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Re: Question about pap test frequencyFrom: Barbara Nicol (blnicol@ix.netcom.com)Fri Jan 26 08:43:14 2007
Dear Gail - Paps could go to every 3 years in a low risk patient - I see that someone's already forwarded at least one of the several sets of guidelines. Digital rectal stool guaiacs are no longer recommended - the previous practitioner was incorrect. Too many false positives. However, anyone over 50 should receive colon cancer screening. The home cards she received are one of the 3 recommended methods. There is no effective screening test for ovarian cancer. What evidence do we really have that putting asymptomatic women through pelvic exams finds ovarian cancer any earlier than just waiting for symptoms? We find it at stage III, by and large. I think, in my more nihilistic moments, that the profession should question the routine policy of asking asymptomatic women to have bimanual exams. My impression is that we do them because we are thorough - sort of an attitude of "well, you're here, let's do a complete exam" rather than because there's evidence that a screening exam produces benefits in asymptomatic women. (Oh, yeah, and because the sympathetic jury will bankrupt us if she shows up with ovarian cancer 2 months later, even though there's zero evidence that we can improve outcomes once a cancer is big enough to feel on pelvic, compared to waiting for symptoms. But is that really an ethical reason to do the exam?) That said, if a woman is very worried about it, scheduling annual exams is fine. Heck, scheduling monthly or weekly exams would be fine, if she wants to pay for them and put up with them. Just don't think that there are data showing that this practice is of benefit in early detection of ovarian cancer, or in producing better outcomes. (It may help reduce anxiety, though - I'm not ignoring that.) Best, Barb
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