- The Washington Times - Saturday, November 21, 2009

A leading medical group added new fuel to a budding health care controversy on Friday by recommending that women delay their first cervical-cancer screening until age 21 instead of starting the test three years after becoming sexually active.

The American College of Obstetricians and Gynecologists (ACOG) also advised that women under 30 undergo the screening, also known as Pap smears, every other year instead of every year.

For women 30 and older, the screening can be done every three years for those with three consecutive negative cervical cytology test results, the group said. The recommendations are scheduled to be published in the December issue of Obstetrics & Gynecology.

The group’s guidelines come three days after the U.S. Preventive Services Task Force, a government panel of experts, sparked an outcry among doctors, many women, cancer-prevention experts and Republicans by recommending that women wait until they turn 50 to begin routine mammograms.

The American Cancer Society rejected the report, saying its mammography guidelines - that women should start getting mammograms at age 40 - would not change. Republicans also accused the Obama administration of taking a first step to ration health care.

Health and Human Services Secretary Kathleen Sebelius quickly downplayed the mammogram report, saying it was issued by an independent panel and would not affect insurance coverage or determine government service.

The release of two reports on the subject of women’s health care within days of each other was apparently coincidental. ACOG began reviewing the recommendations in late 2007.

But the message from both panels is clear: Women would be better off with less health care, not more. Both reports cited the emotional and economic distress of having the procedures done at a young age and more frequently than may be necessary.

“Adolescents have most of their childbearing years ahead of them, so it’s important to avoid unnecessary procedures that negatively affect the cervix,” said Dr. Alan G. Waxman of the University of New Mexico, who headed the committee that developed the ACOG document. “Screening for cervical cancer in adolescents only serves to increase their anxiety and has led to overuse of follow-up procedures for something that usually resolves on its own.”

Women with certain risk factors such as HIV were advised to receive more frequent screenings. The American Cancer Society estimates there will be 11,270 new cases of cervical cancer and 4,070 deaths in 2009.

The cervical-cancer guidelines failed to unleash anything close to the opposition met by the mammography report for several reasons. Because ACOG is a private research and advocacy group, its guidelines don’t carry the same force as those issued by a government-appointed panel.

Cindy Pearson, director of the National Women’s Health Network, said that ACOG’s guidelines already have widespread support within the medical community.

“We’re actually pleased. Fewer Pap smears are actually going to result in better health,” said Ms. Pearson. “This is not a surprise in the medical community. Other groups had made this recommendation in the past, but it took this long for obstetricians and gynecologists to be comfortable with it.”

Cervical cancer is caused by the human papillomavirus virus, or HPV, an extremely common sexually transmitted infection. Still, in most adolescent women, the immune system clears the virus within one or two years without treatment.

Sen. Tom Coburn, Oklahoma Republican and an obstetrician, said he worried that women who opt to forgo an annual Pap smear would also skip their pelvic exams, which are used to detect ovarian cancer.

Mr. Coburn’s main political concern was how the recommendations might fit into the debate over health care reform. Under the current legislation, any set of physician-endorsed recommendations, especially those seen as cost effective, could take on the rule of law under a government health care plan and, as a result, limit treatment flexibility, he said.

“You take the ACOG recommendations and give them to a cost-effectiveness panel, they’re going to mandate that,” said Mr. Coburn. “And if you want to do something different, you’re going to have to explain why. It’s a lose-lose situation for doctors and patients.”

ACOG has been active in supporting an expansion of government health care. In 2008, the group launched a reform agenda titled, “Health Care for Women, Health Care for All” that called for universal health coverage and guaranteed benefits.

“We call on Congress and the States to cover all people in the U.S. and to guarantee coverage that meets women’s lifetime needs,” according to its Web site www.acog.org.

The group applauded the introduction of a Democratic resolution in February calling for guaranteed health coverage, saying that “health care reform must be accomplished this year.”

c Ann Geracimos contributed to this report.

• Valerie Richardson can be reached at vrichardson@washingtontimes.com.

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