Recent cancer screening guidelines reveal delicate balance between public health, private practice

Breast and cervical cancer screening guidelines
are controversial, so talk to your provider about them

The two recent recommendations on breast and cervical cancer screening have caused a bit of controversy, to say the least. Earlier this week, the U.S. Preventive Services Task Force changed the recommendations on breast cancer screening, with the major recommendation being that routine breast cancer screening for women should start at age 50 instead of age 40 in women without a family history or without high risk factors.

That recommendation caused an uproar among some groups, especially in light of the current debate on health care reform. The Secretary of Health and Human Services got into the mix, backing down from the recommendation and suggesting that patients and providers continue their usual practices.

And now the American College of Obstetricians and Gynecologists (ACOG) has issued its own recommendations on cervical cancer screening. The ACOG is recommending that women hold off on their first pap smear (a screening test for cervical cancer and other genital abnormalities) until age 21, instead of within three years of becoming sexually active. Furthermore, it is recommended by ACO that women over 30 with three consecutive normal pap smears can go for three years without a test.

Both sets of recommendations come from long-term studies of the effects of cancer screening, testing, and treatment. Both studies cite the high number of false-positive findings (screening tests that point to cancer when there is none). In the case of breast cancer, false-positive findings lead to unnecessary and invasive biopsies where breast tissue is removed for analysis, not to mention the emotional burden of possibly having cancer. With cervical cancer, false-positive findings may lead to unnecessary and costly treatment, including surgeries and uncomfortable follow-up testing. Again, emotional burdens were also considered.

The debate and concerns that these recommendations raised have unveiled the concerns of the general public, politicians, and health care practitioners with regards to health care. It is very hard to explain to a woman who is found to have breast cancer at age 50 that she could have had it detected much earlier, assuring long-term survival, had she started her screenings at age 40 as was previously recommended. At the same time, it is very hard to explain to budget committees and investors why so much money is wasted on screening otherwise healthy women for breast cancer when they are 40. And it is also very hard to explain to a constituency weary of government intervention that guidelines from government-sponsored studies and groups will not be imposed in any new health care legislation.

The bottom line is that reasonable and professional health care providers (physicians, physician assistants, nurse practitioners, etc.) will analyze the data available to them, combine that with their personal experience on the subject of cancer screening, and give the best level of care possible to their patients. This is why public health studies must be done in a vacuum absent any political or special-interest pressures, so the results the studies yield are of the most benefit in the decision process of the provider.

So talk to your doctor about your concerns regarding breast and cervical cancer, the advice he or she gives you will be much better than general advice from a panel, a politician, or an anti-vaccine blog.