Intended for healthcare professionals


Calls for cervical screening should treat women like adults

BMJ 2023; 383 doi: (Published 24 November 2023) Cite this as: BMJ 2023;383:p2772
  1. Margaret McCartney, GP, Glasgow

Northwest Cancer Research, a cancer charity in the northwest of England and north Wales, has set up an eye catching installation at Manchester Piccadilly station.1 “Don’t keep ’em crossed” they say, “Get screened instead.” Suspended from pillars are three pairs of slim plastic legs, all crossed, stuck on a pillar, disembodied, like parts of a Barbie doll. The woman is being instructed not to rely on luck to avoid cervical cancer but instead—silly girl—to organise herself to attend screening. I find this sexualised and patronising—women’s bodies made for public display, with a mixture of shock value and shame.

Why is there such difficulty in treating women like adults? A few years ago the Scottish government used a video, featuring pink roses, voiced with a low, slightly threatening tone, “Does the thought of getting your flower out for a smear test make you shiver? How does the thought of developing cervical cancer feel? Six women are diagnosed with cervical cancer every week in Scotland. So it’s time to stop fannying about and get tested.”2 What about the #MyCat campaign, run by an app service contracted to the NHS, which said “Bushy, bare or half-way there” and wanted people to post cat pictures on social media with various degrees of fur in order to “remind your friends to get a cervical screening.”3

Or we have an advert predating that, with a small, tearful boy, sitting alone on a stairway. He is accompanied by the caption “My mum missed her smear test. Now I miss my mum.”4

Compare and contrast. Here’s an advert for aortic aneurysm screening, featuring the broadcaster Gyles Brandreth. He is fully clothed, and faces the camera. The caption is “65+ and male? A free and quick NHS scan can tell you if you have an abdominal aortic aneurysm.” Giles says that he would “urge other men aged 65 and over to consider seriously the offer of screening.”5

There are many rational debates about how cost effective screening is. I am not opposed to screening per se. I am, though, opposed to adverts for screening that are used to persuade, rather than inform people of what the service is, and make an offer based on the known evidence of outcomes. There is a rich history of advertising for cervical cancer screening using fear, sexualisation, or guilt in order to push women into attending for it. Screening, remember, takes people with no symptoms and offers them an intervention. As Muir Gray and colleagues put it, “All screening programmes do harm; some do good as well, and, of these, some do more good than harm at reasonable cost.”6 Because screening can cause healthy people harm—whether through anxiety, false positives, or unnecessary treatment—it is essential that informed consent is given. Using emotion to persuade is dangerous.

We should be honest. Cervical screening is not foolproof in preventing cervical cancer. And many women are reluctant to attend because they have a history of being sexually abused and find the process traumatic. Others find it painful. Women who are unfortunate enough to be diagnosed with cervical cancer should not be shamed into thinking that they are to blame for not being screened earlier, or at all—a guilt that does not seem to have attached itself to advertising for screening aimed at men. Women who do want screening should be enabled to have it. What is wrong with giving women the unadulterated facts?