A public campaign called “Choosing Wisely” is helping to raise awareness about the potential harms of unnecessary medical tests and treatments. The campaign, launched by the American Board of Internal Medicine Foundation and nine American physician organizations, promotes discussion between doctors and patients about unnecessary treatments and testing. Fifteen commonly used tests and treatments have been singled out for discussion due to their questionable efficacy and potential to cause harm. Four of the fifteen brought into the spotlight for scrutiny are related to pap tests and pelvic exams and include the following:
- Don’t perform Pap tests on women younger than 21 or those who have had a hysterectomy for reasons other than cancer. In Canada, it is now recommended that Pap tests begin at age 25 and follow at three-year intervals
- Don’t screen women older than 65 for cervical cancer if they have had adequate prior screening. *Cervical cancer is rare in this age group, so the test offers little benefit.
- Don’t screen women younger than 30 for cervical cancer with HPV testing alone or in combination with cytology. HPV testing is now being done instead of Pap tests in some cases because it is more precise, but it is still not useful in younger women.
- Don’t require a pelvic exam or other physical exam before prescribing oral contraceptives. There is no reason to do a pelvic or breast exam before prescribing the Pill.
Some people have been concerned about the persistent and prolific propaganda that promotes screening and ignores the potential for harm, but thankfully that is changing as research scientists, campaigns and mainstream media have been helping to raise public awareness. Andre Picard, an award winning health journalist, states “Over-treatment is a serious problem in the U.S. and in Canada too: Performing unnecessary tests, prescribing drugs inappropriately are not benign activities. They have the potential to cause harm, and they waste in addition to wasting money.” http://www.theglobeandmail.com/life/health-and-fitness/health/unneeded-treatments-can-hurt-budgets-and-patients-too/article14567958/
And of course the ‘choosing’ involved in ‘choosing wisely’ should ultimately belong to the patient.
*Cervical cancer is rare in all age groups: http://www.statcan.gc.ca/pub/82-003-x/2012001/article/11616/tbl/tbla-eng.htm
Over-treatment in America: http://www.youtube.com/watch?v=uJ6NufAb2qc
Benefits and harms of cancer screening: http://www.youtube.com/watch?v=861GCKemvtQ
Financial incentives contributing to overtreatment and overdiagnosis: http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001500
Women “duped” over benefits of breast cancer screening: http://www.dailymail.co.uk/health/article-2182932/Women-duped-benefits-breast-cancer-screening.html
What is what you survived wasn’t cancer? http://www.bloomberg.com/news/2013-08-18/what-if-what-you-survived-wasn-t-cancer-.html