Wendy Hoffman blogs about menopause and women's health—particularly focusing on how diet and nutrition can positively affect a woman's life around the age of menopause.See all posts »
Think Twice About Screening Tests
There’s been so much discussion and debate this year over when and how often women should be screened for diseases that the North American Menopause Society (NAMS) devoted an entire day to midlife screening at their recent annual conference for gynecologists, scientific researchers and other medical professionals. Even this professional audience is confused and at odds with some of the recommendations from the U.S. Preventive Services Task Force (USPSTF), an independent panel of non-governmental experts in prevention and evidence-based medicine.
I count myself among those who have always subscribed to the “better safe than sorry” adage, meaning that if there’s a test for a condition or disease, why not take advantage of it if there’s little or no risk to your health? Physicians have been just as willing to order up screening tests as well - just to be safe.
But according to USPSTF, this attitude has led to a lot of unnecessary imaging tests in low-risk and/or asymptomatic patients, resulting in more false-positives and even more unnecessary biopsies in women without cancer.
This is the rationale behind the committee’s controversial 2009 directive for breast cancer screening, which called for biennial screening mammography for women beginning at age 50 and stopping at aged 74. And, to top it off, the panel advised medical professionals against teaching breast self-examination (BSE) saying that “adequate evidence suggests that teaching BSE does not reduce breast cancer mortality.”
There are many medical professionals who vehemently disagree with this position. But regardless of which side of the debate you’re on, you have to admit that new guidelines, which take into consideration the latest research findings, force us to take a fresh look at screening tests. Are they really necessary every 12 months? Should a test really be considered “routine,” if we have no symptoms, nor a family history of this condition?
At the NAMS conference, I learned about the latest guidelines concerning cervical cancer screening, commonly known as the PAP test - another “routine” screening that we’ve come to expect in our annual well-woman visit with our gynecologist. The new guidelines suggest screening every three or five years instead, depending on age and circumstances. The rationale? Cervical cancer is slow to develop; improved technology results in better screening accuracy; and it will prevent patients from having a falsely-positive test that could lead to a work-up that’s not needed.
These are sound reasons to update screening guidelines. However, when I mentioned this latest USPSTF guideline to friends, they were unanimously shocked. “There’s no way I’ll go three years without a Pap Test,” they all said.
As for myself? I don’t agree with all of the USPSTF recommendations, but they have succeeded in making me think twice about what screenings are really necessary based on all the scientific evidence and my own risk factors. When my doctor orders a routine test, I now plan to gently push-back and ask if he thinks it’s absolutely necessary.