Et tu, American College of Obstetricians and Gynecologists?

The American College of Obstetricians and Gynecologists (ACOG) has issued new guidelines for pap smears, which screen for cervical cancer. Previously, they suggested beginning testing after becoming sexually active and testing annually starting in your twenties. Now, they say women in their 20s only need to be checked every two years and testing should begin after 21. Women in their thirties should only be tested every three years after three clear test results, according to the new guidelines. The new guidelines are based on the newer science, which also shows that unlike other cancers, cervical cancer tends to be slow growing and the doctors say that less frequent testing will lead to less frequent procedures, which, they claim, could lead to disrupted fertility.

Cervical cancer rates have dropped by 50% due to regular pap testing.

The ACOG is quick to add that this should not disrupt women's annual exam schedule.

In the last month, women's health care  has taken a heavy and hard hit. Women's reproductive care hit the metaphorical equivalent of the Great Wall of China with the Stupak-Pitts Amendment, which just received endorsement from the US Conference on Catholic Bishops. Prominent women, including Senator Kirsten Gillibrand and Ohio Secretary of State Jennifer Brunner have publicaly criticized and opposed this amendment, saying it is an insult to women's health care and an assault on privacy and access to legal care.

Next, the United States Preventive Services Task Force (USPSTF) announced that it is changing its guidelines for mammography and no longer recommends routine screening for women between the ages of 40 and 49. The American Cancer Society, however, continues to "recommend annual screening using mammography and clinical breast examination for all women beginning at age 40."

Otis W. Brawley, M.D., chief medical officer, American Cancer Society said, “The American Cancer Society continues to recommend annual screening using mammography and clinical breast examination for all women beginning at age 40.

"Our experts make this recommendation having reviewed virtually all the same data reviewed by the USPSTF, but also additional data that the USPSTF did not consider. When recommendations are based on judgments about the balance of risks and benefits, reasonable experts can look at the same data and reach different conclusions."

Dr. Brawley said, “In 2003, an expert panel convened by the American Cancer Society conducted an extensive review of the data available at the time, which was not substantially different from the data included in the current USPSTF review.

"Like the USPSTF, the Society’s panel found convincing evidence that screening with mammography reduces breast cancer mortality in women ages 40-74, with age-specific benefits varying depending on the results of individual trials and which trials were combined in meta-analyses. And like the USPSTF, the American Cancer Society panel also found that mammography has limitations – some women who are screened will have false alarms; some cancers will be missed; and some women will undergo unnecessary treatment. These limitations are somewhat greater in women in their forties compared with women in their fifties, and somewhat greater in women in their fifties compared with women in their sixties.

"We specifically noted that the overall effectiveness of mammography increases with increasing age. But the limitations do not change the fact that breast cancer screening using mammography starting at age 40 saves lives.

“As someone who has long been a critic of those overstating the benefits of screening, I use these words advisedly: this is one screening test I recommend unequivocally, and would recommend to any woman 40 and over, be she a patient, a stranger, or a family member."

And now pap smears.

I'm concerned about this trend to decrease and block women's access to preventive care. I'm concerned it will persuade women to decrease their annual exams and let health -- especially preventive care -- slide, possibly to dangerous levels.

These organizations are all extremely influential on policy and women -- even those who want to maintain their safe and healthy annual health care -- may find it increasingly challenging to be able to watch over their health responsibly.

Women need to maintain their annual exams, and if the guidelines are confusing and make it hard to track when you should be screened (and they are confusing, enough so to be a major deterrent for busy women who already have to track too many calendar and schedule items) the American Cancer Society offers an easy to use health reminder prompt for free.

As much as these organizations argue that this is about science and necessity, deconstruction of the logic reveals a more financially based reasoning.

Dr. Brawley said, "With its new recommendations, the USPSTF is essentially telling women that mammography at age 40 to 49 saves lives; just not enough of them. The task force says screening women in their 40s would reduce their risk of death from breast cancer by 15 percent, just as it does for women in their 50s. But because women in their 40s are at lower risk of the disease than women 50 and above, the USPSTF says the actual number of lives saved is not enough to recommend widespread screening."

ACOG has allegedly been working towards these new guidelines for the past decade. It's curious timing to me to release these new guidelines right now, as the health care reform debate rages and a major debate point is providing better equality in health care affordability and access for women.

What do you think of this assault on preventive women's health care, especially centering around female-specific bodies and cancer? What do you think of the rapid release back-to-back new guidelines for health care for women happening right now?

UPDATE: Here are the guidelines from the American Cancer Society to clarify and eliminate confusion:

Cervical cancer

    * All women should begin cervical cancer screening about 3 years after they begin having vaginal intercourse, but no later than when they are 21 years old. Screening should be done every year with the regular Pap test or every 2 years using the newer liquid-based Pap test.

    * Beginning at age 30, women who have had 3 normal Pap test results in a row may get screened every 2 to 3 years. Another reasonable option for women over 30 is to get screened every 3 years (but not more frequently) with either the conventional or liquid-based Pap test, plus the HPV DNA test. Women who have certain risk factors such as diethylstilbestrol (DES) exposure before birth, HIV infection, or a weakened immune system due to organ transplant, chemotherapy, or chronic steroid use should continue to be screened annually.

    * Women 70 years of age or older who have had 3 or more normal Pap tests in a row and no abnormal Pap test results in the last 10 years may choose to stop having cervical cancer screening. Women with a history of cervical cancer, DES exposure before birth, HIV infection or a weakened immune system should continue to have screening as long as they are in good health.

    * Women who have had a total hysterectomy (removal of the uterus and cervix) may also choose to stop having cervical cancer screening, unless the surgery was done as a treatment for cervical cancer or pre-cancer. Women who have had a hysterectomy without removal of the cervix should continue to follow the guidelines above.

And remember the American Cancer Society offers an easy to use health reminder prompt for free.

You can read more about this at the New York Times.

Comments

[Corina]

It is the "just not enough" of them that bothers me so much. These are women, mothers, daughters, friends and wives. Isn't one out of them enough? It is about saving the almighty dollar. And in the eyes of the ACOG and the USPSTF, these women LIVES serve as an acceptable risk against that dollar. A life is an acceptable risk? This is an all out assault on women's healthcare. And is PAINS me to see the double standard. We won't pay for abortions because it "saves a life". In pretty close to the same breath, we deny women the screenings that can "save a life" because, apparently it doesn't save enough lives. I see the common thread, saving the money, see that women are under full assault in both LIFE and LIBERTY. It is time to act.

[Karen]

Well, I'm not surprised. ACOG is not actually woman-friendly. They have released some incredibly sexist decisions in the past...for example, advising women against home birth because it is a mere cause "celebre," as if women cannot make a wise, informed decision about where to have a baby and who should attend the birth. Any organization with that type of sexism at its core will be under suspicion from me.

[Lawyer Mama]

I don't think some of this is new. I've had 3 different obgyns over the last 6 years & I've been screened every 2 years since then. I remember my gnecologist telling me that I didn't need to be screened every year since I'd never had an abnormal pap. All of my gynecologists since then have followed the same guidelines. The political timing of the new announcement does really bother me though.

[Kris Underwood]

I don't see them issuing any new guidelines on Guardasil.....

[Happybell]

It seems odd to me.Their line of reasoning seems off. But then, here there's even a law stating that women get to have their day off (paid) so that they can go get a PAP smear done. Obgyns here insist that women have the pap done every year, mine even checks the date of my last pap first thing during a consult. Same goes for mamograms after a certain age, you get a paid day off to go have it. Although I think the main reason for the law was that not enough women got tested.

[nancy]

where does this information come from? you quote people and I am guessing you are copy and paste from news articles but I see no attribution. bad form to take credit for other's work and it is confusing as well.

[Julie Pippert]

Nancy, I quote, attribute quotes, cite sources and link throughout my article. If you have another read-through, you can see that the long quote is clearly attributed to Dr. Brawley, and standards to ACS. It is from a statement he released that allowed quoting, and the standards I have permission to use. In fact, I provide more source citing than the average msm article. Your comment is unsubstantiated criticism that sounds like trolling. If you have a question about data or information, please feel free to ask a question.

[Julie Pippert]

Corina, I share those same concerns. I understand they are citing evidence-based medicine, but the problem is there are CLEARLY shades of gray because the USPSTF and the experts at ACS reviewed the exact same data and came to very different conclusions. I've since received a statement from another group that was confusing, and probably a pitch, but did mention alternative screening tools. of course, there isn't enough data on newer tools and I've no idea if insurance would cover them or allow annual screening.

I'm not sure about applying an actuarial approach to health care.

[Julie Pippert]

Karen, you bring up a very valid point - consider the source. ACOG does regularly come out with guidelines that are often not per se in the best interest of the individual woman, or that may create a problem for women who do not fit within the guidelines. More importantly, it may prevent a woman from making the best health care choice for her. Then again, I am not impressed with their communication or with reporting.

Happybell, I wish such protections were at play by and large throughout the US.

Steph, allegedly they've been reviewing and considering this for ten years. I still question the data and conclusions drawn from it, probably due to skepticism I hold about their motives, particularly asking me to believe its a MAJOR coincidence they HAPPENED to release this NOW, hot on the heels of the mammogram guideline changes and the health care reform debate. Sorry, my suspension of disbelief doesn't extend that far, lol.

Kris, intriguing question.