Two recent revisions to cancer screening guidelines could carry dangerous consequences for women’s health. One is particularly harmful to college-aged women and younger, who are now being told to put off Pap smears until they are 21.
Earlier this month, the American College of Obstetricians and Gynecologists changed the long-standing recommendation that women receive their first cervical exam three years after becoming sexually active or at age 21, whichever came first, and be screened annually thereafter. The recommendation is now to wait until age 21 and then be screened every two years.
The stated reason for the change is that overtreating young women can impact their ability to carry a child full term. Dr. Thomas Herzog of Columbia University told MSNBC.com doctors have been “overtreating” and “overdiagnosing” young women. Along with sending the message that the medical establishment does not care whether young women may have cancer, this reasoning ignores the reality of young women’s lives and the services many patients receive during Pap smears.
A Pap smear examines cervical cells for abnormalities that can lead to cervical cancer, which is the second most common cause of cancer-related death among women worldwide. It also can detect viral infections that can lead to cervical cancer such as human papillomavirus, which often shows no symptoms, can go undetected for years, infects an additional 6 million people annually and will be carried by 50 percent of men and women in their lifetimes, according to the Centers for Disease Control and Prevention.
Testing for infections and other abnormalities allows for early detection of cervical cancer and has lead to a precipitous drop in cervical cancer deaths in recent years, with 2 to 3 million abnormal Pap smear results being found each year.
Knowledge of a high-risk strain of HPV can allow a woman to continue regular screenings and catch cancer early; it’s not much of a leap in logic to assume a lack of testing will lead to the opposite. The exam is also a time to have conversations about birth control, menstrual cycles and anything else.
These recommendations seem even worse because they immediately followed another change from the U.S. Preventive Services Task Force that women should have routine mammograms every two years beginning at age 50. The recommendation used to be to have annual exams beginning at age 40.
The government-backed panel says too few women develop cancer in their 40s to justify the anxiety, excess biopsies and false-positive test results. The task force found one cancer death is prevented for every 1,904 women tested between the ages of 40 and 49, one death per tested 1,339 women is prevented for women aged 50 to 59.
That’s all well and good, unless the life saved is yours. The recommendation was met with fury by breast cancer advocates and doctors. News organizations had no trouble finding women whose lives were saved by mammograms, and who would have died if they had waited another year to be screened.
Those opposed to health care reform legislation have seized on these recommendations as proof the government will ration health care. While Health and Human Services Secretary Kathleen Sebelius said the recommendations were only that and would not stop private insurers from covering cancer screenings, one has to be a little suspicious. Surely some excessive testing in the medical field will need to stop in order to provide more people with health insurance.
But these are not those tests. And it is dubious that these recommendations come down on only half the population. It’s taken years to make early detection an effective tool against breast and cervical cancers, and these changes will only harm the progress that has been made in saving women’s lives.