I don't know about you, but I'm confused. Who is telling me the truth about mammograms and Pap smears? A federal panel says women can wait until 50 for yearly mammograms. A group representing obstetricians and gynecologists advises women can wait until 21 for their first screening for cervical cancer.(acog.org)
For years, women have been advised to get annual mammograms beginning at age 40. Even teenagers were told to get yearly Pap smears within three years of becoming sexually active.
In truth, while women young and old have been scheduling those yearly doctor visits, the rates for both cervical and breast cancers have dropped dramatically. Since the onset of regular mammography screening in 1990, the breast cancer mortality rate has dropped by almost a third. The cervical cancer rate has declined by half, with credit given to the yearly Pap smear.
Most women won't get breast cancer. More women will get breast cancer after 50 than before. However, a full 40% of the lives saved by mammograms are among women 40-49. These figures come from both the American Cancer Society and the American College of Radiology.
What was Health and Human Services Secretary Kathleen Sebelius trying to say when she backed away from the panel's mammogram recommendations? After all, she heads the federal department that is advised by the panel. What does this tell you? Are their recommendations incorrect or just unpopular? Is this good science and bad medicine? What are women who have been taught to fear breast cancer all of their lives to think?(ahrq.gov)
"My patients are angry," says Manhattan oncologist, Dr. Bonnie Reichman, clinical associate professor of medicine at Weill Cornell Medical College. "This is setting us back 20 years in all of the strides we've made in early detection and treatment of breast cancer," says Reichman.
"I was diagnosed at 54, but I know a lot of women who were in their 40's," says Tanya Adkins, a breast cancer survivor. Where would these women be without early screenings? It's statistically correct to say the numbers are smaller in younger women, but if you're among that number, it's your life.
"Only 50% of women over 40 go for mammograms as it is, "says Dr. Kathy Plesser, a board certified radiologist in Manhattan. "We need to tell these women to go, not others to stop going."
When it comes to cervical cancer screenings, confound it, I'm confused again. A prominent group representing the very doctors who specialize in treating women, says women can now wait until 21 for their first cervical screening. The group says abnormal Pap smears in teenage women leads to unnecessary procedures that can damage the cervix and have led to an increased number of premature births.
Does it only strike me as odd that the new recommendation may place the health and well being of the young female behind the success of a future pregnancy that may or may not happen? If there are unnecessary treatments that may be harmful, why aren't doctors looking more at improving or reducing these treatments than delaying the initial screening, which remember is credited with reducing cervical cancer by 50?
Teenage women rarely get cervical cancer. It is a slow growing disease caused by certain strains of the human papillomavirus (HPV), a common sexually transmitted disease. Generally, the immune system will clear up the HPV infection within one to two years among most adolescent women.
There is a higher incidence of HPV-related precancerous lesions in adolescent women, but most cervical dysplasias in teens resolve on their own without treatment. Treatment may be unneeded, but a doctor and patient can't even talk about that without the initial screening.
With delays in these screenings can we expect the cancer rates to increase? "I would expect the rates to go back up and I certainly won't be following any of these recommendations," says Dr. Thomas Caputo, the chief of the division of Gynecologic Oncology at NY Presbyterian/Weill Cornell Medical Center.
In putting forth their recommendations, both auspicious groups did express and advantage in decreased costs. Treating a man or woman with cancer costs a lot of money. The screenings are by comparison inexpensive. Again, I'm confused.
(For more of my stories and to see Gossip Gram go to nbcnew york.com.