Screening

Vitally necessary or a waste of time?

Using an appropriate device, one can “screen” the sand on a beach in order to locate a lost silver dollar. Chances of finding the dollar increase with knowledge that it is, first, really lost, and second, lost in just this precise spot.

We may refer to this as “focussed” screening. Sifting all the sand of a huge beach on the off chance that someone may have lost a silver dollar in all that sand has a negligible yield of dollars. We’ll call this “unfocussed” screening.

Focussed medical screening includes routine mammography and testing for colon cancer. It also includes routine PAP smears for all young women who are sexually active. (PAP smear screening detects early changes in the uterine cervix which may lead to cancer. This cancer is caused by a virus which is sexually transmitted.)

An example of unfocussed screening is doing PAP smears on celibate members of some church affiliated groups, meaning you don’t need to do this test on the Little Sisters of Saint Agnes.

Since the introduction of the PAP smear, most gynecologists and many family physicians have performed it ritually, annually, on ALL their female patients. They are so programmed that they continue to screen women who are at zero risk for cervical cancer. At the top of the zero risk list are women whose uterus has been removed for anything other than cancer of the cervix. (A treated cervical cancer patient may have a slight risk for residual cancer in neighboring tissues.)

Old time doctors, usually those who weren’t really well trained, used to do an operation called a supra-cervical hysterectomy. It’s a lazy doctors’ procedure in which the cervix is left intact, meaning there is still a risk for cancer to occur in it.

So. Here’s a good question for you to ask the person busily engaged in doing a PAP smear when you thought your uterus was long gone: “Pardon me? Do I still have my cervix? If I don’t, why are you doing what you are doing?” Ooops. That’s three questions.

I can think of only one reason for recalling women for annual PAPs after hysterectomy, and that’s to get them into the office. The hard-wired symbolism of annual PAP testing is a powerful tool.

Women whose ovaries were left intact at the time of surgery may benefit from an examination without a PAP smear. The operative word is “may”, since there is not yet an effective screening method to detect ovarian abnormalities including cancer.

As one who has done them for a number of years, I believe an annual physical examination is a good thing, and appropriate screening / testing can be accomplished at that time. If we don’t do an annual exam, it becomes too easy to skip mammograms and colon cancer tests.

A good screening test is one in which the target disease can be detected and treated before it advances, thus resulting in INCREASED QUALITY OF LIFE YEARS FOR THE PATIENT. Routine PAP tests after hysterectomy fall well short of that goal. In fact, they are unnecessary, a waste of medical resources, and a waste of somebody’s money.