Last week, the U.S. Preventive Services Task Force released its latest recommendations regarding cervical screening guidelines. The public has until November 15, 2011 to make comments at which time the organization will then compile all results and determine the final outcomes. The American Cancer Society (ACS) is expected to make their recommendations regarding this information some time next year.
Comments can be made at:
http://www.uspreventiveservicestaskforce.org/tfcomment.htm
The recommendations and rationale include several changes of which women should be aware. One thing which strikes me is the fact that they admit they have no information available to determine how to incorporate known risk factors into these guidelines! One must ask, with all the research being conducted -- why not?
As a registered nurse, I always considered a patient's risk factors for any disease with respect to that patient's follow-up and treatment, yet is not happening here. I disagree with the exclusion of testing of all women under 21 years of age.
This blatantly disregards two of the known risk factors which can affect persistent disease -- early sexual onset and multiple partners. Yet in the 2006 guidelines, this same organization stated: "Indirect evidence suggests most of the benefit can be obtained by beginning screening within 3 years of onset of sexual activity or age 21 (whichever comes first) ..." and, "The USPSTF concludes that the benefits of screening substantially outweigh potential harms."
If this were a static situation and people never changed relationships perhaps these proposals would be more plausible but this simply isn't the case. By way of example, if a woman changed relationships a month after receiving her Pap, she may then be dealing with a high risk strain of HPV for three years before being tested again.
I have spoken to too many women, even those in monogamous relationships, whose HPV has advanced at a far faster pace than this.
HPV is the known cause of 99.9 percent of all cervical cancers and is also responsible for precancerous and cancerous lesions involving the vagina, vulva, penis, oropharyngeal area (throat/mouth) and anus. It is responsible for approximately 12,000 cases of cervical cancer in the United States and over half a million cases worldwide annually.
A very interesting point is the total reversal of the recommendations made in the 2006 guidelines regarding HIV-infected women which, according to those guidelines, should be no different than the screening for non-infected women. This made no sense from the outset since HIV is know to reduce the body's immune system and leave the individual compromised regarding other infections including HPV.
The point here is not HIV but how organizations so convinced that they know what is right have now in essence acknowledged that they've had it wrong for the past five years.
The new proposal states the following: "In contrast, women who are HIV positive are at such increased risk that the U.S. Public Health Service has issued separate screening guidelines suggesting that they be screened twice within the first year after initial HIV diagnosis and annually thereafter."
This is quite a turnaround from the recommendations which have been followed for the last five years. Can we afford to be waiting five years for these organizations to recognize the error of their ways with these newly proposed guidelines?
Women must speak out and make their voices heard on this subject, one where they are the ones having to deal with the ramifications of a delayed or missed diagnosis, up to and including loss of fertility. Hopefully you will take this limited opportunity and make the time to speak out on a very serious issue affecting all women in this country.
Sources:
"CDC - Number of HPV-Associated Cancer Cases per Year." Centers for Disease Control and Prevention. N.p., n.d. Web. 17 Oct. 2011. http://www.cdc.gov/cancer/hpv/statistics
"Opportunity for Public Comment (USPSTF)." U.S. Preventive Services Task Force. N.p., n.d. Web. 24 Oct. 2011.
http://www.uspreventiveservicestaskforce.org
http://www.uspreventiveservicestaskforce.org/3rduspstf/cervcan/cervcanrr.htm
http://www.uspreventiveservicestaskforce.org/draftrec4.htm
"2006 consensus guidelines for the management of women with
cervical intraepithelial neoplasia or adenocarcinoma in situ",
Thomas C. Wright Jr, MD et al Web October 2007
http://download.journals.elsevierhealth.com/pdfs/journals/0002-9378/PIIS0002937807009337.pdf
Bonnie Diraimondo, RN is a Nobel Prize winner-endorsed author, freelance writer, international speaker and is considered an expert in the topic of HPV. She maintains her own website and patient forum as well as a regular blog.
Reviewed October 24, 2011
by Michele Blacksberg RN
Edited by Jody Smith