Days after a controversial recommendation from the US Preventive Services Task Force on breast cancer screening, a separate organization has recommended less screenings for cervical cancer. Anyone seeing eerie parallels or ready to scream about “rationing” needs to read a bit more closely:
New guidelines for cervical cancer screening say women should delay their first Pap test until age 21, and be screened less often than recommended in the past.
The advice, from the American College of Obstetricians and Gynecologists, is meant to decrease unnecessary testing and potentially harmful treatment, particularly in teenagers and young women. The group’s previous guidelines had recommended yearly testing for young women, starting within three years of their first sexual intercourse, but no later than age 21.
Arriving on the heels of hotly disputed guidelines calling for less use of mammography, the new recommendations might seem like part of a larger plan to slash cancer screening for women. But the timing was coincidental, said Dr. Cheryl B. Iglesia, the chairwoman of a panel in the obstetricians’ group that developed the Pap smear guidelines. The group updates its advice regularly based on new medical information, and Dr. Iglesia said the latest recommendations had been in the works for several years, “long before the Obama health plan came into existence.”
She called the timing crazy, uncanny and “an unfortunate perfect storm,” adding, “There’s no political agenda with regard to these recommendations.”
I would argue that there would be a political agenda if these recommendations were somehow muzzled until after the health care bill was dispensed with. The fact that they’re coming out at this sensitive moment would be the opposite of how any good plotter would act. In the case of the USPSTF, they operate independently of the Dept. of Health and Human Services and were stunned by the reaction to their report.
Further, the American College of Obstetricians and Gynecologists has absolutely no role in the health care bill whatsoever, and they don’t agree with the USPSTF recommendation on mammograms. They find that there are more potential pitfalls to overscreening on pap smears than on mammograms. In addition, the findings of either group are not binding on doctors or patients; as the Health and Human Services Secretary made abundantly clear the other day, even the USPSTF recommendations are little more than advisory – though I still maintain they may effect cost sharing gudelines.
Preliminary reports show that insurance companies will continue to pay for mammograms starting at age 40. They have little ability not to – the procedure is mandated at that age in 49 of the 50 states. Changing the guidelines would involve changing all those state laws. There has been no comment from insurers yet about the cervical cancer guidelines.





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Most cervical cancers are caused by STDs, so women who are not sexually active with a male don’t have a lot to worry about. At least that’s what Dr. Susan Love told me quite a few years ago.
Well I certainly wouldn’t say that women worrying about being shortchanged with all the potential change going on in healthcare is silly. Case in point: Stupak.
That would be true if it were prominently women making the claims of rationing here. It’s not – it’s the mostly-male Republican caucus.
As a general matter, I think there’s far too much medical testing done in the U.S. Third party payment made it easy for patients to just go along without questioning its necessity. Then, once docs figured out the racket, their colleagues set up testing labs to which docs were only to eager to refer. Then they figured out a new racket. Blame liability for the excess testing.
To begin with: Kill this BS HCR bill slithering through Congress. Instead, pass some of the more sensible patches and hold out for Universal Coverage! All or nothing cannot be anything but pure BS !
The consequence would be no W for Rahm, yet a W is needed before the mid terms, so the Administration would turn to strong financial industry regulation to assuage the rising emotional discontent among a broad swath of the public. That would yield a must win for democrats going into mid terms, and a win for democracy in general.
Considering the larger picture – the USPSTF should not have been surprised in any way at the reaction to their recommendation. If an organization releases medical guidelines for the public they should have at least a general awareness of current the public mindset. The wording was extremely poor – to the point the spokesperson apologized for it on the PBS Newshour. What is the matter with these people? They couldn’t wait a few months to release this info? If it was just a stupid move then it would be forgivable. Who is going to listen to their message now? And how would anyone think this would influence people’s concerns about pending healthcare legislation? My immediate response is that if these organizations are this stupid at communicating they could well be that stupid when it comes to analyzing data. Not just bad – pathetically bad.
Did someone declare war on women and forget to tell me? First the health care[?] bill outlaws abortion for poor women, now this group of Bush appointed nuts says we shouldn’t be screened for cancer as often. What’s next, our right to vote?
And will these nuts soon release similar findings for prostate and testi-cular cancer?
I agree with you. Women’s worries about being shortchanged in healthcare reform are not silly. Not given the events of the past few weeks. Regardless of what Congressional leaders say about removing Stupak, until it happens, it is still there. It passed, and it passed because of the Democratic reps who voted for it. And I’m waiting to see what abortion restrictions the Dem Senators come up with.
It is very odd timing to see, on the heels of Stupak, the guidelines changing for breast cancer and now cervical cancer screening. I do think we do too much testing in this country. But I do not believe all unnecessary tests are performed on women! I’d like to see some decrease of men’s exams. I won’t hold my breath…
These recommendations are being implemented worldwide for two reasons. The first is that the rate of abnormalities on Pap smears in women under 35 years is high but the rate of cancer is very low. In other words, most positive smears are falsely positive and the woman does not have cancer. The next step is a cone biopsy, a procedure with a small mortality but increasingly recognized risks to any future pregnancy of premature labor or caesarian section.
The second factor is HPV vaccination (Gardasil). This is likely to reduce the rate of cervical cancer by 90 to 95% in those vaccinated. This, together with the above mentioned problem of falsely positive smears in young women, means that on balance more harm than good might be done. Screening is always a numbers game.
Cervical cancer is one of the few screening programs that has had a detectable effect on the disease it is aimed at. The Breast and especially Prostate screening programs don’t appear to be anywhere near as effective. They are diagnosed earlier but the evidence that that is helping is less impressive.
You beat me to it docs. Gardisil (and, as of last month, Cervarix) change the game completely in much the same way as the polio and smallpox vaccines.
Note to NCgal and oldhippiejean, give it a rest, not everything is misogyny in action. This isn’t a popularity contest.
Breast cancer isn’t just a woman’s disease, and prostate cancer kills men just as dead as gynecological cancer kills women. You’re trivializing suffering.