Local health workers speak on test debate

Yuma health care professionals say they support one recent recommendation for women’s health, but say a second recommendation may be off base.

Recently the U.S. Preventive Services Task Force, a government-appointed, independent panel of doctors and scientists, and the American College of Obstetricians and Gynecologists both made recommendations to change health screenings for breast cancer and cervical cancer, respectively.

The independent panel now recommends that women receive mammograms to screen for breast cancer starting at age 50. The American Cancer Society's long-standing position has been that women should get annual cancer-screening mammograms starting at age 40.

Local certified nurse midwife Susie Rhoads, with the office of Dr. Surendher Lokareddy at Associates for Women's Health, said with the recent news about changes in recommendations, "women, of course, I'm sure are confused."

Rhoads said she recently discussed the new mammogram screening recommendations with other health care professionals. The news came out while she and others attended a seminar about birth control, she said.

"Everyone around the table was talking about a patient in her 30s," Rhoads said.

Rhoads said that they all knew a patient who had been tested earlier and was able to detect breast cancer because of it.

"For us, breast cancer is personal and everyone knows a sister, a cousin, a neighbor, a friend who's had breast cancer."

She said she worries that more insurances will fail to cover the screening for women below the recommended age.

"So you're going to have more women who it will be unavailable to. I think this is more of a cost-saving thing."

Rhoads isn't the only local health care professional who said the recommendation is controversial.

Dr. Terry Lewis, with Zia OBGYN in Yuma, said he has some real concerns about the study.

Part of the problem, he said, is that the study came to a conclusion about the number of tests to prevent one cancer death. "That's going to skew results."

Another issue with the study, he said, is the discussion of "false positive" results.

That implies two things, Lewis said. First, that a negative biopsy is a bad thing, and second, that mammography is the only criterion for diagnosis and correct 100 percent of the time.

"In the real world, a false positive is not necessarily a bad thing," he said. "Until I see a lot better studies supporting this, I just can't agree with it."

Yuma obstetrician-gynecologist Dr. Nader Haddad, with Sunset Community Health Center, said they will also still use the current recommendation for mammograms.

"Right now, the evidence that we have, a lot of women would benefit from having the mammogram at age 40."

However, when it comes to the recent recommended changes in cervical cancer screening through the Pap smear procedure, Haddad said, physicians and midwives with Sunset might change their recommendations.

Previous recommendations for women to receive the test at age 21 or three years after the start of sexual activity could now change to women only receiving the test after they turn 21, he said.

Rhoads said the Pap smear change is something she's glad they're finally recommending.

"I think it helps us to see younger women who were afraid of having a Pap smear. They won't have that fear, and you already establish a relationship with them without having the Pap smear as their first initial encounter."

In addition, Rhoads said, cervical cancer is slow-growing. "I think it will help us not to be doing so many procedures to cervixes."

She said their office has always taken a conservative approach to the procedure if women are low risk or have had three negative results in a row.

"That's something I've always recommended."

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WHO'S SAYING WHAT

The latest advice from the major medical groups for routine screening — primarily for people who don't have a family history of a particular cancer or other risk factors:

Breast cancer:

• American Cancer Society: Mammograms yearly beginning at age 40; breast exam by doctor at least every three years in 20s and 30s, annually after 40; breast self-exam an option.

• American College of Obstetricians and Gynecologists (ACOG): Mammograms every 1-2 years for women in their 40s; annual mammograms age 50 and older; breast exam by a doctor annually from age 19; breast self-exam can be recommended.

• U.S. Preventive Services Task Force: Mammograms every two years for women ages 50 to 74, after 75 the risks and benefits unknown; recommends against self-exam; value of exams by doctors unknown.

Cervical cancer:

• Cancer Society: Start Pap tests about three years after first intercourse but no later than 21; annually or every 2-3 years for women over 30 who have three normal tests; stop at 70 after at least three negative tests and no abnormal tests in last 10 years; discontinue after a total hysterectomy.

• ACOG: Start Pap tests at age 21 and then every two years; 30 years and older, every three years after three normal tests; reasonable to stop at age 65 or 70; discontinue after hysterectomy.

• Task Force: Start Pap tests within three years of sexual activity or by age 21; at least every three years, stop after 65 if negative tests and no high risk; discontinue after hysterectomy.