Recommendations for Women’s Health Keeping up with current guidelines for preventative health exams can be extremely confusing, since recommendations frequently change. How often should a woman have a Pap smear? What about mammograms or breast exams? The reason that recommendations change is that advances in medicine and new research findings sometimes call for a reassessment of how we go about preventing certain diseases. Let’s start with Pap smears. The Pap test, introduced in 1941, is considered the most successful cancer screening technique ever discovered. Cervical cancer rates have fallen more than 50% in the past 30 years in the US due to the widespread use of the Pap test. The incidence of cervical cancer fell from 14.8 per 100,000 women in 1975 to 6.5 per 100,000 women in 2006. In 2009, the American College of Obstetricians and Gynecologists (ACOG) came out with these recommendations: - Start having Pap tests at age 21 years (or three years after you have started having vaginal intercourse, whichever occurs first). - If you are younger than 30 years old, have a Pap test every 2 years. - If you are 30 years and older, have a Pap test every 2 years. After three normal Pap test results in a row, a woman in this age group may have Pap tests every 3 years if she does not have a history of moderate or severe dysplasia, is not infected with human immunodeficiency virus (HIV), if her immune system is not weakened (for example, if she has had an organ transplant), and if she was not exposed to diethylstilbestrol (DES) before birth. Having a Pap test every 2 years is a change from the yearly screening that many women have had in the past. But based on recent research, these are safe options for women. You should still see your health care provider every year for a check up where your individual needs can be discussed. Now lets talk about breast exams. Breast cancer screening recommendations vary among organizations. Here is a summary of recommendations for women who are not at an increased risk for cancer: - In 2003, the American Cancer Society recommended annual mammography beginning at age 40 years, and annual clinical breast exam (CBE) after the age of 40 years. It does not recommend MRI for women at average risk for breast cancer and states that there is insufficient evidence to recommend breast self exams (BSE). The American Medical Association, in 2002, and the National Comprehensive Cancer Network, in 2009, have made recommendations similar to those of the American Cancer Society, except for the inclusion of a positive recommendation for BSE. - The American College of Physicians recommended in 2007 that screening mammography decisions in women aged 40 to 49 years should be based on individualized assessment of risk for breast cancer; that clinicians should inform women aged 40 to 49 years about the potential benefits and harms of screening mammography; and that clinicians should base screening mammography decisions on benefits and harms of screening, as well as on a woman’s preferences and breast cancer risk profile. Examples of harms of screening are false positive screening results as well as unnecessary biopsies and treatments in these cases. - In 2003, ACOG recommended mammography every 1 to 2 years for women aged 40 to 49 years and annually after the age of 50 years. It recommended CBE for all women and noted that BSE can be recommended. - In 2009, the World Health Organization recommended mammography every 1 to 2 years for women aged 50 to 69 years, but does not recommend CBE or BSE. - Finally, in November of 2009 the federally funded U.S. Preventive Service Task Force (USPSTF) changed their past guidelines that recommended women to get annual mammograms to say that routine mammograms are not necessary for women in their 40s who have normal cancer risk. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient’s values regarding specific benefits and harms. Women between 50 and 74 need a mammogram only once every two years. They recommend against teaching BSE. These new USPSTF recommendations have caused many raised eyebrows as well as strong opposition, as for example this statement by the non-profit organization Breastcancer.org. Since there obviously is not one recommendation which experts seem to be able to agree on, the best solution is to ask your health provider at your annual visit whether any breast cancer screening would be appropriate for you. After all, these are all just suggestions and you are responsible for your own health and need to make the final decision about what screening tests, if any, you will need at a given time. Finally, many women detect their breast cancer during BSEs. This article describes the simple steps you can take to periodically check your breasts for lumps and other irregularities. It could save your life.
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