Put yet another medical test in the more-is-better category — even when science shows that’s not the case.
New draft guidelines recommend healthy women wait until they are 21 to get their first Pap smear, then repeat it every three years and stop when they turn 65. Most of that is not new advice, and it’s not being propagated by bean-counting death panels that consider “women issues” an expendable way to cut costs.
The U.S. Preventive Services Task Force and a group including the American Cancer Society, the American Society for Colposcopy and Cervical Pathology and the American Society for Clinical Pathology developed the guidelines. They found that scaling back tests to every three years does not result in more cancers being found (precancerous cells take 10 to 15 years to become cervical cancer) and that testing before age 21 can lead to false positives and unnecessary surgeries.
The findings echo other recent studies involving annual mammograms for women without a high-risk history, the need for repeat cesarean deliveries after a first C-section, the efficacy of angiograms and the use of the PSA blood test to detect prostate cancer in otherwise healthy men. And yet those tests continue to be heavily utilized.
Dr. Alan Waxman is a professor of obstetrics and gynecology at the University of New Mexico’s School of Medicine, and the lead author of the 2009 American College of Obstetrics and Gynecology guidelines on cervical cancer screening, which recommended Pap tests every two years. He says that while “the annual Pap test is dead, health care providers are reluctant to drop it. What we’re trying to do is use scientifically based recommendations that avoid over-screening and over-treatment.”
The studies don’t mention costs, but as Medicare goes broke and Medicaid breaks states’ banks, and as insurance premiums go nowhere but up, know that if you had to pay for your test, that pap would run you $25-$75, that mammogram $80-$212, that angiogram $10,000, and that PSA $70-$400. Would you opt for the science or the false security blanket if you had to make a decision that directly affected your wallet?
It’s understandable that testing at a minimum allows patients and doctors to feel like they are doing something. But it’s important to recognize the science showing the efficacy and risk-reward ratio of that testing. Otherwise, doing something can at best be doing nothing at all.
This editorial first appeared in the Albuquerque Journal. It was written by members of the editorial board and is unsigned as it represents the opinion of the newspaper rather than the writers.