The Politics of Pap Smears


A new vaccine, Gardasil, claims to protect against four strains of the human papilloma virus (HPV), and has been hailed as a cervical cancer vaccine. Once approved, the vaccine will be administered to pre-teen girls and boys throughout the Western world.

However, there is no evidence of a direct, causal relationship between HPV and cervical cancer. Half the adult population is infected with HPV yet only 1 per cent of women develop the cancer.

Screening for cervical cancer has been around for the last few decades. Second wave feminism of the 1970s saw the rise of activism around health issues for women generally, and one of these was the right to pap smears for all women. National screening programs were initiated, urging women to front up regularly and submit themselves to this invasive test in order to detect the early stages of cervical and uterine cancer.

When a woman undergoes a pap smear, a number of cells are collected from her cervix. These are examined for changes which may be early warning signs that cancer will develop. Whether the tests are an accurate test of a woman’s gynaecological health or not is up for debate. Pap smears produce a false-negative rate of 15 to 20 per cent.

I developed an interest in the pap smear test in the 1980s after I received a phone call from my local GP informing me that my recent smear test results were abnormal. At a visit to my gynaecologist I was told I had cervical dysplasia. This is also called cervical intraepithelial neoplasia (CIN), which can be graded into CIN I, II and III. The common belief is that these abnormal cells, if left untreated, will develop into cancer.

The next procedure I was subjected to was a colposcopy. This has to be one of the most degrading and painful procedures known to woman. I describe it as like being seated in a dentist’s chair, only it is your vagina which is opened up while a doctor peers into your cervix. The reason for this excruciating experience is to take a biopsy of the cervical cells. I was told this would not be painful. Other than childbirth itself, I have yet to experience such agonising pain as my (male) doctor sunk his sharp blade into my cervix and lifted out my wayward cells.

The recommended treatment was a hysterectomy. Being 35 years old and the mother of three children it was assumed that I would not want to mother again so let’s just whip out the uterus! Thank goodness I sought a second opinion on the necessity of a hysterectomy. Since this experience I always urge women to read up and think for themselves.

The year 2000 figures on the mortality rates for cervical cancer are 3.3 women per 100,000 in the US, and four women per 100,000 in Australia. According to the Australian Government Health and Ageing website ‘ the role of HPV infection in causing cervical cancer, the second most common cause of cancer in women worldwide, is undisputed.’

But most women with HPV don’t get cervical cancer, and some women get cervical cancer without having HPV infection. The US National Cancer Institute says that direct causation has not been proven: ‘In a controlled study of age-matched women, 67 per cent of those with cervical cancer and 43 per cent of those without were found to be HPV-positive. These cancers are observed, on average, only 20 “50 years after infection.’

HPV was proposed as the cause of cervical cancer in the 1980s. However, not all scientists agreed. Nicholas Regush, Editor of Red Flags Weekly, an independent, health news site, writes that back in 1992, questions were raised about the increasingly entrenched theory that HPV causes cervical cancer:

It came from Peter Duesberg and Jody Schwartz, molecular biologists at the University of California at Berkeley. Among the various issues they raised about the acceptance of HPV as the cause of cervical cancer was their fundamental concern that there was a lack of consistent HPV DNA sequences and consistent HPV gene expression in tumors that were HPV-positive.

In short, Duesberg and Schwartz were pointing to the possibility that ‘carcinogens may be primary inducers of abnormal cell proliferation rather than HPV or HSV.’ And here’s the key point: ‘Since proliferating cells (cancer cells dividing wildly) would be more susceptible to infection than resting cells, the viruses would just be indicators rather than causes of abnormal proliferation.’

And yet little attention is paid to the other possible causes of cervical cancer such as smoking, and dietary factors like low levels of Vitamin A and folate.

Health researcher Christine Maggiore was also diagnosed with a grade III pap smear with cervical dysplasia, a result that insinuates cancer. Christine was well aware that diagnostics were notoriously unreliable, and the fact that pap smear slides are read by lab technicians for a matter of seconds, so she had her test repeated. The second smear came back grade II, suggesting the presence of HPV. Christine refused the mainstream tests and treatments, and after a few months went back and had another test.

The result was normal.

She was told by the receptionist at her doctor’s surgery that, ‘Most women get an abnormal pap after having a baby. We just run the test again and it usually comes back normal. If not, the doctor gives them this little cream and that takes care of it.’

The overwhelming majority of my female friends have received abnormal pap results like mine and Christine’s. In every case, their results reverted to normal with no therapy.

The medical world itself is split on how the results of the pap smear should be followed up. The Federal Government has set up a committee to recommend new guidelines for screening. Head of the committee, Professor Ian Hammond, reported to The World Today ABC radio program in March this year:

Basically, what we’ve suggested is these women are being referred far too soon for evaluation, because most of these virus infections will go away. And therefore, it’s been suggested that rather than referring women immediately for evaluation, there should be a delay of one year, to allow the virus to go away, and if the virus hasn’t gone away, or the changes haven’t gone away in one year, then those women will be referred for colposcopy.

Perhaps the medical profession is at last coming around to admit what we women have known for some time.

Launched in 2004, New Matilda is one of Australia's oldest online independent publications. It's focus is on investigative journalism and analysis, with occasional smart arsery thrown in for reasons of sanity. New Matilda is owned and edited by Walkley Award and Human Rights Award winning journalist Chris Graham.