Michael Abrahams | PAP smears and biopsies save lives

Recently, a patient of mine sent me a video of a woman delivering a health talk to a live audience. As she strode confidently across the stage, she instructed the attendees to avoid Pap smears. She said, “Please don’t have a Pap smear. Every time you have a Pap smear, you’re damaging the cervix,” adding, “And please don’t have a biopsy. A biopsy causes damage, further damage.”

Two weeks later, I came across a similar post. It was shared on X by a woman claiming to be a registered nurse. The post was titled “CANCER IS A PARASITE NEST” and stated, “Cancers are parasite nests. If you biopsy or operate, you disturb the nest. The parasites go everywhere and make other nests. Your doctor will tell you I’m lying while giving you chemo that kills 97 per cent of healthy people.”

I am a physician, an obstetrician and gynaecologist, and I am proud of my profession. The field of medicine has produced innumerable breakthroughs that have saved countless lives and improved the quality of life of many. However, I am aware that we have had our failures too. There are times when we have been wrong and times when, due to ego or greed, some of us have acted in ways that have placed lives at risk. Understandably, there is some mistrust of the medical profession. Unfortunately, purveyors of misinformation now have access to platforms that allow them to spread their ludicrous and dangerous theories, positing them as fact, and placing the lives of their followers at risk.

REFUTE THE NONSENSE

Fortunately, I, too, have a platform and would like to take this opportunity to refute the nonsense mentioned above. Pap smears are of supreme importance because they are the only readily available non-invasive affordable tests that can help to prevent cancer. A mammogram can detect early breast cancer, but a Pap smear can detect abnormalities years before cancer develops in a cervix, as it takes an average of approximately eleven years for cancer to become established in that location. When a Pap smear is performed, cells are taken from the cervix for microscopic evaluation. The removal of cells does not “damage” the cervix. One of the more commonly used tools for obtaining a specimen, a cytobrush, is similar to a mascara brush. It is not traumatic. If examination of the cells detects certain abnormalities, a biopsy can be taken to determine the degree of the abnormality, enabling the affected area to be treated, to eliminate the diseased tissue and prevent cancer from developing.

The evidence supporting the efficacy of Pap smears is overwhelming and convincing. In countries with well-organized screening programmes utilising Pap smears, such as the United Kingdom and Nordic countries, cervical cancer is not in the top ten list of cancers affecting women. In Jamaica, where we do not have such a system in place, cervical cancer is the second most common cancer in women after breast cancer.

Biopsies guide treatment. The warnings about biopsies are, therefore, ridiculous. A biopsy involves taking a tissue specimen for histological evaluation, meaning examination of the tissue with a microscope. Cancer and other tumours are not diagnosed by looking at a lesion with the naked eye, or by radiological imaging, but by examining the cells in a tissue specimen. Microscopic evaluation will not only reveal if cancer is present, but also the type and grade if is indeed a malignant tumour.

For instance, there are several types of breast cancer. Some are non-invasive or ‘in-situ’ and show no evidence of spreading, and some are invasive and display spread into adjacent tissues. And each type may have different grades or levels of abnormality and aggression. Breast cancers also have different levels of responses to hormones. Unless a biopsy is taken, we will not be privy to this type of information, which is crucial in dictating the kind of management to undertake. For example, some types of breast cancer may only require removal of the mass (lumpectomy), and the breast can be spared, while some may require removal of the entire breast (mastectomy) and various types of chemotherapy (which does not “kill 97 per cent of healthy people”) and radiotherapy.

CAUSE FOR CONCERN

The erroneous and irresponsible statements by these women are cause for concern because the social media platforms on which these messages were shared have the potential to be viewed by and influence millions of people. The woman discrediting Pap smears and claiming that they and biopsies damage the cervix is an Australian, Dr Barbara O’Neill. Although she has given herself the title “Doctor”, she does not have any recognised qualifications, and in 2019, the New South Wales Health Care Complaints Commission indefinitely banned her from providing health services or education after finding her guilty of breaching five clauses of the Code of Conduct for Unregistered Health Practitioners. However, despite efforts to rein her in, she has 1.2 million followers on TikTok.

The woman who declared cancer to be a “parasitic nest” claims to be a registered nurse and uses the handle @ricosangel333 on X. Her pinned post, the post at the top of her page, states another outlandish claim, that “Vaccines are made with random aborted foetal blood and tissue,” which is utter rubbish. At the time of writing this, she has only 5,806 followers. However, her misleading post about biopsies was shared by a social media influencer named Prince EA on Facebook, where he has 17 million followers. Her post there garnered 12,700 “likes” and was shared 4,100 times.

Nowadays, with the advent of the Internet, anybody has the potential to be an influencer. Be mindful of who you follow online and listen to. Fact-check and discuss advice you may want to follow with a qualified medical professional. If it were not for Pap smears and biopsies, many people alive now would not be here with us. As a physician, I do not profess to know everything, but I can confidently tell you that Pap smears and biopsies save lives.

Michael Abrahams is an obstetrician and gynaecologist, social commentator, and human-rights advocate. Send feedback to columns@gleanerjm.com and michabe_1999@hotmail.com, or follow him on X , formerly Twitter, @mikeyabrahams