abnormal cells, records of past smears are needed to see if the cells have changed. This highlights the need for a coordinated and consistent government screening program that coordinates the analysis of pap smears to ensure accuracy.

Dr Heather Mitchell spoke to the 1988 ANZAAS conference stating that “only one-third of Australian women at risk appear to be screened regularly with another third being screened irregularly and a third not at all”.

Heather Mitchell cites a number of problems with Australian screening programs. She says many women fail to have regular pap smears. There is no concerted and appropriate educational campaigns aimed at all groups of women including those from non-english speaking backgrounds, women with poor literacy skills and Aboriginal women. There is no fail safe follow up mechanism for women with abnormal smears. Organisations don’t agree on a single frequency of screening for women in general. Quality control measures in many laboratories reporting on pap smears are inadequate. Finally the whole program is ad hoc with no defined channels of responsibility or accountability for the overall program.

Dr Mitchell advocates that all of these issues need to be addressed. There is a need for an educational campaign to inform women of the benefits of pap smears. A centralised register of pap smear data should be kept and women should be able to be informed of when the last pap smear took place and when the next one is due. Also raised at the ANZAAS conference was the need to establish pap smear clinics employing multi disciplinary workers from a range of ethnic community backgrounds. This is essential is the issue of pap smears is to be seriously addressed; the system can’t simply cop out by saying that it is women’s fault if they don’t have pap smears. We also need public health screening program laboratories the emphasise preventative health rather than private clinics that are driven by the need to generate profit. At present in Australia these private companies are raking the money in. Private laboratories receive more than twice the amount of money provided to laboratories in the public sector for each pap smear analysis performed.

In the United States an increasing number of women are having pap smears but because the system is driven by profit rather than preventative health care, women are losing out again. The pap smear test in the United States is the most common lab test. Since it was introduced it has reduced the number of women dying from cervical cancer. However, it is also the most inaccurate lab test. Wall Street Journal reports “the test as it is being done today, fails to detect roughly one in four cases of cancer or precursor cell abnormalities”.

A report from the Wall Street Journal investigated why so many pap smears were inaccurate and found “a picture of a pap screening industry kept afloat by overworked, under-supervised, poorly paid technicians; it is an industry that often ignores what few laws exist fails to protect women from slipshod testing”.

Apparently as pap smear volumes are rising a number of qualified screeners are leaving for better pay and working conditions.

It is common for labs to introduce piecework, that is being paid for the number of slides that each individual worker screens. These methods are especially common in large commercial labs. Workers are forced into the situation of hurrying through slide screening because they get grossly underpaid. Some technicians earn as little 45¢ per slide to do the key analysis on a test that may cost the patient $35 or more! A large majority of workers find it necessary to have two jobs and some lab technicians actually take slides home. San Francisco’s Dr Eileen King argued in the Wall Street Journal  that “better pay and working conditions for technicians is needed to bring the error rate down”.

What we see happening in the United States is a blatant attack not only on women’s health but on workers conditions and rights as well. The women’s movement and unions need to take up both issues to initiate campaigns to educate the community about the role of the capitalist system that advocates private enterprise and profit at the expense of women’s health and workers’ conditions.

The United Kingdom experience is a bit different but is still quite unsatisfactory. A national cervical screening program was implemented in the 1960s but there are a number of difficulties with it. The government issues directives about when and how often smear tests should take place but the health services work autonomously and as a consequence there is a great variation in the actual services being offered. Brettony Mundy writes in Spare Rib, “unless the government is prepared to pressure the health authorities into operating in a more uniform manner by making specific financial commitment and by stressing its appreciation of preventative health care, this fundamental weakness will contribute to the failure of the cervical cancer screening program”.

Sixty eight percent of women who die of cervical cancer in Britain have never had a pap smear test. This again reinforces the need for an educational program tied in with accurate testing and well funded public pap smear clinics that are accountable to a centralise body.

Scandinavia has introduced a computer controlled program that has cut the mortality rate between 60 – 70%. If similar programs were introduced in other countries and a financial commitment to them maintained, the number of women dying from cervical cancer would dramatically fall.

The women’s movement needs to take up the issue of cervical cancer in the trade union movement and the community. We need a system that provides us with quality preventative health care that is freely available, accessible and informative. Cervical cancer is a preventable disease; it is the prevalence of private enterprise in the health care system and the lack of government funding and responsible attitudes from them that currently prevents it from being so.

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