If healthy women no longer need Pap smears every year -- and all major health groups now agree they don't -- is there any reason to see obstetrician/gynecologists every year?
The country's leading group of such doctors, the American College of Obstetricians and Gynecologists, says yes. In newly updated guidelines, the doctors encourage women to keep coming annually for "well woman" exams.
Even if that visit does not include a Pap test for cervical cancer, it should include a pelvic exam, the group says. But it acknowledges that "no evidence supports or refutes" the value of the exam for finding problems in women with no symptoms. So the final decision is up to women and their doctors.
The recommendations come just as new federal rules, which took effect Wednesday, require most insurers to fully cover annual checkups for women by gynecologists or other doctors. The changes, part of the new health care law, likely will increase the number of women who seek exams, health advocates say.
But the guidelines also come a few months after medical groups said most women need a Pap smear just every three years, starting at age 21, and even less frequently after age 30, if they combine them with tests for the human papilloma virus (HPV), which causes cervical cancer. Women with no history of problems can stop the tests at 65, the groups say.
That could decrease routine visits to obstetricians/gynecologists, says Gerald Joseph Jr., vice president of practice activities for the college. "Many women refer to going to see their gynecologist as going in for their Pap smear. But there are many other things involved."
Annual visits can be used to check blood pressure and weight, update immunizations, counsel on healthy living, screen for sexually transmitted infections and other health problems, perform breast exams and build doctor-patient relationships, the group says.
$8 billion for preventive visits
But despite the new coverage rules, many experts now question the use of special annual appointments for such purposes, says Ateev Mehrota, a professor at the University of Pittsburgh School of Medicine. In a study in 2007, he found that 19 million U.S. women, about 17%, had a yearly preventive visit with a gynecologist, accounting for 26% of all visits to gynecologists. Average cost for each visit: $136.
"We estimate that about $8 billion a year is spent on preventive yearly physicals of all kinds," he says. "The question is whether we could spend those $8 billion more wisely." It may be more efficient for patients to get preventive services when they come in for other reasons or for computers to remind patients and doctors when they are needed, he says.
'It's a ritual' for women
Even some gynecologists question the need for an annual visit. "I'm in favor of a more individualized approach," says Marcie Richardson, a physician at Harvard Vanguard Medical Associates in Boston. Some women, she says, already see other primary care doctors for annual checkups or routine care and don't need to see a gynecologist unless they are planning a pregnancy or have other reproductive or sexual health concerns. She says she allows some healthy women who only want to renew birth control to do so over the phone.
But Joseph predicts that the annual pelvic exam will endure. "Many women are not going to feel comfortable unless they have (one) even though the studies don't show in general that it makes a huge difference to their health." He says "it's a ritual," and many women are reassured when a doctor finds no obvious abnormality, which usually happens.
Judy Norsigian, executive director of Our Bodies Ourselves, a non-profit women's health group, says it's good that insurers will cover annual visits for women who need them. But "most women don't like going once a year to a doctor. If they are told there's no evidence they benefit from it, they are not going to do it."
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PUBDATE = 08/02/2012
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