tag:blogger.com,1999:blog-5660425647872666134.post3030856331254673978..comments2012-09-25T16:01:54.563+01:00Comments on Pondering Practitioner: Worried wellPondering Practitionerhttp://www.blogger.com/profile/10954642565723591490noreply@blogger.comBlogger3125tag:blogger.com,1999:blog-5660425647872666134.post-77321957315154595522010-04-22T14:10:31.823+01:002010-04-22T14:10:31.823+01:00I think that a lot of the trouble (as I see it) wi...I think that a lot of the trouble (as I see it) with cervical screening lies in how the data are presented. You mention a 95% reduction in mortatlity rate. If only 1 person per million died in the first place, your figure still looks impressive, but is actually of little statistical importance.<br /><br />If you looks at the actual risk, rather than the relative risk however, an unscreened population has a 1.7% risk of mortality from cervical cancer, whereas a screened population has a risk of around 0.63%. (http://www.nature.com/bjc/journal/v91/n3/full/6602002a.html)<br /><br />The relative risk reduction is 37% which sounds far more impressive than the actual 1.07% reduction.<br /><br />Given this information I wonder how many women would still get tested? Perhaps that's why they aren't given it.<br /><br />To do so would risk upsetting the apple cart, and most GPs would lose a valuable source of income due to the loss of incentive payments. These payments themselves, should the general population be more aware, would likely lead to a mistrust in the advice given by doctors, as they're essentially being paid to take a position.<br /><br />If we then take a look at the ethics behind the screenign itself, WHO states that screening should be "an important health problem for the individual and community". As once of the rarer cancers, cervical cancer screening would seem to have failed at the first hurdle.<br /><br />If also states that there should be a "suitable and acceptable screening test or examination." If the test were acceptable to the female population, then why is it necessary to pay GPs to coerce patients to attend?<br /><br />Don't get me wrong - any loss of life it tragic, however attempting to screen an entire population, requiring an intimiate examination, to detect a rare disease doesn't seem practical, ethical or cost effective in my humble opinion.<br /><br />Now as to HPV testing......Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5660425647872666134.post-76344818350942682832010-04-22T10:36:31.125+01:002010-04-22T10:36:31.125+01:00I think you have to look beyond the sensitivity of...I think you have to look beyond the sensitivity of a single screening smear test. Having 3 yearly checks increases the sensitivity. Looking more at population statistics, the figures show that if 80% of the population (women aged 25 - 65) can be screened a reduction in death rates of around 95 per cent is possible in the long term. Perhaps the biggest difference between prostate cancer and cervical cancer are the treatments available. To effectively treat early stage cervical changes, small, safe and comparatively minimally invasive excisions can be used. "Burning a section of your cervix off' is a dramatisation. Prostate cancer treatment is much more invasive, often requires a combination of surgery, chemotherapy, hormonal therapy and or radiotherapy and can give rise to serious side effects such as impotence. Given that the prognosis of prostate cancers is very variable and often completely uncertain, this is much harder to justify.Pondering Practitionerhttps://www.blogger.com/profile/10954642565723591490noreply@blogger.comtag:blogger.com,1999:blog-5660425647872666134.post-16795582324302049082010-04-21T11:28:26.484+01:002010-04-21T11:28:26.484+01:00Your comment about PSA testing is interesting.
Ho...Your comment about PSA testing is interesting.<br /><br />How would this compare to cervical screening? The sensitivity of which is only around 50% so half of those women with abnormal cells would be missed.<br /><br />Of those testing positive, very few would actually go on to develop cancer if left untreated.<br /><br />The test is instrusive to begin with, and the first line treatments involve burning a section of your cervix off.<br /><br />But this is not only endorsed by the government, women are actively chased to attend.<br /><br />Why the disparity?Anonymousnoreply@blogger.com