New Screening Guidelines Aren't Cause for Panic

Cynthia Haines, MD Health Guide
  • If you're a woman who stays on top of her health, the news about health screenings during the past month may have been confusing - as well as frustrating - to witness.

     

    After all, if you've been donning paper gowns for years so your health care provider can swab, squash, and prod your body hither and yon to find early signs of cervical and breast cancer, you'd like to know that your time, money, and effort was well-spent.

     

    But new government recommendations regarding mammograms, which reflect the fact that benefits from screenings aren't perfectly clear, triggered an enormous outcry. The U.S. Preventive Services Task Force's new guidelines advised against routine screening mammography for women in their 40s. As for women ages 50 to 74, the guidelines recommend screening mammograms every other year. The American Cancer Society, for its part, still recommends annual mammograms for all women starting at 40.

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    The breast-screening controversy overshadowed news that came out at the same time regarding cervical cancer screening. The American College of Obstetricians and Gynecologists released new guidelines on when women should have Pap tests. Previously, women were advised to start Pap tests at age 21 or three years after they become sexually active, whichever comes first. The new advice is simply to start at 21. In addition, most women ages 21 to 30 should have a Pap test every other year instead of annually.

     

    Some commentators in the media and online speculated on whether these changes were simply intended to help the health care system save money by giving women less health care.

     

    But the national conversation less often touched on the harms that can come from overusing screenings. Yes - harms. A simple Pap test can bring more than just a chilly moment on the exam table.

     

    In medical testing, there is a risk of false positives...that is, showing signs of trouble when none actually exists. And false positives can not only lead to anxiety over what this could mean, it can lead to additional (and perhaps unnecessary) testing along with procedures that also are not without risk. In the case of an abnormal Pap test, this can mean colposcopy, accompanying biopsy, and/or greater removal of cervical tissue.

     

    Research has found that women who've had cervical tissue removed (such as following a suspicious Pap finding) via a loop electrosurgical excision (LEEP) procedure appear to have higher risk of later having a preterm childbirth.(1)

     

    Still, screenings do catch early cancers and precancerous changes. You may know a woman who found such a problem at a screening. However, a lot of factors play into when we should be screened (and treated) for health threats. And as new research provides more information to influence these decisions, organizations will keep updating their recommendations.

     

    Though the details in these guidelines will change, here's what you should hold true: Keeping up with regular screenings is best. But what's right for your sister, mother, friend, or women in general may not be right for you. Your personal risk factors should figure into whether - and how often - you should be screened for cervical and breast cancer.

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    So get together with your doctor and make your important screening decisions based on your personal needs.

     

    1. http://www.ajog.org/article/S0002-9378(09)00189-6/abstract

     

Published On: December 09, 2009