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'More heightened anxiety' about proven cervical-cancer treatments since CervicalCheck controversy, says oncologist

“My perception is that there is an increasing reluctance to tend for smears because they just feel there’s relatively little point,” Dr Charles Gillham told TheJournal.ie.

File photo.
File photo.
Image: Shutterstock/Bricolage

A RADIATION ONCOLOGIST has said that there is “more heightened anxiety” about proven cervical-cancer treatments since the CervicalCheck controversy broke in 2018, with women more frequently questioning what the treatment involves. 

There is concern that the free cervical cancer screening programme CervicalCheck is in jeopardy following waves of controversy over the non-disclosure of smear test reviews to over 221 women with cervical cancer over a 10-year period. 

Though the programme has been found to have broadly the same clinical margin of error as others internationally, public health officials are concerned at the level of mistrust that remains towards the CervicalCheck programme. 

A 2018 review by Dr Gabriel Scally found that the information given to women about CervicalCheck wasn’t as clear as it could have been: women were told cervical smear screenings “are not 100% accurate”, when similar programmes in the North and Wales told women that it “prevents 7 out of 10 cervical cancers” and is “75% accurate”, respectively.

There is now some suggestion that this mistrust of the screening programme has extended to hesitancy towards clinically proven cervical-cancer treatments.

Charles Gillham is a consultant radiation oncologist at St Luke’s Radiation Oncology Network in Dublin.

He’s worked in the area for 10 years, and would see an average of 10-15 women a week about their ongoing treatment for cervical cancer.

As radiotherapy and chemotherapy are used to treat more advanced types of cervical cancer, and in general surgery is used to treat cervical cancer at earlier stages, many of Gillham’s patients wouldn’t have been referred on from CervicalCheck, as screening would have caught cervical cancer at an earlier stage.

Speaking to TheJournal.ie, Gillham said that he and his colleagues are concerned about the increased frequency of stories about mistrust in the cervical screening programme. 

‘Increasing reluctance for smears because they think there’s little point’

Gillham said that he and his colleagues are concerned that the friends and family of their patients seem increasingly mistrustful of the screening programme.  

“We’re all really quite concerned that the people we’re seeing are telling us that their friends and family are very apprehensive about having smear tests. Because they fear that even if they did have cancer, it’s not going to be identified, and their sentiments are ‘Well, what is the point?’ By no means is this everybody, but that’s what I’m just hearing more frequently. 

“I have a young woman at the moment and she has gone through treatment. She will never be able to have children, and it’s desperately sad.

“And I said to her last week, ‘Out of interest, are you telling your friends to have smear tests?’ and she said ‘I am, but most of them aren’t listening’. They don’t have any faith in the system, they don’t want to go for smear tests, they don’t think it would be helpful.

“My perception is that there is an increasing fear about or reluctance to attend for smears because they just feel there’s relatively little point,” he said.

Misinformation about treatments

Gillham also says that a lot of women with cervical cancer who he is meeting for the first time are expressing “much more heightened concern about what the treatment involves”.

If cervical cancer is diagnosed at a very early stage, surgery can be recommended to remove the woman’s cervix, uterus, the tubes, and sometimes the ovaries. If the cervical cancer is more advanced, and has travelled to the vagina or lymph glands (but is confined to them), surgery isn’t sufficient and radiotherapy and chemotherapy is required.

The average age of these women, based on 10 years of data from St James’ Hospital, is 44.

“The important thing is most women who receive these treatments [for Stage II or Stage III cervical cancer] are invariably cured,” Gillham said.

“When we treat people who have not had surgery, but are having radiotherapy and chemotherapy alone for their cervical cancer, the treatment involves a combination of radiation from the outside, which is called external radiation, and internal radiation.”

This is also known as brachytherapy, which is used where the tumour is accessible.

“It involves the placement of radioactive sorters in direct contact with the tumour, and it’s an extremely safe way of delivering a very high dose of radiation.

Patients are telling me that they have read articles that state that internal radiation is like having a very hot rod put into your vagina.
It’s not the case. They’re not rods, they’re carefully designed plastic applicators that are not ever hot, and the person is either under general anaesthetic, or anesthetised from the waist down.

He said that some patients are asking about alternative therapies – but no more frequently than other people who have been diagnosed with cancer.

Despite the increased apprehension about treatment, Gillham said that in his experience, the number of women with cervical cancer who refuse the treatment advised by health specialists remains at the same low rate, both before and after 2018. 

‘Hesitancy has definitely increased’

“The number of people who are more hesitant has definitely increased. And they do require a lot more time and encouragement,” Gillham said.

I would always say it’s somebody’s choice. We can only give our advice, we can give our recommendation, we can tell them why we’re suggesting that they have what we’re telling them to have, but I would never force anyone to have treatment that they didn’t want to have.

Of the apprehension about and the public perception of CervicalCheck, Gillham said: “What I and my colleagues find so disheartening, is the impact it’s having on yet to be diagnosed or recently diagnosed ladies who are facing a very traumatic time anyway.”

‘CervicalCheck’ has been in the headlines and news bulletins regularly since 2018.

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“On top of [the diagnosis], they’re picking up bits in the media, on TV, or any sort of platform, social media, that makes them feel even more vulnerable, and more frightened.

“It just just feels a little bit out of control – it’s not about me making my job more difficult, it’s just about making their lives more easy, or less difficult.”

From 2015 to 2017, there were 264 cases a year of cervical cancer in Ireland. Of that number, around 160 women a year are diagnosed via the Cervical Check programme (around 60% of all diagnoses).

Each year in Ireland, 90 women die of cervical cancer. 

Without a cervical cancer screening programme, the numbers could increase to as high as 320 women diagnosed a year, and 180 women could die.

Most women who are diagnosed with cervical cancer are cured, Gillham says, but this doesn’t come without risk of very serious side effects.

These side effects include loss of fertility, loss of sexual function, or entering menopause.

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