New women’s health care guidelines not for everyone

By The Columbia Chronicle

Since new female health care recommendations were announced Nov. 16 by the federal Preventive Services Task Force and the American College of Obstetricians and Gynecologists, many cancer survivors, doctors and women from around the country have been scratching their heads and shaking their fists.  Some are calling the announcements the beginning of rationed health care; some are calling it the end of preventive care.  Some are yelling sexism, others are yelling murder.  Pundits are calling cash-strapped insurance companies puppeteers of the whole change, directed and produced by the mostly Bush administration-appointed Task Force.  The announcements were definitely an unusual surprise.

The new, more limited guidelines should not become routine for every woman.  As a 20-year-old who has undergone two separate ovarian surgeries, I know they’re

not for me.

The Task Force said mammogram screenings should start at age 50 and continue every two years, discarding the long-held practice of beginning annual screenings at age 40.  The Task Force also said monthly self-breast exams are not necessary.  In an apparently unrelated announcement, the ACOG reviewed its own guidelines and concluded women only need a Pap smear every two to three years starting at age 21, regardless of when they became sexually active.

With women in their 40s accounting for more than a quarter of breast cancer diagnoses, and nearly half of sexually active youth expected to contract the Human Papilloma virus (HPV) that can lead to cervical cancer, cutting back on these preventative procedures is a risky and controversial step.

The American Cancer Society quickly spoke out against the new mammogram advisory, as did Health and Human Services Secretary Kathleen Sebelius and former National Institutes of Health chief Dr. Bernadine Healy.

It is important to remember these new guidelines are just two groups’ recommendations. Both breast cancer and cervical cancer guidelines vary between the Task Force, the ACOG and the American Cancer Society, as well as other advisory groups.  They all urge routine screenings, but when they should start and how often varies.

The Task Force panel said women under 50 have a higher risk of false positives in mammography, which in some cases can lead to more invasive procedures, unneeded biopsies and of course, high anxiety.  The new reasoning behind less frequent Pap smears is similar, in that cervical cancer is a slow-growing cancer and most young, healthy bodies will fight mild HPV outbreaks on their own.

To avoid confusion, women should not just read the headlines.  Every report explains that these guidelines are not for all women and women in higher risk groups should still see their doctors for frequent screenings.  Dr. Alan G. Waxman, who helped write the new Pap test guidelines, said doctors should remind women of the benefits of annual check-ups, even if a mammogram or Pap test is not part of the visit. Many professionals are echoing the sentiment.

It is also important to remember a routine gynecological exam does more than just screen for cervical cancer.  I am six months shy of 21, the new recommended age for a woman’s first Pap smear. I have had two separate ovarian surgeries to remove precancerous ovarian cysts.  Cysts are relatively common, but not usually dangerous in young women. The precancerous cysts I had are not something that would be found in screening for cervical cancer, but would most likely be detected as part of any regular gynecological exam.  Women should still see their doctors regularly and talk with them to plan a routine that is best, taking into account their medical history and personal concerns.

In addition to keeping in touch with doctors, women need to listen to themselves and their bodies.  If I ignored the changes I recognized rather than consulting my doctor, I would have developed ovarian cancer.

Monthly self-breast exams and regular check-ups remain a good idea, whether or not screenings are part of the exam.  Keep a strong relationship with your doctor and keep the responsibility of your health care in your own hands.  Don’t grant any government agency more control over women’s bodies.

by Eleanor Blick