It was a busy, confusing week last week for women’s health news. And for the time being, women and their doctors are left to figure out the new mammogram and Pap smear recommendations for themselves. Here's what you need to know:
Friday, the American College of Obstetricians and Gynecologists issued new guidelines on Pap tests, recommending that women begin the tests at age 21 (instead of 18) and that they have tests every other year in their 20s and every three years in their 30s (instead of annually). Questions of whether women in the United States are being over-screened and over-treated are at the heart of the issue.
The announcement came just a few days after the U.S. Preventive Services Task Force published new recommendations for mammograms – that women not be screened at all until age 50, and then only every two years. Tempestuous days ensued, in which patients, doctors, hospitals and cancer umbrella organizations balked and vowed to follow the old guidelines, which call for annual mammograms after age 40.
Women who had gotten breast cancer in their 40s – or even their 30s – and survived due to early detection told their stories as often as they could, hoping to blunt the effect of the new guidelines. Health and Human Services Secretary Kathleen Sebelius said the government would ignore the new recommendations, at least for now. And women who had found their own cancers through breast self-exams felt betrayed when the task force said that emphasis on self-exams wasn’t worth the trouble.
The timing of the cervical cancer screening story was accidental. But it couldn’t have been worse. Not only did the two announcements come back to back, they also came while the Senate was working through its version of the health care reform bill. The questions came quickly: Is this the wave of the future: Less care, perhaps leading to less insurance coverage as well?
"There's no link between us and the [task force] recommendations," Greg Phillips, a spokesman for the ob/gyn group, told CNN. "And it's a different animal. Cervical cancer is very slow-growing versus some breast cancers."
The timing was “an unfortunate perfect storm,” said Dr. Cheryl B. Iglesia, the chairwoman of a panel in the obstetricians’ group that developed the Pap smear guidelines. She noted that the new guidelines had been in the works for years, long before the Obama administration.
From the New York Times:
“Dr. Iglesia said the argument for changing Pap screening was more compelling than that for cutting back on mammography — which the obstetricians’ group has staunchly opposed — because there is more potential for harm from the overuse of Pap tests. The reason is that young women are especially prone to develop abnormalities in the cervix that appear to be precancerous, but that will go away if left alone. But when Pap tests find the growths, doctors often remove them, with procedures that can injure the cervix and lead to problems later when a woman becomes pregnant, including premature birth and an increased risk of needing a Caesarean.”
And:
“There are 11,270 new cases of cervical cancer and 4,070 deaths per year in the United States. One to 2 cases occur per 1,000,000 girls ages 15 to 19 — a low incidence that convinces many doctors that it is safe to wait until 21 to screen.
“The doctors’ group also felt it was safe to test women less often because cervical cancer grows slowly, so there is time to catch precancerous growths. Cervical cancer is caused by a sexually transmitted virus, human papillomavirus, or HPV, that is practically ubiquitous. Only some people who are exposed to it develop cancer; in most, the immune system fights off the virus. If cancer does develop, it can take 10 to 20 years after exposure to the virus.”
Unlike the mammography recommendations, the cervical cancer screening guidelines met with some support early on. From the CNN story:
"This change in recommendation will not result in fewer cervical cancers being diagnosed," said Dr. David Soper of the American College of Obstetricians and Gynecologists, a professor of obstetrics/gynecology at Medical University of South Carolina. "This will just be a better screening recommendation."
“The American Cancer Society expressed support for the ob/gyn group's position on Pap tests. Debbie Saslow, director of breast and gynecologic cancers for the American Cancer Society, likened getting an annual Pap test to getting a mammogram every four months.
"We're not going to see an increase in the rate of cervical cancer if women are screened every two or three years versus one year," she said.
“The National Cervical Cancer Coalition, composed of people battling cervical cancer and human papillomavirus-related issues, family members and caregivers, also supported the new reduced screening guidelines.
"Our country's leading scientists are supportive of the types of efforts ACOG put together," said Alan Kaye, chairman of the cancer coalition's board of directors. "It has nothing to do with health care rationing. If it did, we'd be the first to stand up on a mountain and yell."
What do you say?
As a daughter, a mother, a friend, a sister, an aunt, a niece -- these recommendations affect you and many people you love. What are your thoughts about the new guidelines? Will you feel safe having fewer Pap smears? Fewer mammograms? Or will you ask your doctors to continue using the previous standards?
Here's the CNN story:
http://www.cnn.com/2009/HEALTH/11/20/cervical.breast.cancer.screenings/index.html
The New York Times story:
http://www.nytimes.com/2009/11/20/health/20pap.html?
_r=1&adxnnl=1&ref=health&adxnnlx=1258984810-gD8/EIzQvChqF+fIS2Vd7g
A Washington Post story on the guidelines:
http://www.washingtonpost.com/wp-dyn/content/article/2009/11/19/AR2009111904743.html