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October 31, 2010

BehindTheMedspeak: Nuns, virgins and spinsters — cervical cancer revisited


I recently noted that there are groups of women who have essentially no risk of cervical cancer, and thus need not get regular Pap smears.

Dr. Margaret McCartney then pointed me toward a 1991 reassessment in the British Journal of Obstetrics and Gynecology (BJOG) of this hoary belief, which turns out to be based on a less than rigorous 1842 paper by an Italian surgeon in Padua, Dr. Domenico Rigoni-Stern.

According to the 1991 paper, "The quality of Rigoni-Stern's work is poor by modern standards. His paper is littered with errors of arithmetic. He adduces importance to differences which we would not now regard as being statistically significant. Interesting as Rigoni-Stern's observations were, it is somewhat surprising that his work is quoted as being authoritative. It is alarming that it is almost universally misquoted."

I find the detailed reassessment in the BJOG convincing to the point that I believe now that all women — the sole exception being those who have had hysterectomies which included the cervix — should have regular cervical cytology screening.

The abstract of the BJOG article follows.


The view that nuns have a very low risk of cervical cancer is questioned. The historical evidence for this view is reviewed, from the beginning of the eighteenth century to the present. An estimate of the actual mortality rate from cervical cancer suggests that risk of death from this neoplasm among nuns is little different from that among the general female population. It is recommended that nuns should not be excluded from cervical cytology screening. When symptoms which might suggest cervical cancer arise in such women, full gynaecological assessment is necessary.

Present Department of Health policy regarding provision of cervical screening suggests that such screening is not necessary for 'nuns, virgins, and spinsters' (Warden 1990).

This policy is supported by the widely accepted view that cervical cancer is extremely rare among such women. Only if this view is correct is it reasonable to dispense with cervical screening in such women. If it were to be shown that such women had a lower, but still significant risk of cancer, then such an omission would he unreasonable.


October 31, 2010 at 12:01 PM | Permalink


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woops, I meant - ' low risk not no risk '

Posted by: margaret | Oct 31, 2010 1:11:15 PM

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