New pap screening guidelines
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Posts: 6,651
Further proof of a government conspiracy! :roll:
Press release from the American Society for Colposcopy & Cervical Pathology (ASCCP):
November 2009
New screening guidelines
Today the American College of Obstetricians and Gynecologists announced new guidelines for cervical cancer screening. ASCCP had a role in developing guidelines, in part by identifying adolescents as a group who needed less aggressive management at the 2006 Guidelines Development Conference and through the June 2009 ASCCP-sponsored Practice Improvement in Cervical Screening and Management (PICSM) committee conference. The new guidelines break from past practice in ways that all clinicians should understand.
What’s changed and why:
- Begin screening at age 21. The old guideline was to begin at 21 or 3 years after first intercourse. But the risk of cervical cancer in women under age 20 is only about 1-2/million. British data suggest that those cancers that occur aren’t detected through screening. Most lesions are HPV infections that women clear: diagnosis results in stigmatization, disrupted relationships, anxiety, and cost without benefit. Treatment for lesions destined to resolve without therapy raises the risk of preterm delivery.
- Screen only every 2 years between 21 and 29.
- Screen only every 3 years between 30 and 65-70. Women without diagnosed CIN 2,3 are at low risk for cervical cancer. As in adolescents, more frequent screening is likely to identify transient lesions. Continue frequent screening for women at high risk: those with HIV or other immunosuppressive conditions and those with a history of CIN 2,3 or cancer.
- In women treated in the past for CIN 2, CIN 3, or cancer, continue annual screening for at least 20 years. These women remain at risk for persistent or recurrent disease for at least 20 years after treatment and after initial posttreatment surveillance.
- Consider stopping screening at age 65-70 for women with three or more consecutive, documented, negative Paps and no abnormal Paps within 10 years.
- Liquid based and conventional cytology are similarly effective in preventing cervical cancer.
- Stop screening after hysterectomy for documented benign disease. Continue to screen after hysterectomy for CIN 2,3 or cancer and those without documentation.
- Use cotesting (Pap+ HPV test) only every 3 years. Again, more frequent testing just identifies lesions likely to regress.
ASCCP will be working hard to educate clinicians and answer questions in upcoming courses and meetings.
Our congratulations go out to member Alan G. Waxman, MD who served as the primary author for the new ACOG Practice Bulletin.
The Practice Improvement in Cervical Screening and Management (PICSM) symposium was organized and conducted by the ASCCP in June 2009 at the National Institutes of Health in Bethesda, Maryland. Participating organizations included the American Cancer Society, American College of Obstetricians and Gynecologists, National Cancer Institute, American Society for Clinical Pathology, American Academy of Pediatrics, American Academy of Family Physicians, Nurse Practitioners in Women's Health, Centers for Disease Control and Prevention, Food and Drug Administration, etc.
Press release from the American Society for Colposcopy & Cervical Pathology (ASCCP):
November 2009
New screening guidelines
Today the American College of Obstetricians and Gynecologists announced new guidelines for cervical cancer screening. ASCCP had a role in developing guidelines, in part by identifying adolescents as a group who needed less aggressive management at the 2006 Guidelines Development Conference and through the June 2009 ASCCP-sponsored Practice Improvement in Cervical Screening and Management (PICSM) committee conference. The new guidelines break from past practice in ways that all clinicians should understand.
What’s changed and why:
- Begin screening at age 21. The old guideline was to begin at 21 or 3 years after first intercourse. But the risk of cervical cancer in women under age 20 is only about 1-2/million. British data suggest that those cancers that occur aren’t detected through screening. Most lesions are HPV infections that women clear: diagnosis results in stigmatization, disrupted relationships, anxiety, and cost without benefit. Treatment for lesions destined to resolve without therapy raises the risk of preterm delivery.
- Screen only every 2 years between 21 and 29.
- Screen only every 3 years between 30 and 65-70. Women without diagnosed CIN 2,3 are at low risk for cervical cancer. As in adolescents, more frequent screening is likely to identify transient lesions. Continue frequent screening for women at high risk: those with HIV or other immunosuppressive conditions and those with a history of CIN 2,3 or cancer.
- In women treated in the past for CIN 2, CIN 3, or cancer, continue annual screening for at least 20 years. These women remain at risk for persistent or recurrent disease for at least 20 years after treatment and after initial posttreatment surveillance.
- Consider stopping screening at age 65-70 for women with three or more consecutive, documented, negative Paps and no abnormal Paps within 10 years.
- Liquid based and conventional cytology are similarly effective in preventing cervical cancer.
- Stop screening after hysterectomy for documented benign disease. Continue to screen after hysterectomy for CIN 2,3 or cancer and those without documentation.
- Use cotesting (Pap+ HPV test) only every 3 years. Again, more frequent testing just identifies lesions likely to regress.
ASCCP will be working hard to educate clinicians and answer questions in upcoming courses and meetings.
Our congratulations go out to member Alan G. Waxman, MD who served as the primary author for the new ACOG Practice Bulletin.
The Practice Improvement in Cervical Screening and Management (PICSM) symposium was organized and conducted by the ASCCP in June 2009 at the National Institutes of Health in Bethesda, Maryland. Participating organizations included the American Cancer Society, American College of Obstetricians and Gynecologists, National Cancer Institute, American Society for Clinical Pathology, American Academy of Pediatrics, American Academy of Family Physicians, Nurse Practitioners in Women's Health, Centers for Disease Control and Prevention, Food and Drug Administration, etc.
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Comments
But then I usually go for the conspiracy idea.
I thought the same thing when I saw this in the paper today...insurance companies will try to change what they cover as far as frequency..same thing with the new guidelines on mammograms
Sorry for the rant- really bothers me these big corp and their CEO's making billions and they couldn't if it wasn't for all us little guys paying in.
Just a side note, the American College of Obstetricians and Gynecologists do not do what's in best interest for patients, I know this first hand as this organization was behind the statistic of 90% of fetuses with the chance of being born with Down syndrome were suggested to be terminated by women's Obstetricians. Only with a gov't bill by Senator Ted Kennedy has things changed with enforcing that doctors give all patient FACTS, including positive facts, not OPINIONS when delivering a diagnosis to a pregnant mother with no experience with Down syndrome. God, if I listened to what my doctor wanted me to do, I wouldn't have my daughter today. Not to mention this same college puts more research into prenatal tests detecting Down syndrome than for research into what causes the syndrome. A eugenic society in the making! Gotta love that. :roll: :x
Have you noticed that so much of the recent health care-related news only applies to women? the mammograms and pap tests, the birth control and abortion issues in the health care bill...I feel like this country is going backwards.
I find it fascinating that people not only think that revisions in screening recommendations are a plot to lower the quality of their healthcare but also think that our system of so many tests and treatments is a plot for doctors to make money.
I'll admit right now that this is personal for me for two reasons:
1. I'm smack dab in the middle of getting a master's degree in public health so that I can serve the underserved and make the world a better place and all I read hear is resistance to all things public health. When I go to do my homework at night it makes me wonder "What's the point?"
2. I personally know the guy who wrote this new recommendation and I'm 100% sure that he is not conspiring against you - for the sake of the insurance companies or the government or anyone else. He has dedicated his entire life to figuring out the best way to serve the gynecological needs of women and this is the thanks he gets – people not trusting his intentions or his professional knowledge. Why doesn’t everyone just provide their own fucking medical care if they know so much more than the professionals? (I’d love to see those self-paps!)
I’m sorry – I know this is an alcohol-induced rant – but seriously! Not everyone’s out to get you. I swear.
People are so reactionary and see only the benefits of screening being "taken away" from them (although these are medical practice guidelines, not insurance reimbursement policies). I would like to encourage everyone to see all sides of the issue and recognize the downfalls to over-screening. For paps, that includes damage to the cervix done by unnecessary cervical biopsies.
[/rant]
The only problem is that insurance reimbursement policies are based on (among other things) medical practice guidelines. We know how shady insurance companies are, revisions like this give them something to point to when deciding what they can get out of covering.
Maybe it's just the cynic in me, but I agree with Lauri... the timing of these revisions (and both revised toward less testing) raises my eyebrow a bit.
was like a picture
of a sunny day
“We can complain because rose bushes have thorns, or rejoice because thorn bushes have roses.”
― Abraham Lincoln
I understand and share that concern. I, more than most, hate and distrust insurance companies. I don't think they have any place in healthcare.
My frustration, however, lies with the lumping together of insurance companies and the healthcare fields. These guidelines are about what's best for the patients - not what's best for the insurance companies. Should the healthcare field no longer be solely about healthcare?
I feel like it's being suggested that healthcare guidelines are only about healthcare if there is no possible way for it to be suggested that insurance companies, pharmaceutical companies, doctors, hospitals, the government, or anyone else could benefit…. which isn’t possible. It's like healthcare can't win for losing anymore. No matter what they say, people dismiss it with the claim that they’re just in-cahoots with some evil organization. Had they changed the guidelines to say that there should be more screening, they would have been slammed for that too.
Also, although I do share your concern that the healthcare companies will use this new recommendation for evil instead of good (through no fault of the people who wrote it), they should pay for any tests a patient’s doc says is medically necessary. And this guideline even recommends that some people should be tested more frequently than others.
Again, both of these recommendations have been in practice long before the actual official guidelines were released. It’s unfortunate that the formal release of the mammogram one came at a time when it could be used by the media and the GOP as an argument against healthcare reform. But I think that’s more a reflection of the scoundrelous nature of those groups than anything.
That’s further demonstrated by the timing of the release of the new pap guidelines. These guidelines were not supposed to be released yet. The information was embargoed until it’s publication in ACOG’s medical journal – but the media violated the embargo and released it now… just to keep the conservative base riled up, if you ask me.