Read the Bills Act Coalition

Friday, November 20, 2009

Guidelines Ditch Annual Pap Smears - ABC News

From Good Morning America (something I have never typed before:):

Pap smears may no longer be called "annuals" if doctors follow new cervical cancer screening recommendations from the American College of Obstetricians and Gynecologists. ....A new recommendation from experts suggests women need fewer pap smears.The group announced today that women should start getting cervical cancer screenings at age 21 instead of 18, and that women could wait longer between the screenings -- regardless of when a woman starts having sex....Women in their 20s with normal Pap smear results now should get screenings every two years instead of every year, and women in their 30s can wait three years between screenings, according to the new ACOG guidelines. ...After a week of uproar over the controversial recommendations for less mammogram screenings for women, doctors say they will have to wait and see how the public reacts to the new pap smear guidelines

Read Here:Guidelines Ditch Annual Pap Smears - ABC News


Melissa said...

My sister-in-law suffered from cervical cancer this year in her 30's. She would be dead with these guidelines.

Jody L. Wilcox said...

these guidelines are crazy to say the least

Anonymous said...

Women have no idea about cervical screening because they've been deliberately misled...
Annual smears amount to overscreening - they will lead you straight to the day procedure room for biopsies for a false positive.
The more often you screen, the higher the risk, for no real benefit.
So many women say, "I had cervical cancer last year" which has added to the hysteria and misinformation about this cancer. Cervical cancer is rare - abnormal smears and biopsies are common. Almost all of these women who think they had cervical cancer either had false positives and unnecessary treatment or had treatment for something that would never have become cervical cancer. The hugh over-detection and over-treatment of healthy women is concealed by the medical profession. This test is very unreliable and causes so much unpleasant and harmful over-treatment.
We know from Angela Raffle, UK based world expert on cervical cancer screening, that 1000 women need regular screening for 35 years to save ONE woman from cervical cancer. (see British Medical Journal)
Women hugely over-estimate their risk of cervical cancer and hugely over-estimate the value of smears. *Research show that roughly 99.35% of women will not benefit at all from smears or may be disadvantaged (false negatives - 0.35%) ADD to that the fact that 95% or more of US women will have a colposcopy and potentially harmful cervical biopsies in her lifetime (very few will have a problem) and 77% of Australian women (with 2 yearly screening) shows only a tiny % of women "benefit" from smears, but a HUGE number face biopsies.
Applying well known risk factors would enable any woman to assess her risk. Many women are more likey to be hit by lightning than get cervical cancer. Low risk women are most unlikely to benefit from smears, but still face high risks of over-treatment with testing.
You are more likely to die from almost any other form of cancer, including high risk women.
If you choose to have screening, don't allow doctors to over-screen you and never allow a doctor to demand smears or make them a pre-requisite for birth control - your informed consent is required for all cancer screening tests. Birth control has nothing to do with cancer screening - this is an unethical tactic used by doctors to over-ride your right to choose and ignore the legal and ethical requirement of informed consent.

Screening before 25 or 30 leads to huge numbers of unnecessary biopsies and so young women need to be very careful with screening. Women under 30 or 25 are excluded in some countries to contain the harm. Cancer in this age group is exceedingly rare. Because so many young women have abnormal smears, many assume cancer is rampant in this age group - it's not....
The cervix is changing in our teens and 20's and the smear picks these up as abnormal. These changes regress without treatment.
Biopsies can leave you with continuing health issues, mental and physical.
Three to five yearly screening from 25 or 30 reduces the odds of a false positive, but gives sound protection.
There is no real benefit to annual or biannual screening, but lots of harm.
See: Richard DeMay, "Should we abandon pap smear testing", American Jnl of Clinical Pathology 2000. (puts the value of screening and the risk of this cancer in perspective)
James Dickinson, "Time to Change the Policy" - both available on-line via google search. (the latter includes a chart showing how US, Australian and German women are hugely over-screened and therefore, over-treated to their detriment. US women are the most over-examined, over-screened and over-treated women in the world - a practice much more likely to harm you, than help you.)
You'll also find some great discussion with linked articles at Dr Joel Sherman's blog on Patient Privacy, Women's Issues.

Sam said...

Totally agree with the above post. Many women think they had cervical cancer, few did...
Many women think treatment or biopsies is always about cancer.
Almost all biopsies and treatment are unnecessary - caused by false positives from an inaccurate test and most treatment is for changes that would never become cervical cancer. We know even 20% of CIN 3 actually regresses and about 60% of CIN 2 - CIN 1 should never be treated aggressively. All women should be cautious about an abnormal pap smear, which is VERY COMMON - get a second opinion and wait - don't be pushed into treatment. These horrible treatments can leave you with damage to your cervix.
A friend had dysplasia and thought she had cervical cancer. In fact, dysplasia is so common it seems like it's the normal way our body repairs itself. Sadly, with huge numbers of unnecessary treatments, women have been misled as to the incident rates of cervical cancer - it is uncommon and always was...
All of this treatment is not about cancer, it is the result of using an unreliable test. I read that most women getting an abnormal result and referred for colposcopy think they have a 50% chance it will be cancer, in fact, it's less than 1%.
The panic about this cancer is out of all proportion to the risk. If you smoke, don't waste your time worrying about cervical cancer, lung cancer affects 1 in 24 women while cervical 1 in 200.
Know your risk profile and work with that, not with fear and misinformation.

LULU said...

I'm sorry but I disagree with the above two posts. How can you think you have cervical cancer when you don't actually have it? Let’s give these women some credit. Yes, I understand that the Pap smear detects "pre-cancerous" cells which may lead to cervical cancer. If the pap comes back abnormal these women are sent in for further testing coloscopys and or biopsies of the cells. This may make many women nervous but I fail to see how this can EVER be a negative thing?!! Are you people absolutely NUTS!??? Whether or not the test returns a false positive, isn't it better to be screened on a yearly basis to avoid the potential for precancerous cells to turn into cancer? You people have NO idea what you are talking about. This is another way for the health insurance companies to poison the minds of women and take advantage of us by dropping coverage on vital life saving tests like the pap smear and the mammogram. They did it with the mastectomy, kicking women out of the hospital that same day. It is absolutely disgusting. It’s a disgrace and I hope that anyone reading this especially young woman who are sexually active and/or have been diagnosed with HPV WILL absolutely continue to see their physicians annually to have this life saving test. Yes, the Pap test may not be 100% effective and may often return false positives, but it also returns false negatives. Often times the test fails to show pre cancerous cells. Instead of extending the time between screenings shouldn't they be making it more effective and working to ensure that it returns accurate results. I think the new guidelines are crazy and you should be ashamed of yourselves for suggesting to women that they are worrying unnecessarily. We can't afford to be lax when it comes to out health and we certainly can't afford to be misinformed by ignorant people like you.

Jill said...

I actually agree with the posts.
I think it's time we questioned a lot of this screening. They have almost become laws for women and many doctors and other women insult us if we choose not to screen or screen less often...that's wrong.
Cancer screening is always optional and like men, we're entitled to make our own decisions.
If you want to have annual testing, go ahead, you know the risks, but I want to know about the risks. I do NOT want to go through excessive and unnecessary biopsies. I hate all things medical and cared for my sister after a negative cone biopsy. It was a deeply traumatic experience for her and she has permanent damage to her cervix as a result.
My sister was never asked if she wanted the test and was never told the risks. We now find out through a Dutch Dr that the risk of this cancer is very low, about 1%, but annual testing will send almost everyone for follow-up.
We should have been told by our doctors.
Don't underestimate these procedures...they are invasive, painful, stressful and embarrassing. My sister was terrified and she was sore and bled for weeks afterward. The test was just plain wrong in her case, a false positive, and now we find out that often happens.
Again, we should have been told..
I don't want to risk that to cover the smallest of risks.
I'm considering the Dutch program which offers 5-7 tests in total over your lifetime starting at 30. It still sends about half of all women for follow-up, but it's way better than the risks of annual and 2 yearly testing.
This offers good protection from cancer AND false positives. We're doing more reading, we've found we haven't been told the whole story.
I think it's time to open our minds and to give women ALL of the information so we can make our own decisions.
I think we should stop criticizing each other as well..every woman should be free to make her own decision.
I read a piece written by a Dr who doesn't agree with the pressure women face to screen...he reminds all women that choosing not to screen is never wrong.
I'd add choosing to screen on your own schedule is fine as well.
I think the article by pathologist, Richard DeMay is excellent. I'd recommend it to others..I found it easily googling his name.

Anonymous said...

These unnecessary treatments and biopsies are a negative thing.
Anyone suggesting otherwise has definitely not been through the process.
I had a negative cone biospy in 2001 caused by a false positive as well. I didn't know anything about false positives and found it impossible to get any straight information out of my Dr.
I got a referral to an oncologist who laughed and said I'd never had cancer and probably never would...the test is very often wrong.
I found that shattering...that whole nightmarish experience was for nothing. I had been perfectly healthy.
I think many women in my position still think they had a cancer scare and the treatment saved their lives. It seems that's rarely the case.
The cancer simply doesn't occur that the other posters have said, it's quite rare. The oncologist told me the risk is around 1% without screening and with screening you still have a small risk caused by false negatives. (around 0.30% or 0.40%)
Assessing your risk is therefore vital and screening sensibly to reduce the risk of a false positive. Some very low risk women have no chance of being helped by smears and they need to be very careful.
I have such severe scar tissue on my cervix that I couldn't get pregnant. I'd need medical help, I've had enough of their help!
We're trying to adopt a girl from China.
Even if they helped me to get pregnant, I might need a suture in my cervix to hold the baby and would probably need a c-section. Having a prem baby is a risk too.
I was a healthy young woman before pap smears.
I don't blame the smear, I blame the doctors for testing me too early and too often and not giving me any straight information. Most women have no idea...they read a womens magazine and think they have the answers, they don't. It scares me to hear young women say they have them every year, like more is better.
Less is better with pap smears. That is a fact.
We must be told the truth and if we feel we can benefit from smears, be permitted to screen in a sensible way.
Our doctors are pap smear happy, and that's dangerous to our health.

Anonymous said...

After a very bad experience as an 18 year old girl, I've refused all screening ever since. I was refused birth control, so my partner had a vasectomy. He has three children from his first marriage and we didn't want any's expensive enough educating three of them.
I was fearful of not having exams and testing, but my fear of going through another bad experience was greater. The damage to mind and body at such a young age kept me away from doctors.
I found a great website recently that contained statistics and knowing that information, I feel a lot better and calmer. I had no idea the risk of this cancer was so small and that I'm low risk for this cancer as well. I can live quite happily with that risk. I've been harmed enough by testing to take the high risk of more, which is many times greater than a diagnosis of cancer. This cancer only affects small numbers of usually high risk women.
I don't agree with misleading and scaring women. I think my bad experience was caused by the excess and lack of common sense in our medical world. In most countries I would not have been tested, in fact, it would be considered negligent to test me.
Screening the wrong people, too often, too early...harms women and puts us off screening for life.
If the screening hurts you in body or mind, you'll naturally protect yourself in future.
It's time to stop the pressure, the lies, the misinformation, the half-truths, the coercion, the scare tactics and the profitable excess.
It's time to allow women to make their own decisions about preventative medicine. We have a right to be in charge and be an active participant in our health care.
Katie H

Anonymous said...

If women are interested in finding out the actual risk of this cancer...which is not even close to what you've been told by doctors...take a look at an amazing article by a world expert in the field, Dr Angela Raffle.

Facts (as opposed to propaganda)
"Without screening approx 80 women would have developed cervical cancer by 2011 of whom 25 would die. The screening of 10,000 women over 35 years would prevent 10 of those deaths".
I'll bet your doctor didn't tell you that!
Over that period, thousands of women are worried and harmed by unnecessary treatment and biopsies. It's killing a flea with an atomic bomb.
Sadly, many women have closed minds, but if you want the truth, do some reading. We finally have access to the truth.
Remember...this Dr is a world expert.

Anonymous said...

I found that doctor's research really interesting as well. Like many other women, I didn't know about the over-detection and over-treatment. I also didn't know this cancer is rare. I always assumed the abnormal results and treatments were for cancer or things that would become cancer.
Rather it represents false positives and treatment for things that would never have become cancer.
When you see money desperately needed in other areas of medicine, it seems unfair that a rare cancer keeps getting the money and attention. It's almost the "pin-up" cancer.
There are other unfashionable illnesses and cancers and if some of this money were directed there way, we'd save a lot more lives.
When you think doctors spend most of their time treating women who would never have had a problem with cancer, but for screening, it seems like a waste of time and money. The women left infertile and with scar tissue after treatment then become patients again. It seems very unfair to healthy women who are told this cancer is a real risk and that the test is reliable - both wrong!
The information given above mentions Angela Raffle, a British doctor and cervical screening expert. I read some of her research in the British Medical Journal. (thanks for the research tips and references!)
Angela Raffle is quoted by Richard Smith, the editor of the British Medical Journal 2003;325 (26 April) and Dr Raffle's research is at pg 904.
We have the 1000 figure, cited above,
1000 women need regular screening to prevent one death from cervical cancer AND, the rest is just as interesting and important,
one nurse performing 200 tests a year would prevent one death in 38 years! During this time, one woman would die despite screening.
Also, out of the 1000 women, 152 would get abnormal results, over 79 women are referred for follow up and over 53 would have abnormal biopsy rates. Over 80% of cases of high grade dyskaryosis and high grade dysplasia do not progress to invasive cancer. That's a vast amount of over-detection to save a few women.
I'll bet your doctor didn't give you any of that information!

Surely the rights of healthy women matter as well. We at least should get the facts so we can make the right decision for ourselves.
I'm low risk and have decided not to have testing. I'll be very careful with all screening tests from now on. We are never given a fair appraisal of any test.
Once introduced, doctors only care about numbers and not about the health and rights of individual women.

Anonymous said...

Sorry, I misquoted Dr Raffle's research,
1000 women need regular screening FOR 35 YEARS to prevent one death.
It's the 35 years that's the surprising statistic. Most women think it's a very common cancer.

Med Student said...

95% of all colposcopies and biopsies are excessive or false positives. It's only acceptable because women don't know about it.
Only a very small number of women would get this cancer without screening, with screening a huge number of women are harmed by unnecessary treatments.
This test would not be approved today and was never properly evaluated before its release. Women who had hysterectomies after an early abnormal result are very likely to have been victims of an unreliable test and not cancer.
The program has been modified over the years to limit the harm, like a human experiment, but the over-detection is unacceptable and the fact women are unaware of this high risk is shameful. Women also think this cancer is a huge threat, it's not and never was.
11,000 cases per year compared to 200,000 for prostate and 200,000 for breast.
The HUGE reduction is only a small drop when you look at actual numbers. Also, other factors are responsible for the decrease like hysterectomies. It was a cancer in steady decline before screening started...
A lot of damage to save a few women.

Anonymous said...

Unnecessary hysterectomies are still happening. If you look at websites like hystersisters you'll read some horror stories. We overuse this test which increases false positives and excessive treatments.
There are HUGE numbers of young women having LEEP, conizations, cold knife excisions. These women have the smallest risk of all, a really tiny risk.
Yet we go on "treating" cervix after cervix.
One friend had her first LEEP at 18, two more in her early-mid 20's, 3 to 6 monthly testing which increased the risk of more false positives and now she's told the "abnormal cells" have returned.
After all the unnecessary treatments she has very little cervix left, but "apparently" the "bad cells" are higher up the birth canal now and a hysterectomy is being discussed. She hasn't had kids yet.
I know having lived in Europe for a few years that all of these treatments were unnecessary.
If she had been lucky enough to be living in another country like the Netherlands she would have been excluded from screening until she was 25 or even 30 and spared this nightmare.
Our doctors know they're creating work for themselves and money on the back of destroying the lives of young is appalling what we're doing to our young women.
We'd be better off scrapping this testing and putting the money into research to find better treatments for the very small number of women who get this cancer or find a better test.
21 is still FAR too young, when will we stop destroying the lives and bodies of our young women? Why can't our doctors be forced to follow a foreign program that catches more cancer but respects and preserves the health of all women.
I was lucky enough to live in Amsterdam and have the knowledge to protect my body from our doctors. I won't test before 30 and then only 5 yearly and may self-test which is also an option provided by many Dutch doctors.
I wonder how many more young women will have unnecessary hysterectomies before something is done.