Wednesday, September 12, 2007

Speculum reprieve...

for certain groups of women. The U.S. Preventive Services Task Force has reviewed the pros and cons of that annual dreaded ritual of a Pap smear and determined that some of us can pass:

The USPSTF recommends against routine Pap smear screening in women who have had a total hysterectomy for benign disease.

The USPSTF recommends against routinely screening women older than age 65 for cervical cancer if they have had adequate recent screening with normal Pap smears and are not otherwise at high risk for cervical cancer.

This does NOT mean those of you in the above mentioned groups should forego the annual exam, including the health review, blood pressure check, and breast exam. Just say no to the speculum.


Dr. Smak said...

I have found that the response to this shift in recommendation interesting. It seems that most of us in primary care are comfortable skipping the pelvic, whereas most OB/Gyn's insist on continuing the exam to screen for 'other problems', ie ovarian, uterine issues.

While I feel that one ought not put things in others' orifices without evidence of some sort of benefit, I feel that I am on some thin ice. Many patients are very attached to the annual pelvic after being beaten over the head with it's importance for decades. And their friends who see OB/Gyn's are still getting them, so they ask me why I'm not.

It's somewhat akin to the conversation that we are supposed to be having with male patients regarding prostate cancer screening. Most doctors, myself included, err on the side of testing, generally for medicolegal reasons.

Overtesting seems easier to defend than undertesting.

But I'm glad to hear someone else is forgoing those unnecessary pelvics.

Femail doc said...

Well, actually not necessarily skipping. Like you, I find many women just feel more comfortable with ongoing exams so I don't feel right about talking them out of them. I tell them the recommendations (including the one I didn't list about pts. >30 with low risk of cervical ca and 10 years of normal paps need them only every 3 years), and if they light up with smiles and say 'hell yes,' we skip it.

Otherwise, pap on.

Mauigirl said...

I would think it would still be beneficial to have the Pap even if cervical cancer is not of concern. Isn't the Pap also useful in diagnosing other conditions, such as certain infections?