Will Insurance Companies Determine Your Risk For Cancer? -- Editorial

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The ACIP (Advisory Committee on Immunization Practice) voted last week to rule in favor of making the HPV vaccination recommended instead of approved for boys and young men, as had been for or so many years. Once the ACIP votes, the FDA typically follows along with those recommendations so we can expect to hear something soon on that front.

The current guidelines for cervical cancer screening which has also been updated reads much like a Chinese menu and is difficult for even the seasoned veteran physician to understand.

The idea behind extending the time frame for initial screening by approximately three years was to reduce unnecessary treatments and procedures, but it makes no difference how these guidelines are changed if physicians are failing to properly utilize them. These recommendations for extension actually occurred in 2009 but were formalized in these new screening recommendations.

These recommendations are available on the Internet for review, and women should take the time to not only review them, but also to comment upon them before November 15th. You can read the draft recommendations at the following link: http://www.uspreventiveservicestaskforce.org/draftrec4.htm

Please provide your comments before November 15th at the following link:
http://www.uspreventiveservicestaskforce.org/uspstf_form4/

Many physicians continue to prescribe unnecessary procedures and even unnecessary surgeries resulting in infertility because they lack the necessary knowledge regarding HPV and these guidelines. Unless sufficient feedback is received before November 15th to justify altering these new recommendations, they will continue to remain.

This brings up the subject of insurance coverage regarding these tests. Even when reporting this information, the news media fail to mention that the patient’s specific situation should take priority over these guidelines.

If simply observing the guidelines, the physician may preclude early diagnosis in many women while unnecessarily testing (each year) those women at low risk for developing cancer. Patients have become accustomed to receiving their annual Pap exam and doctors need to be able to adequately and accurately explain this information to this group of patients, so that they are comfortable extending their Pap exams from one year to three.

Dr. Maurie Markman of the Cancer Centers of America in Philadelphia in a recent MedScape article discussed these new guidelines and said that costs should not be the basis upon which testing is done, but rather what is in the patient’s best interest, regardless of what may be stated in these new guidelines.

One of the main problems is whether or not insurance companies will now begin to use these guidelines as a hard and fast rule for paying for cervical screening. One must remember that these are only guidelines, and that the specific situation of the patient must be taken into account when deciding whether or not to perform certain additional tests as the HPV test or HPV genotyping tests.

If insurance companies are going to use these guidelines as an excuse to refuse payment, this may result in a lack of the care needed by many women at risk. Insurance companies of course are all about making money.

If women were more adequately educated by the government programs designed specifically for this purpose, and if physicians were better educated when it comes to the outcomes when utilizing both Pap and HPV co-testing, they would likely be more willing to extend the Pap screening to three years, based upon that specific criteria.

Source:

Markman, Maurie, Md., MedScape Nurses News, To Pap or Not to Pap? Web. November 9, 2011,
http://www.medscape.com/viewarticle/752439?src=mp&spon=24

HPV Vaccine Reduces Anal HPV Infection and Precancerous Lesions.
" NCI Cancer Bulletin for May 31, 2011 - National Cancer Institute." Comprehensive Cancer Information - National Cancer Institute. N.p., n.d. Web. 9 Nov. 2011.
http://www.cancer.gov/ncicancerbulletin

Reviewed November 9, 2011
Michele Blacksberg RN
Edited by Jody Smith

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