Posted on Wed, Jan 13, 2010
Guidelines for some of the most important tools in preventative medicine have changed considerably in the past few months. In fact both mammograms and PAP smear guidelines were changed within a week of each other. New guidelines suggest using them less than before. Understanding the changes is important for you in terms of taking care of your health and your
medical insurance.
The U.S. Preventative Services Task Force (USPTF) is the group making the recommendations regarding the guidelines for mammograms. They are based on studies and scientific proof. These new basis are only for healthy individuals who are not considered high risk for breast cancer.
The American College of Obstetricians and Gynecologists (AGOG) is the one which has made the recommendation for less frequent PAP smears. The group is made up of specialized OB/GYNs who are chosen by their peers.
Breast Cancer Screening Changes
The 2002 recommendations for breast cancer screening was a mammogram every 1-2 years for every woman over the age of 40. The USPTF has been stating since 2002 that there is not enough evidence to recommend self exams or in office breast exams by physicians.
The 2009 recommendations include mammograms every 1-2 years for women aged 50 to 75. The recommendations for self exams and doctor exams have not changed. Multiple studies have shown no measurable benefit in terms of survival rates for those who did such exams and those who did not.
Cervical Cancer Screening Changes
For years PAP smears have been the standard tool for screening for cervical cancer. In fact, a yearly PAP smear has been the norm for many years and a decline in cervical cancer has been documented. Most cases of cervical cancer were discovered in patients who had neglected to get a PAP smear for 5 plus years. However, other countries have loosened the guidelines for PAP smears and the U.S. is finally doing the same.
The new recommendations as of 2009 include recommended PAP tests for women over 30 only every 3 years, provided their last 3 PAP tests have normal results. Those with risk factors or immune deficiencies are recommended to have them more often. First PAP tests should be done at age 21. Those who have had the HPV vaccine still need to follow these guidelines until further recommendations have been made.
Benefits and Risk Factors
Amongst the benefits for patients is the fact that the stress of false positives is greatly reduced. It is fairly common for mammogram results to show possible cancer when there is actually none, especially in younger women. This leads to unnecessary biopsies. In addition, mammograms actually miss 10-15% of breast cancer in younger women also.
In the case of suspicious cells showing up in PAP smears, the treatment can be overly aggressive, especially in younger women. The treatment can impair a woman's ability to successfully carry a baby to term due to problems with the cervix not remaining closed. It has been proven that many of these abnormal cell cases clear up on their own. Follow-up PAP smears can determine if this has happened or not in cases that are untreated.
The biggest risk for women, in terms of the changed requirements for the screenings, is the possibility of actually developing breast cancer or cervical cancer and having it go undetected. Breast cancer occurs in 135 of every 100,000 women, making it the most common cancer in the gynecological field. Its mortality rate is 27 women of every 100,000. Cervical cancer occurs in 9.3 of every 100,000 women and the mortality rate is 2.9 per 100,000.
Mammograms have actually proven their effectiveness at saving lives. In addition, the risk reduction between women in their 40's and women in their 50's is not that great. Therefore, the change in mammogram frequency is more debatable than the other changes.
Every woman should follow her instincts and rely on her doctor's advice when it comes to cancer screening tests. Being aware of the results of different studies gives you the knowledge to be an active participant in the decision about whether or not to follow the new guidelines for screening.