New pap smear guidelines fly in the face of common sense medicine.

I have a love/hate relationship with the annual pelvic exam (pap smear). I don’t know a single woman who looks forward to this exam. However, professionally, I’ve used it to find cervical cancer in a 74 year old female who was told she did not need the exam.

The medical associations are constantly coming up with new recommendations as to how often we should be doing tests. The pap smear went from yearly to now every 2-3 years if you had a normal pap last time. They still recommend that if you have had an abnormal pap that you get another pap 6 months later, and if that one is clear then repeat the pap in 1 year. I still recommend that my patients get yearly pap smears, and, once they are post-menopausal, based on a patient's history (pap and sexual) we can space them out to every 2 years. But every time I hear my patients say their doctor says they don’t need a pap for another 3 years, or ever again, I think of my 74 year old patient.   

I was shocked when I was reading some headlines, recently, that read “The days of the dreaded annual pelvic exam for women may be numbered.” Recently a medical panel of experts stated “that there’s not enough evidence to support doing them for women who are healthy and not pregnant.” If this recommendation goes through then it will affect the 63 million paps that are done yearly, and, more importantly, it is most unfortunate that insurance companies will take that as an excuse to not cover the procedure for women in certain cases.

This is not the first time the annual exam has been under review, of course. 2014 was the year when the new regulations for fewer annual exams started. The American College of Physicians says that the test causes harm because of its invasive nature. I understand woman do not want a plastic speculum in them, but it can be done gently where the women does not feel it. Paps can be a rather quick procedure that give doctors a lot of information about the vaginal/cervical health of the patient. 

I wish these “experts” would allow us, as doctors, to evaluate our patients needs, and do what is best for them, in turn. Instead, we are asked to follow “new guidelines” that are, unfortunately, black and white. Nothing in medicine is black and white. Nothing. Especially when you get to know your patients, their risk factors, family history, and desires. The female annual exam is just another example of a test that is being considered useless like the yearly mammogram, and the PSA for men. I am still recommending that my patients get yearly paps. This reminds me that I, too, need to call to schedule mine here soon.

Source: Boston Globe

Image Credit: Bart Everson (Wikipedia) (CC 2.0)