Panel Recommends Pap Smear Tests Every Three Years, Not Yearly
I found an article about this in the New York Times. I don’t actually get all my research and scientific reading from The New York Times – I belong to a Research Review Service and have access to the Canadian Memorial Chiropractic College Library online (and in person when I go there), but it is interesting to see what gets published in vehicles that the public reads. It’s interesting seeing how long it takes the research to hit the streets – it’s often a pretty long time!!!
This article is interesting for a number of reasons, but because I’m in an “alternate” health field, I always get a chuckle from how medicine defines prevention.
The article I’ve quoted in the title starts out by saying that the Pap smear test is still the best way to prevent cervical cancer. Well, actually, the Pap smear test is the best way to detect if cervical cancer is developing. So, it’s not actually a prevention – which would mean that you are such a healthy organism that you’re not even at risk for developing such a disease – but a method of early detection. That being said, it is a good test for detecting early cancerous changes in cervix cells.
The standard testing protocol, since as long as I can remember is for the test to be done yearly starting at puberty. The new recommendation is that women should not get tested every year. This is according to the United States Preventive Services Task Force (and has been endorsed by an equivalent Canadian body.) Instead, every three years is the new recommendation. The group named above is the same group that recently recommended against routine prostate cancer tests for healthy men (which is a topic for a whole other newsletter!) Proposed changes are in response to insufficient evidence to weigh harms and benefits of separate tests screening for human papillomavirus, the virus that causes cervical cancer.
In a rare show of unity, groups including the American Cancer Society sided with the panel on the new recommendations on Pap smears and proposed new screening guidelines, bluntly recommending against the common practice of annual tests. “If you test every year you find a lot of benign infections that would go away on their own,” said Philip Castle of the American Society for Clinical Pathology. “You end up overscreening, over managing and over treating women who are not actually at risk of getting cervical cancer.” The task force, composed of primary care doctors who are experts at evidence-based research, is highly influential in setting the tone for primary care practice. Echoing the panels’ recommendations, the cancer groups also said women younger than 21 did not need to be tested. Side effects of over testing could include vaginal bleeding, pain, infections, risks of pre-term delivery and psychological impacts of facing a possible cancer diagnosis, experts say.
As a regular person, you’re probably wondering what all this is about; after all, wouldn’t early detection always be a good thing? Isn’t more testing going to lead to a healthier population? It turns out that it actually doesn’t – at least, not always. What the public doesn’t understand about medical testing is that it isn’t as accurate and clear cut as you believe. It isn’t like on TV with Dr. House – order more tests and come up with a more accurate diagnosis with each test. The tests have certain parameters they measure and, given a whole bunch of variables, can indicate something – but they might also be indicating something else, entirely not related. Tests nearly never prove anything, they more often disprove. The tests have to be given and studied in context. A good history (which is what you tell your practitioner about what you are experiencing, your symptoms, what seems wrong, how long you’ve had it, etc) is still the most accurate and valuable diagnostic tool. Tests should be given to prove or disprove a differential diagnosis (that is one or two or three good possibilities) based on your history.
Basically, what they are saying in this study is that Pap tests, because they are sensitive, but not very specific, show up a lot of things that are not necessarily important, but if you look at them too soon, they can get your doctor excited and he will treat you for something that you probably won’t get, and even if you did, it wouldn’t be important anyway. But if you get tested every three years, it is easier to distinguish what we should be getting excited about. Being treated for anything is not without side-effects and dangers – it is often better to leave well enough along and be sure of what you have before you risk the treatment.
I don’t know if this helps make this subject clearer for you, but I hope it does because medical over treating is dangerous and not health inducing. I’m all about getting and staying healthy.
Now for the real clincher. Want to know how to prevent cervical cancer? (That is, not get it at all?) This isn’t a very popular strategy in our current society, but it is the most effective. Practice abstinence before marriage. Have only one sexual partner in your life who also has only one sexual partner in their life (you). What can I say? Effective, not popular. Instead we invent a vaccine for a couple of the more than several papillomaviruses and give it to little girls.
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