New health advice hurting women?

Loosened guidelines on breast and cervical cancer screenings spark fears -- some unfounded

Published November 20, 2009 10:50PM (EST)

Immediately after reading about the new cervical cancer screening guidelines, which recommend delaying pap smears and having them less often, a friend sent me an e-mail reading: "I mean, should this month's headlines be summed up as, 'New medical guidelines recommend that women get a lot less healthcare than they used to?'" Indeed, this advice comes on the heels of the U.S. Preventive Services Task Force's controversial new guidelines that bump the suggested age for mammograms up to 50. The American College of Obstetricians and Gynecologists, which issued the new pap smear guidelines, says the proximity of both news items is strictly coincidental and that its new position has been in development for quite some time.

Some skepticism on women's part about these relaxed standards makes sense after years of repeatedly being pinned with pink ribbons, lectured about the importance of yearly paps and hit over the head with pamphlets about the lifesaving HPV vaccine. That's especially true for those of us who know women -- some in their 20s and 30s -- with breast or cervical cancer. As my friend wrote, it feels a bit like the overarching message is: "Chill out, chicks! It's just cancer!" Yeah, and it'll just kill you!

That these new guidelines come amid a contentious healthcare debate has also raised paranoia that this is part of an effort to lower healthcare costs -- at the expense of women's health. The impossible-to-avoid Sarah Palin took to Facebook late Thursday to air her worries about this shift in the wisdom about pap smears: "There are many questions unanswered for me, but one which immediately comes to mind is whether costs have anything to do with these recommendations," she wrote. "The current health care debate elicits great concern because of its introduction of socialized medicine in America and the inevitable rationed care." Many other Republicans have jumped on the "rationing" bandwagon as well. (Yeah, now they care about women's healthcare!) Judy Norsigian, executive director of the Boston Women's Health Book Collective (aka Our Bodies Ourselves), told me that "we have a discourse at the moment that is dominated by right-wing rhetoric that the Democrats are all about denying healthcare services."

The truth is that Kathleen Sebelius, secretary of health and human services, insists that the breast cancer screening guidelines will not change "what services are covered by the federal government." (Also, insurance companies claim they won't change mammogram coverage and, as David Dayen points out on FireDogLake, "the procedure is mandated at [age 40] in 49 of the 50 states.") The Obama administration has yet to address the new standards for cervical cancer screening -- but medical opinion on the benefits and risks of pap smears is far less contentious than when it comes to the mammogram debate (which has been going on for decades).

Cindy Pearson, executive director of the National Women's Health Network, an independent consumer-advocacy group, told me that the suggested pap smear routine "is not at all about cost-cutting," but instead "improving women's health." Most women's bodies are able to fight off the virus that causes cervical cancer -- but, when a doctor does detect infection through a test for the virus or the appearance of "disturbed cells" on the surface of the cervix, they typically provide treatment that very well might be unnecessary. This isn't just an issue of experiencing bothersome "cramping, discomfort and missing some work" after having the abnormal cells removed, she says -- "what's actually happening is it's weakening the cervix in some women so that they can't support a pregnancy full-term."

My question for her was why doctors haven't instead adjusted their response to the discovery of the virus' presence -- was it in the interest of avoiding malpractice suits? She explained that the medical community operates under the mantra of "if you see it, you treat it." Essentially, the new cervical cancer screening guidelines reduce the likelihood of a doctor seeing it, so as to avoid their treating something likely to clear up on it's own. "Sometimes there are cases when you say, 'Watch and wait,'" she says, "but almost no one does it."

It just goes to show that you have to be your own advocate when it comes to navigating the healthcare system. As Mary Elizabeth Williams wrote earlier this week about the new mammogram standards, "What’s optional for one woman may be the difference between life and death for another." She also added that "blanket guidelines are just that -- they're fine for covering the many, and they are not laws we have to follow." A woman and her doctor still have to take into account her individual history and particular risk factors. That has always been the case and continues to be so. As Norsigian from Our Bodies Ourselves said: "You give women the scientific evidence and let them make their own choices."

By Tracy Clark-Flory

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