Days after a government task force radically changed its guidelines for using mammograms to screen for breast cancer, another critical preventive test — Pap smears – is under the microscope, heightening concern that both might be a first step down a slippery slope toward health care rationing.
On Monday, the U.S. Preventive Services Task Force recommended that doctors delay mammography screening for breast cancer until the age of 50. The recommendation goes against the American Cancer Society’s long-held position that women receive their first mammogram by the age of 40 and follow up with yearly mammograms until the age of 74.
Breast cancer is the leading cancer in women and the second-leading cause of cancer death in women.
Doctors, patients and lawmakers lashed out against the revised recommendation, calling it a first step toward health care rationing as the Senate moves toward a vote Saturday on its version of legislation that would overhaul health care — including government-funded alternative to private insurance.
In what some see as further attack on women’s health care, the American College of Obstetricians and Gynecologists recommended Thursday that women delay cervical cancer exams, also called Pap smears, until the age of 21 and that women younger than 30 undergo cervical cancer screening once every two years instead of an annual exam. The organization also said that women age 30 and older can be screened once every three years.
The recommendations, the college said, are based on scientific evidence that suggests more frequent testing leads to overtreatment of irregular Pap smears, which can harm a young woman's chances of carrying a child full term.
Reaction to the recommendation has been mixed.
“I think it’s bad timing with the whole health-care reform effort going on and the mammogram recommendations that came out earlier this week,” said FoxNews.com managing editor of health Dr. Manny Alvarez, who opposes the new mammogram recommendations. “But these particular guidelines don’t fall into the criteria of saving money. These guidelines have to do with minimizing injuries to women that are of reproductive age.”
But Dr. Elizabeth Eden, an obstetrician/gynecologist and professor of obstetrics and gynecology at New York University School of Medicine in New York City, disagrees and says it's another attempt by the government to cut costs on preventative medicine.
“I think it’s a bad idea,” she told Fox News Friday. “I think a large number of adolescents are sexually active and by the age of 21 we’re talking about what could be five or six years removed from their first sexual experience.”
The leading cause of cervical cancer in the U.S. is the human papillomavirus (HPV), a common sexually transmitted disease among women and men, which is why sexually active women should be regularly screened for cervical cancer, Eden said.
“There is no money being saved by not testing,” Eden said. “The test isn’t as expensive as the study suggests. There is severe risk in not testing these women and the article is scaring them away from routine tests that could potentially save their lives.”
Still, unlike breast cancer, which can be quite aggressive in spreading to the lymph nodes and other organs such as the lungs, cervical cancer is considered a “slow-moving” cancer.
And Alvarez, a high-risk obstetrician and chairman of the Department of Obstetrics and Gynecology and Reproductive Science at Hackensack University Medical Center in New Jersey, said many of his patients have been injured by the treatment administered to them after an irregular Pap smear.
“Many abnormal Pap smears do not need any medical treatment and yet there has been an abuse in surgical treatment,” he said. “This has led to a large amount of women now having pregnancy complications, such as premature deliveries, incompetent cervix and vaginal cuff damage — all due to surgical follow-ups to irregular Pap smears.
“With mammography, it’s different,” Alvarez added. “Breast cancer is a hidden killer. I’ve only seen two cases of aggressive cervical cancer in my career and that was in women who had never had any type of screening in their lives.”