What about annual pap smears?

 

Quick, what about annual pap smears?

No doubt you have heard that women should go as long as 5 years between pap smears. While this never meant going more than a year between exams for the sake of prevention and early detection of many problems women may develop, the idea that pap smears could be deferred so long was really shocking. Women had been advised for a long time to have pap smears annually? Why was that? And what might have changed that could allow spacing of prevention steps to be so far apart?

 

The new recommendations were based on opinions put forth in a study that, I think, if women were aware of their pre-suppositions, they would clearly not agree.

What pap smears always did was prevent cervical cancer, by catching pre-cancers early and curing them. And even when cancers were found, they were most often found at an early and curable stage.

The assertion that women could go 5 years between pap smears changed the whole focus of attention.

Previously the health goal of a pap smear was early detection of pre-cancerous or cancerous conditions in order to either prevent cancer or catch a cancer early in order to cure. The consequence of not catching early might be death or lost quality of life. This study proposed that the real goal was to avoid the pap smear or to avoid the diagnostic procedures that lead to early diagnosis. Their primary concern was that women don’t like to do pap smears and our goal should be to avoid them. Colposcopy is a procedure that a woman has done in the provider’s office which examines her cervix during a pelvic exam with a microscope, identifying areas that may need biopsy for diagnosis of a potential pre-cancer or cancer of the cervix. The screen was the pap smear, the diagnosis was done with colposcopy and biopsy. This study suddenly proposed that rather than working to avoid cancer in women, what we should be doing is avoiding colposcopy. They set up their study to demonstrate that when you do fewer pap smears, you end up with fewer colposcopies, and therefore women were better off…. DUH!

 

The sad result of this study is that many physicians took that ball and ran with it. At a point 5 years after this study was published, here are the USA figures: 195,000 cases of invasive cancers that would have been prevented with annual pap smears, and 44,000 preventable deaths.

Is this OK with you? While Medicare is the only insurance that I am aware of that with this recommendation took the position that they would not pay for annual pap smears, when I talk to women and explain this to them, they uniformly tell me that even if their insurance did one day refuse to pay for the pap smear, they are willing to pay that $50 themselves.

Cervical cancer is no one’s preferred way to die. If you have further questions about this issue, please come in and let’s discuss it.

If this is enough to convince you, call and let’s get your annual well-woman exam and pap smear done. Waiting is just not worth it!