Pap smear: Cervical screening remains taboo in Turkey

Selina Bieber

Pap smear showing clamydia in the vacuoles

A common sentence uttered between females in their conversations on health, daily life and the “musts” which a woman must tick off to remain in full heath… In Australia, ads initiated by the Ministry of Health or local governments reminding women to have a pap smear can be seen on the back of public toilet doors in a bid to increase the level of awareness of the importance of these check-ups because they are key in preventing the escalation of cervical cancer and preventable deaths at the hands of the disease. The answer to this question is usually “No I haven’t, but I know I must.”

This is in stark contrast to the situation in Turkey where discussing such topics is largely taboo, particularly for unmarried women, because it is immediately assumed to imply that they are engaging in premarital sex. While it premarital sex does occur in Turkey, this is an issue which relates to a much wider group and the need to build awareness and openly discuss the importance of getting a regular check-up is not confined to a small group of females engaging in “inappropriate behaviour”.

Looking at the facts offered by the WHO, the HPV virus which causes cervical cancer is the most common viral infection of the reproductive tract and the majority of sexually active people will be infected at some point in their lives – the Australian Cancer Council puts this figure at 80 per cent of adults. With over 100 types of HPV, most infections go away by themselves; however, a small portion of strands can lead to the development of the second most frequent cancer in women. While it is largely assumed to be transmitted through direct intercourse, it is a virus which can be transmitted through skin-to-skin contact and therefore requires a much greater level of awareness amongst wider society.

Discussing such a topic is seen as almost admitting to behaviour not suited to females, or even worse admitting to the possibility of being “infected”. Speaking to one or two of my Turkish girlfriends, they breach the topic with caution and as they become more comfortable speaking on the subject, they then admit that they initially refrained from sharing the news with their own husbands due to the associated stigmatism. If they were unmarried, I may have been less surprised…Turkey is unfortunately a country in which women’s rights are arguably limited, the majority being confined to the private sphere in which they must play the role of housewife and mother, subservient to the dominant male in the household and such topics are painted as taboo. While it would be incorrect to generalize, for a portion of these marriages enduring infidelity is another part of this and this puts largely unaware women at even greater risk considering that more than 85 per cent of cases occur in developing countries.

According to the World Cancer Research Fund International, cervical cancer is the seventh most common cancer in the world, accounting for four per cent of cancers worldwide. Considering that cervical cancer was once one of the most common causes of cancer death for women in America, prior to the rate dropping almost 70 per cent between 1955 and 1992, it is not surprising that the rate of this cancer is most prevalent in developing countries. The drop in the US, highlighted by the American Cancer Council, coincides with the introduction of the Pap Smear – screening for changes in the cervix before these changes can develop into cancer or spotting the earliest stages of the cancer when they are still treatable. In Western countries now, preventative vaccines are now available and widely administered to young girls to make them immune against the virus. I have been fortunate enough (also thanks to an attentive and supportive GP) to benefit from the Australian government’s initiative to offer the Gardasil vaccine free to females under the age of 26, yet making the decision to use this opportunity was one based on my awareness of the disease and the need to take measures to prevent it.

As a taboo in Turkish society, females have no network of peer support to guide them and ensure they are aware of the facts. At the same time, married women especially those outside of big cities, are perhaps even more segregated from any kind of discussion that would enlighten them on the risks of such a cancer. Rather than advocating for an open discussion of cervical cancer, a step which should arguably be led by the Ministry of Health, Turkish society appears to be growing more and more conservative. One must really question at what cost?