"Unfortunate Perfect Storm": Task Force Releases New, Less-Frequent Pap Smear GuidelinesS

Just days after a task force raised a stink by advising that women wait until age 50 to have mammograms, another group is recommending less frequent Pap smears to detect cervical cancer.

In the past, cervical cancer screening has been recommended starting at age 21 or within three years of a female's first sexual experience, whichever comes first. Now, the American College of Obstetricians and Gynecologists (ACOG) says women can start getting screened at the age of 21, regardless of when they began having sex, and that women older than 30 who have three consecutive normal Paps can get screened every three years instead of every year. ACOG also says some women can put screening on hold between ages 65 and 70, and that women with no history of abnormalities who have their cervix removed through hysterectomy can stop screening entirely.

Like the mammogram guidelines, these new Pap smear recommendations are meant to reduce the harm caused by false positives. But doctors say the risks of Pap smears are greater than those of mammograms — they often detect cervical lesions in young women that would go away on their own without ever progressing to cancer. Removing these lesions can damage the cervix and increase the chances of premature birth.

Dr. Cheryl B. Iglesia, chairwoman of the panel that developed the new Pap smear recommendations, calls their timing — coinciding with debates on mammograms and on healthcare reform overall — "an unfortunate perfect storm." And cervical cancer survivor Patricia Juirc told the Washington Post,

It seems a little bit of a week where women's health is taking a beating, considering the suggested guideline changes for mammography and all. Like they no longer want to be proactive and only see or treat us when we get sick.

But Cindy Pearson of the National Women's Health Network says,

There's something about health reform and guidelines that makes people think they're telling women to do less screening to save money. But we don't have any concerns that women are being asked to give up something that is helpful. These recommendations are sound.

And Thomas Herzog, a gynecological oncologist and spokesman for ACOG, adds, "in this case, if anything, we're taking money out of our own pockets." Part of the skepticism about screening guidelines is no doubt caused by fears surrounding the health care debate. But in part, these guidelines have been so controversial because they go against the prevailing medical culture. The Times's Kevin Sack writes,

For decades, the medical establishment, the government and the news media have preached the mantra of early detection, spending untold millions of dollars to spread the word. Now, the hypothesis that screening is vital to health and longevity is being turned on its head, with researchers asserting that mammograms and Pap smears can cause more harm than good for women of certain ages.

Are we about to see a shift in the way we think about our health, in which the benefits of early detection are weighed against the risks of detecting and treating something that never would have harmed us? This shift might be beneficial — especially if we believe ACOG — but it's not going to happen overnight. And a healthcare debate in which phrases like "death panel" get thrown around isn't going to make it happen any faster. In addition, the new Pap smear recommendations may seem strange to women who take birth control, given that doctors often require yearly Pap smears as a condition for such prescriptions. Girls and young women who want the Pill have long had to submit to screening before even the more conservative three-year recommendation, and the new guidelines are unlikely to change this practice. Beneficial as screening can be, using birth control as a carrot to lure women into the stirrups is a little paternalistic, and reflects an approach to women's health in which the women themselves don't have much power. This approach is evident in the debate over reproductive rights as well — over the years, so many people have tried to exert control over women's bodies that it's no wonder we've become a bit suspicious.

Cervical Cancer Screening Can Wait Till 21, Group Says [Washington Post]
Medical Science And Practice In Conflict [NYT]
Guidelines Push Back Age For Cervical Cancer Tests [NYT]