From the NY Times:
New guidelines for cervical cancer screening say women should delay their first Pap test until age 21, and be screened less often than recommended in the past.
The advice, from the American College of Obstetricians and Gynecologists, is meant to decrease unnecessary testing and potentially harmful treatment, particularly in teenagers and young women. The group’s previous guidelines had recommended yearly testing for young women, starting within three years of their first sexual intercourse, but no later than age 21.
Arriving on the heels of hotly disputed guidelines calling for less use of mammography, the new recommendations might seem like part of a larger plan to slash cancer screening for women. But the timing was coincidental, said Dr. Cheryl B. Iglesia, the chairwoman of a panel in the obstetricians’ group that developed the Pap smear guidelines. The group updates its advice regularly based on new medical information, and Dr. Iglesia said the latest recommendations had been in the works for several years, “long before the Obama health plan came into existence.”
There was actually a really good piece on NPR yesterday about the decisions behind the breast-screening guideline changes that explained the reasons for the change in the guidelines. According to one of the doctors, the problem people are having understanding the reasoning for the guidelines is that the statistics are saying something that is counter-intuitive and goes against our long-held belief that earlier detection is better in regards to cancer. Here is the relevant snippet:
BLOCK: We have been getting a lot of email from listeners, as you might imagine. And a number of people have stories of their own. And I want to read a couple of those letters. This is one from Wendy Hickey(ph) of Pittsburgh who says that three years ago when she was 45, a mammogram identified suspicious tissue in her breast. She had a needle biopsy excisional surgery and is now cancer-free, taking daily tamoxifen.
And Ms. Hickey writes: I can’t imagine what would have happened if I had delayed my mammogram for five more years. But I feel safe in guessing that the outcome and treatment would not have been as positive.
Dr. Lerner, what would you say to Wendy Hickey about that?
Dr. LERNER: If people can take away from this show the notion that what she’s saying may be true but may not be true, I think they would learn a lot.
What the data is showing us is that this woman, even though the mammogram found the suspicious cells early on, the argument is that her overall prognosis would not have changed. She would have gotten treated then as aggressively or more aggressively as when it was found by mammogram, and she would have done exactly the same.
That’s what the point is of this data. It’s hard conceptual leap for people to make, even for a doctor, but that’s what the data show.
BLOCK: And you would assume though that the earlier you find something, the better your results would be.
Dr. LERNER: That has been the guiding principle of cancer research since the early 20th century, but the data for some cancer shows that things are not that simple, and that’s what we’re trying to deal with now.
You can listen to the whole piece here. I thought it was interesting and worth the time.
