Cervical cancer is one of the most common cancers affecting South African women, but prevention should be about more than detecting the disease early. Every woman deserves stigma-free care, at the right time and only the treatment she actually needs.
The pathway from an abnormal screening result to treatment (involving the removal of cervical tissue) is often seen as standard. But it’s not always necessary, and not every woman benefits from the same intervention.
This Women’s Month, Dr Trudy Smith and Dr Judith Carter are encouraging a more patient-centred approach to cervical cancer prevention, which combines accurate human papillomavirus (HPV) screening and colposcopy with evidence-based, proportionate treatment.
The Wits-trained gynaecologists and founders of LadyDocs aren’t questioning South Africa’s cervical screening guidelines, which recommend that women who test positive for high-risk HPV types 16 or 18 should be referred for colposcopy.
But they are questioning what should happen once a woman arrives for her screening.
Smith and Carter believe that colposcopy can be used to examine the cervix under magnification, but biopsies should only be taken from areas that appear abnormal. Rather than assuming treatment is always necessary, it should be guided by confirmed pathology and clinical evidence, not by assumption or fear.
The distinction matters because procedures to remove cervical tissue are not without consequence, particularly for women who still want to have children. Repeated or unnecessary procedures can increase the risk of premature birth, cervical stenosis and other reproductive complications. Preserving cervical health is therefore an important part of providing high-quality care.
LadyDocs is South Africa’s first dedicated private outpatient colposcopy unit, with Smith and Carter proving that specialist assessment can be performed safely and comfortably without hospitalisation or a general anaesthetic.
Women receive evaluation in an outpatient setting, biopsies are taken immediately as needed, and treatment decisions are based on confirmed disease.
Alongside their clinical work, the pair are leading the CervSA study to help build crucial local evidence about cervical disease in South Africa’s private healthcare sector. The research, based at the Wits Donald Gordon Medical Institute, is looking at who is being referred for colposcopy, the abnormalities they present, and which women actually require treatment.
Generating this local evidence is essential. As clinical guidelines evolve, understanding disease patterns within the South African population will help ensure future care pathways remain effective and appropriate.
Smith and Carter are also determined to change the stigma around HPV, a common sexually transmitted virus, which is largely responsible for nearly all cervical cancers. Most sexually active people will contract it at some point in their lives, but in most cases the immune system clears the infection naturally. Testing positive for HPV is not evidence of promiscuity, poor choices or moral failure. It is a common medical condition that deserves informed, compassionate care.
By encouraging women to attend regular screening, understand their results and seek appropriate follow-up care, they hope to replace fear with knowledge and empower women to make informed decisions about their health.
This Women’s Month, their work reminds us that excellent healthcare is measured not only by how effectively it prevents cancer, but also by how well it respects women’s autonomy, protects their future health and preserves their reproductive choices.
