Changed cervical cancer screening guidelines scare and confuse women

pap smearIt's been a tough month to be a women wondering how to preserve her health. First, the American Cancer Society flip-flopped on its previous stance and said screening for some cancers might not be necessary. Then in a landmark move, a government panel issued its guidelines for mammograms, stating most women should skip the screening until age 50. Now the American College of Obstetricians and Gynecologists has changed its mind on how often women should be screened for cervical cancer.

All this waffling has some wondering: Is cancer as bad as we've thought it to be? Meanwhile others fear that the government and some doctors have given up on caring for women.

What's the real deal? Sadly, no one seems to know. If women listen to the new guidelines and recommendations, they'll cut down on the number of trips to the doctor. But that, say some experts, could also result in women playing a game of Russian roulette with their health.

The latest change
Pap smears, the latest screening with a new set of guidelines, have typically been suggested annually for women 18 years of age and older. Now the American College of Obstetricians and Gynecologists says Pap smears every two years is enough to catch cervical cancer.

Despite the unnerving coincidence, the ACOG says it is not out to get women. And that they've been reviewing Pap guidelines since late 2007.

Still, the widespread concern that the government is looking for ways to cut health care costs in advance of the current health care reform looms over women. "To me, the government is sending the message that they don't care about my health," says Carrie Norwood, a 45-year-old woman concerned about not only her health, but that of her three daughters.

Dr. Cheryl B. Iglesia, the chairwoman of a panel in the obstetricians' group that developed the Pap smear guidelines, told The New York Times that the timing of the announcement was "an unfortunate perfect storm" and that "there's no political agenda with regard to these recommendations."

The new guidelines say:
  • Routine Paps should start at age 21. Previously, ACOG had urged a first Pap either within three years of first sexual intercourse or at age 21.
  • Women 30 and older should wait three years between Paps once they've had three consecutive clear tests. Other national guidelines have long recommended the three-year interval; ACOG had previously backed a two- to three-year wait.
  • Women with HIV, other immune-weakening conditions or previous cervical abnormalities may need more frequent screening.
These latest recommendations, ACOG says, are based on scientific evidence suggesting more frequent testing contributes to overtreatment which can impact a young woman's chances of carrying a child full term.

"We were overdiagnosing and overtreating adolescents and very young women," Dr. Thomas Herzog of Columbia University in New York, who is chairman of an ACOG subcommittee on gynecologic cancers told

But terms like "overdiagnosing" and "overtreating" are resonating like nails on a chalkboard with women.

"Whether they intend to or not, doctors and supposed government experts using them make it sound like no one cares if women have - or may have - cancer," says two-time cancer survivor, Candy Antonelli. "Women deserve to have someone advocating for their health. And saying some cancers are overdiagnosed certainly doesn't sound like advocacy."

Some experts fear that in addition to angering women, the new guidelines will confuse them. "Women might develop the thought that "if [random] doctors "out there" say screenings aren't all that important, I shouldn't worry about my health. And that's just not true," says Antonelli, whose lump (later diagnosed as breast cancer) was initially found during a routine self- exam.

"If I listened to the government I'd probably be dead," adds Antonelli. "I hope women trust their instinct and the screening process that's helped drive female cancer rates down in recent years [annual screenings] and not these new ridiculous guidelines."

Sound off: What will you do? Will you continue to have annual breast and cervical cancer screenings? What if your insurance won't cover the procedure? Will you still have the screening?

Gina Roberts-Grey is a freelance writer specializing in health and consumer issues.
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