A worrying number of women in the UK aren’t attending their smear tests. Appointment attendance was recently reported to be at a 21-year-low, and the figure has sharply declined during the Covid-19 outbreak.
We should be clear that cervical screening was put on hold, as nurse time was reallocated to support critical services. But the NHS is under pressure to get through a backlog of patients, and lots of women will undoubtedly put off having their test or avoid booking an appointment all together.
A survey by Jo’s Cervical Cancer Trust – a charity set up to support women affected by the disease – identified the barriers that are putting women off having the test. Embarrassment around body shape is the leading concern for young women – who are also those most at risk – but other issues such as cultural taboo and sexual violence are also significant factors.
There is a lot of research into the effectiveness of self-sampling that can be done at home, which would overcome many of the barriers to attending an appointment. However, we’re still some time away from these tests being ready, if they are approved at all. Something needs to be done in the meantime to make women feel more comfortable about attending their appointments.
Now, we know a thing or two about language. And we can’t help thinking that the name ‘smear test’ should be addressed, asap.
The original name comes from the Pap smear, named after the Greek doctor Georgios Papanikolaou, who was a pioneer of cancer detection in the first half of the 20th Century. He found that by scraping cells from the cervix and then ‘smearing’ them on a glass slide, he could detect abnormalities under a microscope. The name was certainly not invented to put women at ease.
Smear is also a crude word at the best of times. A smear campaign or the action of smearing lipstick, butter or grease has unpleasant connotations. If a contestant on Bake Off is told their icing is smeared across the cake, it’s hardly meant as a compliment.
“There is definitely some negative reaction to the name of the test,” said Kate Sanger, a spokesperson for Jo’s Trust. “For women who are busy and looking for any excuse to miss their appointment, a negative-sounding name adds no incentive. Some of the language around the test needs to be softened too. Women often assume the speculum is still cold and metallic, whereas today it is plastic. They fear they will feel a scrape, and are relieved when it’s a soft brushing sensation. That’s where raising awareness can help make women feel more at ease.”
Should the smear test be renamed? Across medicine, specific acronyms and abbreviations help make a complicated procedure more familiar. For example, an ECG or CAT scan rolls off the tongue easier than an electrocardiogram or computerised tomography scan. Come in for your annual MOT is a kinder way of saying that you probably ought to see a doctor. Other procedures have likewise euphemised into something less chilling. For example, the snip sounds friendlier than a vasectomy. And the bro-sectomy gives it a certain street cred…
Does language contribute to care? Phil Blackmore, creative director at Create Health, certainly thinks so. “The right tone really does help. Yes, we all want to know the truth from a doctor or nurse, whether good or bad, but the way we’re told will make a difference to our reaction to that news. We can think of language as an extension of bedside manner.”
Phil believes this isn’t about marketing or clever branding, but rather finding names and language that put patients at ease, as stress is proven to hamper recovery. “Take VitalScan for example, a new device that can rule out a heart attack in three minutes. It’s simple to say, medical staff can use it as a verb, and it’s easy to explain. In the pressurised triage setting, it’s absolutely right. Again, for a new service like Push Doctor, which allows you to book a GP appointment from an app, you know what you’re going to get. On the other hand, its competitor Babylon Health needs more of an explanation. It’ll be interesting to see which one will do better in this fast-growing sector.”
Catching the ear of patients can be a commercial advantage, especially as we all take greater ownership of our health. “There are two services, Thriva and MediChecks, that effectively offer the same thing: they allow you to measure your health by sending in a blood sample,” said Phil. “To my ear, at least, the language on Thriva is more welcoming and more ‘me’, and so I instinctively feel that it’s a better service. It might not be. But emotion matters – and it will matter even more as the lines between patient and customer continue to blur.”
Which brings us back to the earlier question: should there be a new name for the smear test, given the current one isn’t working as well as it needs to?