Re: Question about pap test frequency [NOW: Colon Cancer]
From: Andrew Folley (agfolley@hotmail.com)
Fri Jan 26 16:55:48 2007
I would think that a rectal exam is part of a complete pelvic exam
regardless of the whether or not the patient has symptoms of ovarian or
colon cancer etc.
>From: Barbara Nicol <blnicol@ix.netcom.com>
>Reply-To: ob-gyn-l@obgyn.net
>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>Subject: Re: Question about pap test frequency [NOW: Colon Cancer]
>Date: Fri, 26 Jan 2007 12:57:39 -0600
>
>Here's a nice NCI site comparing study quality on various modalities of
>colon CA screening.
>
>http://www.cancer.gov/cancertopics/pdq/screening/colorectal/healthprofessional
>
>When I said 3 methods, I meant (1) FOBT (the home cards, not DRE) backed up
>by sigmoidoscopy, (2) sigmoidoscopy, and (3) colonoscopy (higher
>complication rate which must not be forgotten!). I see now that I omitted
>BE and CT colonography. No wonder we're confused....
>
>but in any case, I stand by what I said - DRE is useless for colon CA
>screening, though I do think it is part of a complete pelvic when you have
>a patient who has symptoms suspicious for ovarian cancer - or endo - or
>pelvic mass.
>
>This also gets into the question of whether internal medicine/family docs
>should be doing the majority of preventive exams for women over 50.
>They don't need paps as often, but they do need BP, cholesterol, colon CA
>screens. Internists could be doing these, plus the annual breast exam,
>and just send them to us for paps q 3years (I expect family docs to do the
>whole thing, which is one of their biggest selling points IMHO.)
>
>Again, why would we be recommending screening pelvic exams more frequently?
> Do we really have data supporting this as a measure that will improve
>women's health, or are we just used to doing them?
>
>Honestly curious if there's an evidence-based reason....
>
>- Barb Nicol, M.D.
>
>-----Original Message-----
> >From: "Dean Huffman ." <dean@thehuffpeople.net>
> >Sent: Jan 26, 2007 9:38 AM
> >To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
> >Subject: Re: Question about pap test frequency [NOW: Colon Cancer]
> >
> >.
> >
> >Now days, most people would recommend a colonoscopy rather than just a
>stool
> >guaiac for patients 50 and older.
> >
> >Dean Huffman
> >
> >- - - -
> >
> >From: "Garry E. Siegel, M.D." <garrys@mindspring.com>
> >subject: Re: Question about pap test frequency
> >Date: Jan 26, 2007 11:16 AM
> >
> >I do them at 50 or over, or as needed, and do a guaiac, too.
> >
> >Some do it to all ages, perhaps omitting the guaiac in younger women.
> >
> >Garry
> >
> >At Fri, 26 Jan 2007, Charlie Chambers wrote:
> >>
> >>Speaking of annual exams. I know previously rectovaginal exams were
> >>suggested in an older patient, but I believe that has been de-
> >>emphasized as colon ca screening. Does anyone know what the
> >>guidelines are regarding RV exams?
> >>
> >>On Jan 26, 2007, at 7:44 AM, Barbara Nicol wrote:
> >>
> >>> 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
> >>>
> >>************************************************************************
> >>*
> >>
> >>--
> >>************************************************************************
> >>Charlie Chambers
> >>Hood River, OR
> >>cchamber@alumni.rice.edu
> >>
> >>"No matter where you go...
> >> there you are."
> >>Dr. Buckaroo Banzai
> >>************************************************************************
> >>
> >>************************************************************************
> >>
> >
> >--
> >Garry E. Siegel, M.D.
> >Private Practice
> >Roswell, GA
> >
>
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