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Just Say No to "Just Scoot up": The End of the Pap Smear

Posted Apr 07 2009 11:11pm 2 Comments
http://www.nytimes.com/2009/04/07/health/07virus.html?em

Here is in an insight into everything that's wrong with American Medicine. The New York Times report that a newly discovered dna test is so much more accurate than the traditional Pap smear as to make that humiliating and sometimes painful test (not to overshare, but that's my truth) obsolete. What might be an obstacle to this miracle? American Medicine's Paternalism.

According to Debbie Saslow, executive director of the American Cancer, her greatest problem in getting the Pap smear replaced by DNA testing is that
" [W]e haven’t been able to get doctors to go along,” Why not? Are doctors concerned about the cost or accuracy of the new test? Not at all. They are concerned about the ability of American Women to manage their own health. Dr. Saslow reports that “The average gynecologist, especially the older ones, says, ‘Women come in for their Pap smear, and that’s how we get them in here to get other care.’ We’re totally overscreening, but when you’ve been telling everyone for 40 years to get an annual Pap smear, it’s hard to change.”

I'd like to suggest that if there were a DNA test for prostate cancer that would replace the current hands-on method of diagnosis, it would be adopted faster than you could snap on a latex glove.

I have a student currently writing a paper on the gender inequalities of Health Insurance (why is Viagra covered but not birth control?), but I wonder if our bigger problem isn't that it's hard to focus on the goals of quality and cost effectiveness when you're blinded by paternalism. And lest anyone think this is a criticism of male doctors, it is not. The values of the medical profession in the United States are transmitted equally to men and women. While this quote by Dr. Saslow is directed signficiantly at older doctors (more of whom are probably male)I would be surprised if they are the only ones to endorse this view.
Comments (2)
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American women are hugely over-screened and that is BAD for your health.

Over-screening leads to over-treatment for false positives.

US women have very high rates of false positives and unnecessary biopsies.

Biopsies can leave you with problems...infertility, problems during pregnancy, pre-term delivery, psychological/psychosexual problems...not to mention they are very unpleasant and painful.

There is a great article by Dickinson that contains a chart...you'll see US women face 55+ smears in their lifetime (many women face many more than that)...the country with the lowest rates of cervical cancer is Finland and they send the smallest number of women for biopsies.  They don't screen women under 30...young women have a very high chance of a false positive and cancer in that age group is rare. The rare case that happens in a young woman is often adenocarcinoma that is not picked up reliably in a pap smear...these young women may get a "fale negative" and ignore symptoms reassured by the Normal pap smear. Smears do more harm than good in young women. In the UK smears are offered from 25...the Netherlands, it's 30 years old.

The Finns then offer screening 5 yearly from age 30...stopping at 50, 55 or 60 (depending on past results and risk profile)...a total of 5-7 tests.

Less is more with cervical screening.

Couples who were not sexually active before they got together are unlikely to benefit from screening, but likely to face a false positive...this is such an unreliable test. These woman might choose not to have screening...

You have to catch HPV from someone to get cervical cancer, and you can't catch it from someone who hasn't been sexually active before meeting you.

This means no intercourse or genital contact...

HPV doesn't mean you'll get cancer...only a very small number of women get cervical cancer even though lots of women are infected by HPV. Most clear the virus....doctors believe there is another factor at work...perhaps, smoking and HPV or a compromised immune system and HPV...they're not sure, but now know exposure to HPV is a factor in all cervical cancer.

Condoms provide good protection if used every time...a US study of college women showed 70% reduction in HPV rates if condoms were used everytime and some doctors believe the protection may be even higher than that....

Women who are not yet sexually active should not agree to smears.

No country in the world (except the States) screens virgins.

Your doctors seem to treat womanhood as a disease.

Are you aware the routine annual pelvic, breast and rectal exams are NOT recommended by the vast majority of doctors around the world. German women are the only ones to also face this annual ordeal.

My doctor believes they are harmful as they often lead to further possibly harmful investigation.

We don't have breast exams before 40...breast cancer is rare in young women and breast tissue in younger women is hard to examine and therefore often leads to biopsies.

You're asked to have mammograms from age 40...be very careful with this one...there are real risks with mammograms and even higher risks for women in their 40's...

See the article attached by the Nordic Cochrane Institute re the risks of mammograms...you won't get this information from your doctor.

I was really shocked when I heard from my US colleagues what they're asked to endure every year. They all see doctors in HK and avoid over-examining and over-screening.

The risk of cervical cancer is low even for a high risk woman...so consider your risk profile before agreeing to screening and if you make an informed decision to have screening, settle on a screening interval that will protect you from false positives.

Also, US women are the only ones in the world asked to have full gyn exams BEFORE getting the Pill...and are regularly denied access until they agree....

This is outrageous and cannot be supported ethically, medically or legally.

They are completely unrelated things and your own medical associations say these exams are not required for the birth control pill. This is to coerce women into screening...and screening requires your informed consent.

I understand Planned Parenthood now offer the HOPE program so you can get pills without the exams and screening.

You should also know that one US woman in three has had a hysterectomy - a VERY HIGH number.

I think that is the inevitable result of having a huge medical presence in your lives....controlling, regulating and demanding unnecessary, excessive and possibly harmful exams.

Good luck everyone....watch out for your doctors!

http://www.mja.com.au/public/issues/176_11_030602/dic10690_fm.html

http://www.screening.dk/folder_uk.pdf

 

One final article which gives you an idea of the risk of this cancer...because of the high level of over-treatment for false positives, many women think the threat of this cancer is high...

It's not...it's uncommon and was in decline before screening was introduced...

This article talks about the research of Angela Raffle (UK cancer screening expert) and that 1000 women need regular screening for 35 years to save ONE woman from cervical cancer.

I'm not saying anyone should or should not have screening, but I think all

women should be given risk information and told the truth...I strongly disapprove of scare campaigns to force women into screening programs.

I'm also opposed to doctors being paid to reach high screening targets as well...which in my opinion, is in conflict with the need to obtain informed consent from women.

http://www.guardian.co.uk/society/2003/may/22/genderissues.publichealth

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