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    Wednesday, June 23, 2004

    Needless Paps: New research from the VA says that millions of women are getting needless pap smears:

    Nearly 10 million U.S. women who have had hysterectomies are needlessly getting routine Pap tests, researchers say.

    ...."I actually was quite surprised because, in this case, women are being screened for cancer in an organ they don't have," said Dr. Brenda Sirovich of the VA Medical Center in White River Junction, Vt., and Dartmouth College.

    ...Pap tests involve scraping cells from the cervix and examining them for abnormalities under a microscope. In women without a cervix, vaginal cells are evaluated, but vaginal cancer is extremely rare and Pap tests were not designed to detect it, Sirovich said.

    While the tests are relatively inexpensive, these women are undergoing uncomfortable exams, doctors are being distracted from more important matters, and lab specialists are spending needless time analyzing specimens, Sirovich said.

    In the study, the researchers wonder about the reasons for this:

    The US Preventive Services Task Force recommendations either have not been heard or have been ignored.

    They've been ignored. While it's true that the Pap smear may not be the greatest test for finding early vaginal cancer, if you tell someone they no longer need Pap smears, they stop having vaginal examinations, too. And the risk of a missed vaginal cancer, though small, is too great a risk to take. Esepcially in today's malpractice environment. Vaginal cancer is rare, but I've had two cases in the past seven years. One of those was a woman who stopped having pap smears and pelvic exams because she had a hysterectomy. And a colleague of mine was sued for missing the diagnosis in a woman who had a hysterectomy.

    When the guidelines first came out, I would tell patients with hysterectomies that they didn't need Pap smears, but they did need to have their vaginas visually checked every year or two. The problem was, they'd never schedule for those kinds of check-ups, so I stopped trying to make a distinction between "pelvic exams" and "Pap smears." The two are so hopelessly intertwined in the public consciousness that I couldn't un-entwine them. (The Pap is a laboratory test that's taken during a pelvic exam. The pelvic exam involves looking in the vagina and checking manually for pelvic masses. Just to clarify.)

    And there's another reason doctors continue to do pap smears on women who have had hysterectomies. Hysterectomies used to be much more common up until about thirty years ago. They were done for everything from painful periods to cervical cancer. A lot of patients from that era have absolutely no idea why they had their hysterectomies. An astounding number say, "I just didn't need it anymore." What's a doctor to do? If someone had a hysterectomy because they had cervical cancer or pre-cancerous lesions of the cervix, they're still supposed to get Pap smears after the uterus is removed. If there's the slightest doubt, most of us will err on the side of "needless" testing.

    So, we're not as dense as the press reports of the study make us seem. And we're not in cahoots with the labs to boost their profits. We're just a cautious bunch.

    posted by Sydney on 6/23/2004 07:10:00 AM 0 comments


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