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It’s been drummed into us women for decades — annual Pap smears and mammograms, especially once you’ve reached a certain age, are Good Things. If you’re responsible, you go to your annual exam.
However, more and more research is indicating that annual exams are unnecessary and can actually cause more problems than they solve. In her “Well” blog, Tara Parker Pope notes that national guidelines are urging less frequent screening for breast and cervical cancer, while other factors such as the declining use of menopause hormones and longer-term birth control methods also contribute to less of a need to visit a doctor annually.
Some women are so used to the idea of the necessity of an annual visit, though, that being told otherwise is unsettling. Especially if the annual visit led to lifesaving treatment. Miriam Richards, a 52-year old nurse in Raleigh, North Carolina, says that she worries that this is the wrong message. “I think it’s a bad road to go down because I feel like women, especially young girls, need to stay vigilant.”
But medical experts continue to preach that when it comes to cancer screening, more is not necessarily better. For years, women were advised to start mammography screening at 40; then, in 2009, the United States Preventive Services Task Force raised the recommended age to 50 — and specified every two years, rather than annually.
Last week, the task force and medical groups, including the American Cancer Society, recommended cervical cancer screening with the Pap smear no more than every three years, and said women should not begin screening until age 21. In the past, screening was recommended every one to two years, within a few years of becoming sexually active.
The concern is that more frequent cancer screening, whether of the breast or the cervix, leads to more false positive results — and unnecessary, intrusive and painful biopsies that lead to stress, discomfort and, in the case of cervical cancer screening, bleeding and future risks for women in pregnancy.
The changing landscape of cancer screening is certain to have an effect on women’s health care, although nobody is certain what it will be. Women have long been the most frequent users of health care, particularly for pregnancy care and pediatric visits for their children. But even when pregnancy and pediatric care are removed from the equation, women are still 33 percent more likely to visit the doctor, according to the Centers for Disease Control and Prevention. The rate of doctor visits for annual exams and preventive services for women is double that of men.
And importantly, gynecologists often use the annual visit to bring up nonreproductive issues: smoking, weight gain, high blood pressure, depression.
“I understand the strong relationship that has been formed with a woman’s doctors during what may be her annual visits,” said Dr. Wanda Nicholson, a member of the preventive services task force and associate professor at University of North Carolina at Chapel Hill. ”But our recommendation addresses only cervical cancer screening. It’s not meant to alter or change women’s ability to access their clinicians to discuss other concerns.”
Dr. Susan Love says that while annual doctor visits may feel reassuring, there is no evidence that they yield better health outcomes.
“There is no data that yearly physicals do anything,” said Dr. Love, a breast cancer researcher and prominent women’s health advocate in Santa Monica, Calif.
“In the current health care system, you rarely have the same doctor forever. And so the relationship you build in the 15 minutes you have will be for naught when you actually get sick.”