First fewer mammograms, now fewer Paps

Image via Wikipedia

Not to be outdone by the United States Preventive Services Task Force, the American College of Obstetrics and Gynecology has announced that they are recommending less cancer screening, as well.

New guidelines for cervical cancer screening say women should delay their first Pap test until age 21, and be screened less often than recommended in the past.

via Guidelines Push Back Age for Cervical Cancer Tests – NYTimes.com.

Although their science is sound, their timing is unfortunate.  Piggybacked on the controversial recommendations of the USPSTF for less breast cancer screening earlier this week, these recommendations may stoke the fears of many regarding rationing of services as part of health care reform.  Not only that, but given that both sets of recommendations apply only to women, I wouldn’t be surprised if some started to worry about gender bias in health care.

However, both sets of recommendations have been a long time in the making, despite the apparent abruptness in these announcements.  There have been numerous studies over the past several years looking at the efficacy of screening tests when applied to large populations.  Medical practice is about as agile as the Titanic, changing course only when there’s an iceberg of evidence confronting it, and even then usually a little later than it should have.  Apparently the USPSTF and ACOG encountered their icebergs at the same time.

As to gender bias, I say coincidence.  Women anatomically have more things to screen, so it stands to reason that their screening protocols would be reviewed, and potentially changed, more often.

Unfortunately, I suspect the double-whammy of less screening for women via mammograms and pap smears is going to poison the waters of the health care reform debate and lead to decisions based more on emotion and less on scientific evidence.  If we want reasonable health care, we need to be making reasonable and evidence-based decisions.