I’m sorry, but are our country’s medical agencies smoking something? Just a few days after new breast cancer screening guidelines recommended mammograms only for women 50 and older and declared self-breast exams moot, the American College of Obstetricians and Gynecologists is now telling women to delay getting their first pap smear until they are 21 and to get them less often afterwards. This is pretty confusing because, until today, the rule was that women should have their first terribly uncomfortable meeting with the dreaded stirrups shortly after becoming sexual active, and that they should get a pap every year at their annual check-up. So why the change? ACOG says that in young women, HPV—the virus that can lead to cervical cancer—is very prevalent and that the huge majority of women clear the virus on their own, without any medical intervention. They say that there are only one to two cases of cervical cancer a year for every million women between the ages of 15 and 19. But because testing has become so routine, ACOG says that young women who are very unlikely to develop cervical cancer are getting invasive procedures to remove precancerous growths and cells that would clear on their own. And that they’re having complications, like injury to the cervix, that can cause problems if they have a baby. As for recommending less frequent testing, ACOG argues that cervical cancer develops slowly—it can take 10 to 20 years—so can be caught early even with less rigorous testing. [NY Times]
While these arguments sound logical, I have a hard time believing that this can be a good idea. And honestly, it makes me pretty mad.A few years ago, when I worked at Jane Magazine, amazing editor Sara Lyle began working on a story about her good friend, Heather Lyn Martin, who had been diagnosed with cervical cancer. After a few years of skipping pap smears (she was a bartender without health insurance), Heather started feeling intense pain during sex. She made an appointment at Planned Parenthood for a pap, and midway through, the nurse practitioner gasped—Heather had a giant tumor. Sara set out to write about her friend battling and eventually beating cervical cancer. That didn’t happen. A few months later, Heather died. At age 28. Read the full story here and check out the informational website Sara created in Heather’s honor. Be prepared to cry.
Seeing a case like this second hand makes me think it’s a terrible idea to tell women to get screened less frequently. It’s not the screening that’s the problem—it’s invasive procedures gone wrong. Seems like a much better solution would be to work with gynos and surgeons on recognizing what cells and growths are dangerous and need to be removed and which they should let go and keep an eye on. Teach them to be more conservative in what they remove, and perhaps even provide more training so the procedures aren’t botched as often.
Getting a pap smear isn’t fun. Actually, it’s one of the least comfortable things in the world and I’m getting freaked out just thinking about it. So don’t give women an excuse to skip it. Sure, the incidence of cervical cancer is extremely low for teenagers. But what about women in their 20s, 30s, and beyond? Eleven thousand women get cervical cancer every year. It’s rare, but happens. And if you can prevent a death, why wouldn’t you?
*This rant has been brought to you by a non-medical professional. I welcome comments and thoughts from people with more knowledge.