Women make .77 cents to every dollar men make, they hold less than 20 percent of seats in U.S. Congress and are CEOs of only five percent of the country’s highest revenue-producing companies. To top it off, women are still forced to have their sexual reproductive rights determined by others.
That was my initial thought.
It is important to disclose the science behind the American Cancer Society (ACS), the American Society for Clinical Pathology (ASCP) and the American Society for Colposcopy and Cervical Pathology’s (ASCCP) September 2014 release of new guidelines for Papanicolaou test (commonly known as the Pap smear). They suggested increasing the number of years that a woman should be checked for cervical cancer. Before September, this was a yearly exam that is done to check for abnormalities on the outer opening of the cervix and the uterus. These samples are then examined for signs that may be precursors to cervical cancer or Human Papillomavirus.
Generally, if the test comes back positive, a patient’s next step is to perform a biopsy to learn if findings are low-grade or high-grade neoplasia (abnormal tissue growth). If the abnormalities are high-grade, the progression to cervical cancer is at a higher risk and further procedures take place like the LEEP procedure or a cone biopsy. These procedures can be painful and often cause stress, anxiety and trauma for women. They can even compromise future pregnancies.
Earlier this month, I learned that the ACS-ASCCP-ASCP changed the yearly-suggested exams to every three years for ages 21 through 29 and to every 5 years for women 30 to 65-years-old. (These guidelines don’t apply for women who have test results that come back positive). At first I was overrun once again with contempt at our healthcare system and with the seemingly patriarchal culture. I admittedly acknowledge now my that rationale was premature and ill conceived.
Dr. Carolyn Howard, gynecologist at the University of Rhode Island’s Health Services, educated me on the reasoning behind the longer exam periods and why she agreed that more time in between exams causes more benefit than harm. Howard said she has heard women upset over the recent change, and said it’s going to take time for women to understand the reasoning behind it. Once she explains the science behind the changes, patients begin to juxtapose the information to their feeling of an infringement of women’s rights.
Cervical cancer can take three to seven years to develop. The abnormalities from Pap smears don’t mean a patient has developed cancer, so procedures are often unnecessary. I’m not diminishing the severity of this cancer nor that it’s excessive for those who wish to be screened every year. Though this change was an initiative to minimize the amount of unnecessary procedures and distress that women suffer after slightly abnormal test results.
We can’t forget these are suggestions from the organizations and that they’re not mandates. This is still very individualized and patients can speak with their gynecologist and decide what intervals they want to do, however if you are a person who has received three consecutive negative Pap smear results, insurance companies may not be so willing to pay for your next one. Yes, this minimizes costs for insurance companies having to pay for women’s annual Pap smear, but science behind these guidelines can allow us to look past this. It started to make more sense now, why would women go through the anxiety and pain of often unnecessary medical procedures.
Howard said that in the 21 to 29 age bracket, sexually transmitted diseases screenings are much more important because of their prevalence. Peaks in cervical cancer have been found in women’s mid 30s and 60s, with no concrete evidence as to why. There are about 12,000 cervical cancer diagnoses yearly. Of those patients, 4,000 die. Treating women in their earlier twenties may be a reason for Howard’s positive viewpoint on the modification. She wondered what other physicians treating older women might think.
Like I did, Howard wondered how much of this change is men shoving it down our throats, but she said that we shouldn’t let that bias dictate science. She called this period a “state of flux,” and that the coming years will tell if the change in guidelines is positive. Howard hopes that this doesn’t make women feel less empowered about reproductive healthcare and sexuality. She said it’s critical for gynecologists to educate their patients about the woman’s anatomy and hopes women don’t view their appointments with gynecologists as simply a stop through.
Past health issues for women have garnered widespread activism, like mammogram screenings and contraception availability. It is no surprise why a change to Pap smear guidelines has affected the reflection of the United States healthcare system toward women.