Friday, November 20, 2009

New Guidelines Push back Screenings for Breast and Cervical Cancer

I have been following this debate for a while now. It all started with an article in one of my magazines by this woman who was advocating that women should receive less mammograms unless they are in a high risk group because of the chance of false positive and unnecessary stress and worry. That was the only good reason she gave for decreasing the number of mammograms a woman receives and pushing back the age for required screenings. I personally would rather have a false positive one or twice, and catch a potential cancer early than not screen and then suddenly be hit with advanced breast cancer. There have been advances in breast cancer treatment in recent years resulting in higher success rates in fighting the cancer, but the fact remains that it is a largely incurable disease. Additionally, the high success rate is due largely to catching the cancer earlier due to heightened awareness and better screening processes.

Now they are pushing back the age at which women should get their first PAP screening to 21. I really can't believe this. Sure, young women may present irregular results that will go away with time, but this test usually comes as a bundle with other tests for STD's and general female reproductive health. If we are recommending that young women stop getting PAP tests until a certain age, this raises a whole set of problems. First, doctors caveat that sexually active young women should still receive these tests, probably to screen for precancerous cells from contracting HPV. How is a young woman, say, in high school supposed to broach this topic to her parents that she wants to go to the gynecologist to maintain her reproductive health when it is no longer "recommended" without blatantly saying "Hey mom and dad, I'm now sexually active and want to be safe about it." Second, if women aren't going for their recommended yearly PAP test, chances are they won't visit the gynecologist every year for other vital tests for ovarian health since the yearly exam usually bundles all of these tests together. Also, I would be willing to bet that now that these new recommendations are in place, insurance will stop covering these necessary procedures for women, or will only cover them in an even more restrictive manner than before.

No one loves getting their breasts smooshed by some stranger or stripping down and putting their feet up in the stirrups. They are uncomfortable procedures that we all suffer through as women to protect our health. They save lives, and prevent the spread of STDs. Many of the diseases that both mammograms, PAP tests, and other reproductive health testing detect symptoms that can go unnoticed in many women without these screenings if she is not particularly in tune with her body. Maybe breast cancer and cervical cancer can still be sufficiently detected with these new standards. But what about the side effects of these changes? Women visit the gynecologist less frequently, missing out a forum to comfortably discuss her sexual health, and most likely also decreasing the rate of STD testing. In all likelihood, insurance carriers will decrease the number of tests, both mammograms and PAP screenings, they will cover for women, without distinguishing between women who are high risk, sexually active at a younger age, or have a family history of these cancers. I would really like to see them try to scale back the number of years between when men go for their prostate PSA test, and see if the recommendations are pushed through so easily.

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