Just days after a government task force changed what women have always been told about mammograms, there is new advice on pap smears.Some women we talked to say they won’t follow the new guidelines.The new advice comes from the American College of Obstetricians and Gynecologists. The doctors now say most women can wait longer to get their first pap smear and don?t need to get one every year. The tests help detect cervical cancer.Elizabeth Jubenbille, of Kent, says, ?I will always continue to go once a year. I will continue to go. I owe it to myself and my family.?Jubenbille says cancer runs in her family and she won?t gamble with her health.?I lost my sister at 45 to breast cancer so I’ve been getting mammograms since I was 27 and pap smears as well because cancer’s in my family. To me, if they catch it and it’s early enough, we’ve got a lot more time.?The American College of Obstetricians and Gynecologists now says a woman can have a pap smear every two years. The old recommendation was annually. The new guidelines also say routine pap smears should begin at 21, not within three years of a woman becoming sexually active. Also, women 30 and older should wait three years between pap smears, if the last three have come back clear.?We have to look at the data a little more closely before we decide for ourselves if it?s better, and it will be individualized based on the patient?s medical history and background,? said Doctor Wendy Dwyer, an OB-GYN practicing in Greece. ?We?re hoping that we don?t miss any diagnoses of cancer, but at the same time, not be having a patient go through too many interventions that might be unnecessary both from the cost aspect as well as the patient anxiety aspect.?Pap smears can spot pre-cancerous changes in the cervix, Dwyer says those changes may occur slowly enough to detect every two years. But women, like these St. John Fisher College students, have differing opinions.Kelly Cook, of Greece, says, ?It?s scary. They saying coming in two years, we?ll see you in two years. I like having that relationship with my gynecologist. It’s better.?Melanie Mancuso, also of Greece, says, ?My mom has had the precancerous cells so that prompted me to go get tested. And my friends. If I have to wait two years to find out, that?s not a good thing for me.?Elizabeth Doring, of Greece, says, ?It depends on your own medical history. Both of them, they have cancer in the family. My family doesn?t, so my sister and my mom might feel comfortable waiting two years to do it, but it depends on how much you worry about it.?Pap smears are credited with preventing invasive cervical cancer. In fact, the rate of cervical cancer has been cut in half in the U.S. in recent decades.There are cases where women should have pap smears every year. Women who have HIV, other immune weakening conditions, as well as previous cervical abnormalities should have the test done every year.–WASHINGTON ? Republicans are seizing on this week’s recommendations for fewer Pap smears and mammograms to fuel concern about government-rationed medical care ? and to try to chip away support by women for President Barack Obama’s proposed health care overhaul.”This is how rationing starts,” declared Jon Kyl of Arizona, the party’s second-in-command in the Senate, during a news conference. “This is what we’re going to expect in the future.”Said Sen. Lisa Murkowski of Alaska: “Those recommendations will be used by the insurance companies as they make a determination as to what they’re going to cover.”Democrats said the recommendations had nothing to do with the big health care bill. And besides, they said, the recommendations, especially one that women start mammograms at 50 rather than 40, were deeply flawed.”It’s entirely possible that this panel got it wrong, and I think they did,” said Illinois Sen. Dick Durbin, the vote-counting Democratic whip. Fears that the government is going to run health care have not come up during negotiations for Saturday’s crucial procedural vote, Durbin added.But the recommendations have given Republicans something new to talk about in making their case that the 2,074-page bill amounts to government-rationed health care.The timing of the release of both sets of guidelines this week, though apparently coincidental, couldn’t have been worse for majority Democrats. The bill faces its first survival test Saturday, when it must win 60 votes to advance to the next step. In recent days, Democratic leaders have struggled to placate three holdouts from their caucus but appeared Friday night to be winning them over.One Democrat wasn’t taking chances on whether the recommendations had jeopardized access to affordable mammograms. Sen. Barbara Mikulski, D-Md., said she would introduce an amendment that would limit the costs of the breast cancer tests for women 40 and older.”Otherwise, insurance companies may use this new recommendation as yet another reason to deny women coverage for mammograms,” Mikulski said.That was unlikely, the White House said.”Under health insurance reform, recommendations like these cannot be used to dictate coverage,” said presidential spokesman Reid Cherlin.The guidelines themselves stress that they’re general recommendations for routine screening, not a replacement for the one-on-one health advice that women with various risk factors for breast or cervical cancer get from their doctors in choosing how often to get a Pap or mammogram.”So, what does this mean if you are a woman in your 40s? You should talk to your doctor and make an informed decision about whether a mammography is right for you based on your family history, general health and personal values,” said Dr. Diana Petitti, vice chair of the task force that made the mammogram recommendations.Still, the new guidelines generated enough confusion and raised enough questions to force proponents of the health care overhaul on the defensive.Health and Human Services Secretary Kathleen Sebelius has said the mammogram recommendation “does not determine what services are covered by the federal government.”Senate Finance Committee Chairman Max Baucus said the Senate health care bill he authored “doesn’t do one single thing to change current law related to the way coverage decisions are made.””Those decisions will be based only on science and thorough review, just as they are today,” said Baucus, D-Mont. “Research comparing the effectiveness of different treatments for different patients cannot be used for rationing care.””We’re not rationing anything,” said Rep. Lynn Woolsey, D-Calif. “It’s a decision between a woman and her doctors.”The specter of the government making deeply personal medical decisions for millions of Americans ? in this case, women ? has been propelled in part by the Republican drive to stymie the Democratic bill.The legislation would require most people to buy health insurance, and the House version would create a government plan that would compete with those offered by private insurers.This week’s recommendations from two different groups called for less-frequent cancer tests for women.On Monday, a government-appointed but independent panel of doctors and scientists said women generally should begin routine mammograms in their 50s, rather than their 40s.Then on Friday, the American College of Obstetricians and Gynecologists said that most women in their 20s can have a Pap test every two years ? instead of annually ? to catch slow-growing cervical cancer.Neither the task force, which provides advice to government officials who may or may not act on it, nor the ACOG set federal policy. The ACOG’s recommendations are aimed at its own members.The Democratic bill would set up an independent institute to conduct studies. It would not authorize the health secretary to deny coverage solely based on the institute’s research.There are other safeguards. All states except Utah make insurers cover mammograms, and 20 states require coverage that starts at age 40, according to 2007 data compiled by the Washington-based National Women’s Law Center.Associated Press writers Stephanie Na
no in New York and Lauran Neergaard in Washington contributed to this report.Copyright ? 2009 The Associated Press. All rights reserved.–The American College of Obstetricians and Gynecologists has issued revised guidelines for cervical cancer screening in the December issue of Obstetrics & Gynecology. Important changes in guidelines include:- Cervical cancer screening should begin at age 21 years (regardless of sexual history). Screening before age 21 should be avoided because women less than 21 years old are at very low risk of cancer. Screening these women may lead to unnecessary and harmful evaluation and treatment.- Cervical cytology screening is recommended every 2 years for women between the ages of 21 years and 29 years. Evidence shows that screening women every year has little benefit over screening every other year.The College continues to recommend the annual well-woman exam, which is not the subject the recommended changes.
