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Monday, November 23, 2009
New Pap smear guidelines being questioned, too
By Olivier Uyttebrouck
Journal Staff Writer
The controversial new guidelines for when women should start getting mammograms, coupled with new recommendations about Pap smears, have become fodder for a partisan debate over whether the government is trying to ration medical care.
A University of New Mexico professor authored the new guidelines about Pap smears that were issued Friday by the American College of Obstetrics and Gynecologists. They call for women to get their first Pap test at age 21.
The group's former guidelines recommended that girls get their first Pap test within three years of becoming sexually active, or at age 21, whichever comes first.
The new guidelines also say that most women in their 20s can have a Pap smear every two years instead of annually.
Dr. Alan Waxman, a UNM professor of obstetrics and gynecology, said the new guidelines emerged from a raft of new research and knowledge about how teenage girls develop cervical cancer.
"If they're starting on the road to cancer, it isn't going to show up for years and years," Waxman said.
In older women, certain precancerous cells increase the risk of cervical cancer, calling for a treatment known as LEEP, or loop electrical excision procedure, which removes a layer of skin from the cervix.
The procedure is highly effective in removing dangerous cells, Waxman said. But LEEP is often unnecessary for young women, who often lose precancerous cells over time, he said.
The same is true of human papillomavirus (HPV), a sexually transmitted virus that can lead to cervical cancer. Women's bodies can fight off an HPV infection without permanent harm.
"We have learned, in the natural history of HPV, (girls) pick it up quickly and get rid of it easily," Waxman said. By delaying the Pap test, doctors also can delay or prevent a teenage girl from getting a LEEP. The procedure can heighten a woman's likelihood of later giving birth to a premature infant, he said.
Waxman's guidelines came just days after the new mammogram recommendations were announced.
Republicans seized on both sets of new guidelines, calling them examples of government rationing of health care, in an attempt to erode support for President Barack Obama's proposed health care overhaul.
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