Just days after the U.S. Preventive Services Task Force (USPSTF) revised the screening guidelines for breast cancer, The American College of Obstetricians and Gynecologists (ACOG) has revised its guidelines for cervical cancer screening. You can read the revised guidelines here.
Basically, the ACOG is recommending that women should have their first cervical cancer screening at age 21 and be rescreened less frequently than previously recommended. Previous guidelines called for yearly testing for young women, starting within three years of their first sexual intercourse, but no later than age 21. The reason for the revision is to “avoid unnecessary treatment of adolescents which can have economic, emotional, and future childbearing implications.” Cervical cancer is caused by strains of the human papillomavirus (HPV). The ACOG reports that cervical cancer rates have fallen more than 50 percent in the past 30 years and that although HPV infection is high among sexually active teens, cervical cancer is rare in women under 21. Apparently, the immune system can clear HPV infections within a year or two among most young women.
From the ACOG, “Because the adolescent cervix is immature, there is a higher incidence of HPV-related precancerous lesions (called dysplasia). However, the large majority of cervical dysplasias in adolescents resolve on their own without treatment. A significant increase in premature births has recently been documented among women who have been treated with excisional procedures for dysplasia.”
On their own, these guidelines seem reasonable. But many women are frustrated by the changes, and rightly so. After all, there doesn’t seem to be clear consensus on the USPSTF guidelines and now this? The ACOG actually issued a contradictory response to the USPSTF’s guidelines. So did the American Cancer Society. So who do we trust? Secretary of Health and Human Services Kathleen Sebelius also issued a statement on the breast cancer screening recommendations. Here’s an excerpt (full text here):
“There is no question that the U.S. Preventive Services Task Force Recommendations have caused a great deal of confusion and worry among women and their families across this country. I want to address that confusion head on. …
“My message to women is simple. Mammograms have always been an important life-saving tool in the fight against breast cancer and they still are today. Keep doing what you have been doing for years — talk to your doctor about your individual history, ask questions, and make the decision that is right for you.”
Her message may be simple but not realistic. When doctors schedule appointments every 15 minutes, when insurance companies make it very difficult for doctors and patients to order and receive testing outside of the recommended time frames, when referrals and co-pays and paperwork make the simplest procedures complicated, managing your health care is easier said than done.
When it comes to health care women don’t know who they can trust. These new guidelines follow on the heels of The House of Representatives trading women’s reproductive rights for the passage of a healthcare bill. Leading up to that vote, many women were surprised to learn that C-sections, rape, domestic violence are all considered pre-existing conditions by some insurance companies. Is it any wonder we are skeptical when told to scale back on preventative measures?
I am not a health care provider and therefore not qualified to comment on the guidelines. But I am a woman and feel quite comfortable telling the healthcare industry and the government, “Get it together with respect to women’s health.”
