# Do some unpleasant medical tests end up harming public health? **URL:** \ **Category:** Great Debates\ **Created:** [March 19, 2006, 8:43pm UTC](https://boards.straightdope.com/t/do-some-unpleasant-medical-tests-end-up-harming-public-health/349041 "2006-03-19T20:43:35Z")\ **Posts on this page:** 8\ **Page:** 2
**Author:** ![Odesio](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/odesio/32/20003_2.png) [@Odesio](https://boards.straightdope.com/u/Odesio)\ **Post date:** [March 20, 2006, 6:48pm UTC](https://boards.straightdope.com/t/do-some-unpleasant-medical-tests-end-up-harming-public-health/349041/21 "2006-03-20T18:48:41Z")
> [@davenportavenger](#): > > Doctors require these tests to cover their asses. That’s the cynical take on it, and I’m sure that’s a part of it, but from my point of view that’s just how you practice good medicine. You don’t just give someone medicine without checking to see whether it will do more harm than good. Marc ---
**Author:** ![Jackmannii](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/jackmannii/32/311_2.png) [@Jackmannii](https://boards.straightdope.com/u/Jackmannii)\ **Post date:** [March 20, 2006, 7:16pm UTC](https://boards.straightdope.com/t/do-some-unpleasant-medical-tests-end-up-harming-public-health/349041/22 "2006-03-20T19:16:45Z")
> [@Gaudere](#): > > Where is everyone getting the idea that birth control pills + undiagnosed cancer cause some sort of interaction that is worse than cancer alone? As I understand it, you don’t need a pap smear to get BC, they just think you should have one and use the BC as a sort of carrot to put up with the stick of a full gyno exam. Prescribing BC without testing for cancer won’t increase your chances of dying from cancer any more than just not getting tested. Unless I’m totally wrong, but I’d like to see a cite that getting BC without a pap smear is more dangerous that just never getting a pap smear at all. This is still a controversial area, but the preponderance of evidence suggests that long-term oral contraceptive use increases the risk of cervical cancer in women infected with human papilloma virus (the infectious agent that causes cervical cancer). [Cite.](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15128004&query_hl=4&itool=pubmed_DocSum) A literature search turned up one recent paper that found that only a small minority of OB-GYNs would prescribe birth control pills without restriction unless the patient consented to Pap tests, but that many would do so on a short-term basis. This doesn’t seem all that unreasonable on both a health and legal liability basis, but there are those who think that the overall risk is small enough for mandatory Pap provisions to be dropped (and younger docs tend to hold this opinion more often). I’ll concede to **jsgoddess** that my earlier statement should have been that it is better to risk unwanted pregnancy than to risk cervical cancer. There are decent barrier methods that greatly reduce the chance of pregnancy, but no good alternatives to a pelvic exam (involving Pap + HPV testing) for detecting cervical cancer or its precursors. Cervical cancer is a devastating disease. And it’s _readily preventable_. ---
**Author:** ![sailorspook](https://avatars.discourse-cdn.com/v4/letter/s/b38774/32.png) [@sailorspook](https://boards.straightdope.com/u/sailorspook)\ **Post date:** [March 20, 2006, 7:52pm UTC](https://boards.straightdope.com/t/do-some-unpleasant-medical-tests-end-up-harming-public-health/349041/23 "2006-03-20T19:52:56Z")
I’m not convinced at all that the risk factor of cervical cancer is commensurate with the invasiveness (and pain, in my case) of the test. Jackmannii’s cite seems to suggest that prolonged OCP use and persistent viral infections are equal factors. [www.cancer.org](http://www.cancer.org) tells me that the HPV mentioned frequently comes with external lesions or benign tumors. So wouldn’t most women with the predominant risk factor have rather obvious indicators other than the Pap test? Were cervical cancer an epidemic, I would feel differently. But requiring Accutane patients, hormonally imbalanced thyroidectomy patients, or people with no family history of reproductive disorders to undergo the exam just because “well, it might help” seems silly, and expensive. Re the OP: invasive tests would only be directly harmful to public health if large numbers of those with the disease were avoiding treatment, which given the cited low death rate seems unlikely. But as someone who waited until 21 for an exam, I can see how an overused and painful procedure can inure people against going to doctors in general. ---
**Author:** ![EEMan](https://avatars.discourse-cdn.com/v4/letter/e/a6a055/32.png) [@EEMan](https://boards.straightdope.com/u/EEMan)\ **Post date:** [March 20, 2006, 7:58pm UTC](https://boards.straightdope.com/t/do-some-unpleasant-medical-tests-end-up-harming-public-health/349041/24 "2006-03-20T19:58:30Z")
> [@](#): > > So wouldn’t most women with the predominant risk factor have rather obvious indicators other than the Pap test? HPV does not always present with extrenal symptoms. So, no you might not know; more importantly your doctor might be doing something to cause you to get a deadly cancer (without looking for it). The cancer can be sucessfully treated with early detection, I can’t imagine a few minutes of discomfort once a year being worth my life. I don’t much like be checked for Prostate Cancer, but I think it is worth being checked. ---
**Author:** ![Jackmannii](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/jackmannii/32/311_2.png) [@Jackmannii](https://boards.straightdope.com/u/Jackmannii)\ **Post date:** [March 20, 2006, 8:27pm UTC](https://boards.straightdope.com/t/do-some-unpleasant-medical-tests-end-up-harming-public-health/349041/25 "2006-03-20T20:27:00Z")
> [@sailorspook](#): > > Jackmannii’s cite seems to suggest that prolonged OCP use and persistent viral infections are equal factors. No, it concludes that long-term OCP use predisposes to increased cervical cancer risk _in women who are infected with HPV_. > [@](#): > > Were cervical cancer an epidemic, I would feel differently. Cervical cancer is a low-incidence disease _precisely because of the Pap smear/test_. It’s one of the most outstanding success stories in the history of preventative medicine. Pooh-poohing the need for Pap/HPV testing is like arguing that we don’t need vaccinations because of low rates of the communicable diseases they protect us from. ---
**Author:** ![gigi](https://avatars.discourse-cdn.com/v4/letter/g/a587f6/32.png) [@gigi](https://boards.straightdope.com/u/gigi)\ **Post date:** [March 20, 2006, 8:48pm UTC](https://boards.straightdope.com/t/do-some-unpleasant-medical-tests-end-up-harming-public-health/349041/26 "2006-03-20T20:48:15Z")
[http://www.dartmouth.edu/~vox/0304/0209/cancer.html](http://www.dartmouth.edu/~vox/0304/0209/cancer.html) The flip side, with folks preferring being overtested and overtreated… ---
**Author:** ![Hello\_Again](https://avatars.discourse-cdn.com/v4/letter/h/85e7bf/32.png) [@Hello\_Again](https://boards.straightdope.com/u/Hello_Again)\ **Post date:** [March 21, 2006, 7:27pm UTC](https://boards.straightdope.com/t/do-some-unpleasant-medical-tests-end-up-harming-public-health/349041/27 "2006-03-21T19:27:19Z")
> [@sailorspook](#): > > . [www.cancer.org](http://www.cancer.org) tells me that the HPV mentioned frequently comes with external lesions or benign tumors. So wouldn’t most women with the predominant risk factor have rather obvious indicators other than the Pap test? > . In a word, no. \*HPV is a group of related viruses. 30 of these viruses are sexually transmitted. 10 of these viruses are linked to cervical cancer \*According to the CDC, 50% of men and women will aquire HPV at some point in their sexually active lives. \*By age 50, 80% of women will have aquired HPV. \*Many of the strains of virus have no signs or symptoms. Most infected people never notice any symptoms. \*Most women who develop invasive cervical cancer have not had regular cervical cancer screening. Source: [CDC HPV Page](http://www.cdc.gov/std/HPV/STDFact-HPV.htm) Getting a pelvic exam is mentally and physically uncomfortable – even painful for some people. However, do you really want to die of an easily preventable cancer just because you couldn’t suck it up for 15 minutes a year? Really really? ---
**Author:** ![Eva\_Luna](https://avatars.discourse-cdn.com/v4/letter/e/e495f1/32.png) [@Eva\_Luna](https://boards.straightdope.com/u/Eva_Luna)\ **Post date:** [March 22, 2006, 2:41am UTC](https://boards.straightdope.com/t/do-some-unpleasant-medical-tests-end-up-harming-public-health/349041/28 "2006-03-22T02:41:47Z")
> [@EEMan](#): > > HPV does not always present with extrenal symptoms. So, no you might not know; more importantly your doctor might be doing something to cause you to get a deadly cancer (without looking for it). > > The cancer can be sucessfully treated with early detection, I can’t imagine a few minutes of discomfort once a year being worth my life. I am a poster child for this statement, as discussed previously [here.](http://boards.straightdope.com/sdmb/showthread.php?t=143118&highlight=cancer) The strains of HPV that cause genital warts are _not_ the same strains that cause cancer, so it’s quite possible to have cancer, feel fine, and have no symptoms at all. A routine Pap smear may very well have saved my life; the cancer was just becoming invasive, and yet I’d never had a previous abnormal exam, though cervical cancer normally develops over years - or even decades. Long-term survival rate for cervical cancer, detected early: well over 95%. Survival rates for cervical cancer not detected while still localized: [not nearly as good.](http://canques.seer.cancer.gov/cgi-bin/cq_submit?dir=surv2002&db=100&rpt=LINE&sel=1%5E0%5E14%5E2%5E0%5E2%5E0%5E%5E&x=Survival%20interval%5E0,1,2,3,4,5,6,7,8,9,10&y=Stage%20at%20diagnosis%5E1,2,4,5&dec=1&referrer=0&title=SEER+Relative+Survival+Rates+by+Stage+at+Diagnosis~For+Cervix+Uteri+Cancer,+All+Races,+All+Ages,+Females~SEER+9+Registries+for+1988-2001&template=faststats) Personally, I will go for followup testing as often as my doctor wants, and urge everyone else to do the same - Pap smears aren’t my idea of a good time, but they sure beat the alternative. [Previous page](https://boards.straightdope.com/t/do-some-unpleasant-medical-tests-end-up-harming-public-health/349041.md?page=1)