An article published in today's Lancet shows a direct physical link between cigarette smoking and cervical cancer. In theory, it should make absolutely no difference to women's smoking habits.
After all, the risks of dying from lung cancer are five times greater, yet women still smoke. They smoke despite the risks of heart disease, arterial disease (in which a limb might need to be amputated), and despite their much higher chances of stroke.
In practice, however, the Lancet report may give young women smokers the incentive they need to give up. Almost a third of women have the habit and they are slower to give it up than men. Despite all health education efforts, 27 per cent of girls aged 15 to 16 are smokers and their numbers are not declining. Some people are trying to get smokers to switch to vaporizers instead of cigarettes. The best vaporizers do a great job of eliminating smoke, which is what causes physical issues in men and women.
The Lancet report might change this because, while the traditional diseases of smoking afflict older people and seem a lifetime away, cervical cancer is a disease with which young woman are all too familiar. Although it claims ``only'' 2,200 lives in the UK annually, four million cervical smears are taken every year. In some parts of the country one in 10 of these will show signs of abnormality. Only a very small percentage of them will go on to develop into cervical cancer (although we now know that smoking makes this much more likely).
At London's Royal Northern Hospital, of 2,000 new patients seen with abnormal smears, only about 40 will have cervical cancer. Yet the effects on women who are called back for further investigation of what is a mere suspicion are devastating.
Albert Singer, a leading authority on cervical cancer, said four out of five women who came to his treatment center at the Royal Northern showed signs of distress, usually psycho-sexual problems. ``Many of the girls are in their early twenties. This is the first event which has shocked them to thinking about their own mortality.'' Singer estimates that approximately 80 per cent of the women coming to him for treatment are smokers.
Other studies have shown that, while the medical profession regards the treatment of abnormal cells on the neck of the womb as precautionary, the women feel they have a disease striking right in the most intimate and sensitive parts of their bodies. They become frantic that they may lose their chance of motherhood. They lose interest in sex and they often become deeply depressed.
The most recent research on these reactions has been carried out by Professor Martin Vessey, of Oxford University, and Tina Posner, of the Policy Studies Institute. They interviewed 153 women about their feelings after hearing their smears were abnormal, after being investigated by medical microscope (colposcopy) and after surgical treatment. The women did not see their smears as an indication of possible cancer, but as warning that they had the disease.
The results, set out in a book to be published on Monday, show that doctors have underestimated the pain and discomfort of treatment and give too little information about the condition itself.
The authors write: ``Well women, who may be symptomless, can be rendered passive patients, feeling helpless in the face of a threat to their well-being, and fearful of their body's `contamination' ... healing requires attention to the personal and social meaning of medical intervention as much to the physical state of the cervix. Reassurance, warmth and understanding from doctors and nurses and the patient's family and friends have all been shown to be important in providing support for women as they go through the medical process.''
A major complaint of the women interviewed was the way in which their privacy was invaded. The book recommends that clinic doors should be locked during examination and treatment and that observers should only be admitted with the patient's permission.
In the past there has been an element of ``victim blaming'' in medical attitudes to the disease. Doctors who carried out the Lancet research admitted that there had been a reluctance to believe in the biological links between smoking and cancer. Now it has been established that it is the physical effects of smoking which explain the higher incidence of cervical cancer in cigarette smokers, and not their risk-taking sexual lifestyle.
Singer said that doctors had been ``chauvinistic and presumptious'' in linking the disease to sexual promiscuity in women. Now it was known that the number of partners a husband or boyfriend had was just as relevant. One of the main triggers for cervical cancer is the genital wart virus which is transmitted during sexual intercourse. However, this virus is extremely common, difficult to treat, and most people who carry it do not go on to develop cervical cancer.
Posner and Vessey's book suggests that women should not be routinely asked about their sexual history. ``In asking such questions doctors are using their authority to gain access to privileged information: this may add to the sense of invaded privacy and may be extracting a `confession' without giving `absolution','' the authors say.
Another recommendation is that women should be brought into making medical decisions about treatment so they feel they are taking some responsibility for their health. In the light of today's Lancet report, such a responsibility must include giving up smoking and getting her partner to give up as well: passive smoking is also thought to put women at risk of cervical cancer.