10 Million Women Without Cervix Still Get Pap Test??

[Guest guest]

Thanks, Misty.

 

I have lectured and taught my patients about this for nearly 40 years. It is

gratifying to see it finally in the media. The only reason the practice has

continued is economic and physicians should have to refund all the money.

Right! Like that would ever happen! Talk about malpractice............

 

Walt

 

-

" Misty L. Trepke " <mistytrepke

 

Thursday, June 24, 2004 12:19 AM

[s-A] [AltMedForum] 10 Million Women Without Cervix Still Get Pap

Test??

 

 

> Comments?

> Misty L. Trepke

> http://www..com

>

> 10 Million Women Who Lack a Cervix Still Get Pap Tests

>

> http://www.nytimes.com/2004/06/23/health/23PAP.final.html?th

>

> June 23, 200410 Million Women Who Lack a Cervix Still Get Pap

> TestsBy

> GINA KOLATA

>

> As many as 10 million women who have had hysterectomies and who no

> longer have a cervix are still getting Pap tests, a new study finds.

>

> The screening Pap test looks for precancerous cells in tissue

> scraped from a woman's cervix and can prevent what would otherwise

> be a common and deadly cancer. But testing most women without a

> cervix makes little sense, leads to false positives and wastes

> money, said Dr. Brenda E. Sirovich, a research associate at the

> Outcomes Group at the Veterans Affairs Medical Center in White River

> Junction, Vt., and the study's lead author. Each test costs $20 to

> $40, she estimated.

>

> The women in question do not include the 1.1 million who had a

> hysterectomy and still have a cervix, which is at the base of the

> uterus, nor the 2.2 million who had their uteruses and cervices

> removed because they had cancer or precancerous cells in their

> cervix. (Doctors occasionally leave the cervix behind in

> hysterectomies, although a large study found no particular advantage

> to doing so.) In both of these groups, Pap tests are warranted. But

> most women who have their uteruses and cervices removed do so for

> reasons other than cancer, like noncancerous fibroid tumors, Dr.

> Sirovich said.

>

> Dr. Sirovich said she was taken aback by her study's findings.

>

> " We were actually quite surprised, " she said. " These women are being

> screened for cancer in an organ that they don't have. "

>

> The 10 million women having unnecessary Pap tests constitute about

> 12 percent of the 85 million women currently being screened, Dr.

> Sirovich said.

>

> No one is suggesting fraud or mendacity on the part of the doctors

> or laboratories. Instead, Dr. Sirovich and others say, the situation

> seems to reflect doctors' habits and women's expectations.

>

> In their paper, published today in The Journal of the American

> Medical Association, Dr. Sirovich and her colleague, Dr. H. Gilbert

> Welch, analyzed national data on Pap testing and on hysterectomies

> over 10 years.

>

> Not only are most women who have had hysterectomies having Pap

> tests, they found, but the proportion having them also held steady,

> at 68 percent, from 1992 to 2002. No professional organization

> recommends Pap tests for most women without a cervix.

>

> The screening guidelines " either have not been heard or have been

> ignored, " the investigators wrote.

>

> When a woman does not have a cervix, a doctor scrapes cells from her

> vagina instead, sending them off to be examined. And that, cancer

> experts say, is problematic.

>

> Vaginal cancer is exceedingly rare, and tests of vaginal cells are

> much more likely to result in false positives than they are to find

> vaginal cancers.. A result is unnecessary vaginal biopsies that can

> result in their own false positives. As a result, women can end up

> having vaginal tissue removed to treat a cancer that is not even

> present.

>

> Dr. Alfred Berg, chairman of the department of family medicine at

> the University of Washington and the former chairman of the U.S.

> Preventive Services Task Force, which issues medical practice

> guidelines, said Pap tests in women without a cervix had been " a

> longstanding issue. " Since 1988, Dr. Berg said, the task force has

> issued more and more adamant statements against it, to little avail.

>

> " We're all fascinated as to why this should be, " Dr. Berg said. In

> part, he said, it might be because the American public is convinced

> that cancer screening is an unmitigated good, making women and their

> doctors reluctant to give up a test as simple and popular as the Pap.

>

> " We have a thing in this country about cancer screening, " Dr. Berg

> said. " It has a deep social value, and when evidence points in

> another direction, people are very skeptical. "

>

> Another possibility, Dr. Sirovich said, is that evaluations of

> doctors and health care systems count the percentage of women who

> have Pap tests, giving little incentive to advise against the tests.

>

> Gynecologists are also puzzled.

>

> " It's kind of hard to figure out, " said Dr. Kenneth Noller, who is

> professor and chairman of obstetrics and gynecology at Tufts-New

> England Medical Center. Dr. Noller is an author of the cervical

> cancer screening guidelines issued by the American College of

> Obstetrics and Gynecology, which does not recommend Pap tests for

> most women who have had hysterectomies.

>

> Dr. Noller said he suspected that a reason the test was being done

> in these women anyway was that doctors were used to it.

>

> " It's a relatively cheap and easy procedure, " he explained. " It's

> sort of become a habit. "

>

> Dr. Alan Waxman, another author of the obstetricians and

> gynecologists' guidelines and an associate professor of obstetrics

> and gynecology at the University of New Mexico, said women expected

> the test.

>

> " Many women equate the Pap test with the pelvic exam, " Dr. Waxman

> said. " So they come in every year for their Pap test even if they

> don't need it any more. "

>

> He spelled out a scenario. " The woman didn't need to be tested, " Dr.

> Waxman said. But she had a Pap test anyway. " The test shows a mild

> abnormality. Then she gets treated, just to be on the safe side. "

> Now the woman is labeled as a cancer patient. " It all adds anxiety,

> discomfort, and expense, " he said.

>

> " Many physicians don't consider the consequences of false

> positives, " Dr. Waxman said.

>

> Instead, he explained, they worry about the consequences for

> themselves if they counsel against a Pap test for the rare woman who

> turns out to have vaginal cancer. " If the doctor didn't do a Pap

> test, then there's the litigation threat, " he said.

>

> Dr. Noller said he tried to dissuade women who do not need Pap tests.

> " I will present the facts to them, " he said. " I will try to talk

> them out of it. "

>

> But, he said, " if they still insist, I would probably do it. "

>

> Copyright 2004 The New York Times Company

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