Re: Question about pap test frequency [NOW: Colon Cancer]
From: Atkinson, Samuel M (ATKINSONS@ecu.edu)
Mon Jan 29 13:52:34 2007
The last time I checked,ACOG does not recommend pelvic exams for ovarian cancer screening. Thry also do not recommend Ca125 nor ultrasounds for screening for Ovarian cancer. In a woman who has no cervix and in whom the hyst was for benign reasons , she does not ever need a pelvic exam by us GYN's. She might need a DRE , if you believe that 50% of bowel malignancies can be palpated by the rectal finger.
Probably the only reason for a gyn to see these patients is to get them to stay on, or be put on estrogen or some other bone stabilizer if you do not believe estrogen the cheapest and/or best choice..OR BOTH. FP's & IM do not Rx estrogen as a rule.
If we really plan to continue to see PM women, we have to become the gp/internist and do all of their work recommendations. Or else learn to do colonoscopies at $ 1800.00 each in Eastern NC (not incl clinic/hosp/anes charges).
Most of my patients refuse my recommendations to see a colonoscopist. Those that do, won't go back for a second one unless they have had a close family member die of the disease.
The reality, get $1200 for a hyst and never see them again or do a colonoscopy Q 5 years for them For colonoscopists entering the peritoneal cavity from the colon is an accepted risk unlike the reverse for us.
sAm
________________________________
From: ob-gyn-l@obgyn.net on behalf of Barbara Nicol
--
________________________________
Sent: Fri 1/26/2007 1:58 PM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Question about pap test frequency [NOW: Colon Cancer]
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
>
