Pap Smear Screening

There was an article in the New York Times by Tara Parker-Pope entitled “The annual appointment loses some relevance”.  It was about the highly publicized, but not so very different, pap smear guidelines by the USPSTF (United States Preventative Services Task Force).  The guidelines had already been changed several years ago making the recommendation for less screening in some women.  At that time, as a member of the Editorial Board of Contemporary ObGyn, I wrote a piece entitled “If it ain’t broke, why are we fixing it”.  The pap smear is one of the single biggest success stories of modern medicine (barely behind the discovery of polio vaccine).  The number of cases of invasive cervical cancer in this country has fallen dramatically over the last 60 years mainly because of the pap smear.  Currently, 50% of new cases of cervical cancer today are in women who have never had a pap smear and another 10% in women whose pap smear is abnormal, but have never bothered to follow-up!  In my 25 years of practice I have had two cases of invasive cervical cancer and both of those women walked into my office with the disease already.  No one who has been under my care has developed invasive cancer.

The decision to reduce pap smear frequency is strictly a financial one, called a cost-benefit ratio.  They did this in England years ago.  They knew that there would be more cases of cervical cancer, but it was felt that it was cheaper to treat the small incremental increase in the number of cases of cancer than it would be to screen every woman annually.   I suppose if I were the Secretary of HHS (Health and Human Services) I too might be looking at the population as a whole, but as your physician I’m only concerned with you.  Let me explain:

If a woman has a hysterectomy for an advanced pre-cancer then the system considers that a victory because she never developed invasive cervical cancer.  If one of my patients were to have such an advanced premalignant lesion that she required a hysteroscopy, I would feel that I had failed her miserably.  My goal is to pick up abnormalities at a stage where they can be treated much more simply than with surgery as radical as a hysteroscopy.  I guess it depends on whether you believe my job is to 1) put out forest fires, 2) put out brush fires, or 3) blow out matches.  I prefer to blow out matches.

Finally back to the title of Tara Parker-Pope’s article … my biggest concern is that if the message is “you do not need a pap smear,” many women will assume that they do not need a visit to the gynecologist.  Many women have come equate the pap smear with the visit.   Thus, if there is no need for a pap, they would feel that there is no need for a visit.  Nothing is further from the truth.  A visit to me is important for a myriad of reasons including the breast exam, blood pressure check, concerns about bone health, vaginal health, contraception, menstrual function, and in my opinion, perhaps most importantly, a transvaginal ultrasound evaluation of your ovaries and uterus.

If you have any questions or concerns, please do not hesitate to call.

In the meantime stay healthy,