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Dr. Birdie on the New Women's Health Guidelines

By , SparkPeople Blogger
Being healthy is about far more than the number on your scale. Just because you lost weight and look fabulous does not guarantee you're healthy on the inside.  As a physician, I have seen many people who are thin and look healthy, but are actually sicker than many overweight and obese people. 

The best way to stay healthy for years to come is to prevent illness.  Focusing on diet and exercise is an important part of being healthy and preventing illness, but there are other aspects of your health that can't be managed with diet and exercise alone. Some areas of your health require regular visits to a qualified medical professional, especially for women. 

So, women of SparkPeople, when was the last time you visited your gynecologist? 

Can I see a show of hands?  Do you know how often you are supposed to get a Pap smear? How about a mammogram?  You are probably thinking I’m trying to trap you into the wrong answer. 

Of course, I am!  Most of you probably said you need to get an annual Pap smear and an annual mammogram starting at age 40.  Right?  Not anymore.

The rules we've all heard have changed, and I'm here to explain the new recommendations for Pap smears, mammograms, and more.

For more information about the reasoning behind the changes, read this New York Times article.

Pap Smear:
Before: yearly between the ages of 21 and 65
Now: every 3 years

Why the change?
For years, we doctors have preached to women to get these tests done yearly, no matter what, between the ages of 21 and 65.
Cervical cancer is relatively slow-growing, and it can be caught in its early stages with screening every three years rather than yearly. When women are screened yearly, there is an unacceptable number of false-positive screening tests, leading to unnecessary procedures which can lead to harm such as infertility. 

Before: Yearly after age 40
Now: Every two years between the ages of 50 and 75

Why the change?
This is a very controversial issue.  The United States Preventative Services Task Forces has recommended mammograms every two years starting at age 50 and stopping at age 75.  Women at high risk (such as those with a family history of breast cancer) should start screening earlier. 

Some groups, such as the American Cancer Society, still recommend yearly mammograms starting at age 40.   

Why the difference?  The reasons are similar to those for the change in the Pap smear recommendations. The risks (women harmed by invasive testing prompted by false-positive screening tests) outweigh the benefits (the number of deaths prevented by yearly testing is relatively low).

What should you do? How often you get screened should be a decision made between you and your physician. 

If you are still confused about when to start mammogram screening--especially with high-profile women in their 40s getting diagnosed with breast cancer--I understand. Knowing your options empowers you to make a more informed decision about when to start your personal screening program.  

Breast self-exams
Before: Monthly
Now: No need to do them.

Why the change?
I remember being reminded every year--and taught--how to do a breast self-exam by my own gynecologist.  Self-exams are no longer recommended because they have not been found to reduce breast-cancer mortality. 
According to the American Cancer Society, breast exams are no longer a part of the screening recommendations because research does not show they provide a clear benefit. However, they suggest that all women be familiar with how their breasts normally look and feel and report any changes to their health care provider right away.

So, what do these changes mean for you?  Does this mean that you get to skip your annual physical? 


My intended message of highlighting these screening changes is to let you know what is currently recommended.   I think we should use this discussion as an opportunity to question your relationship with your health-care provider and learn how to make that relationship more productive. 

You still need to visit your primary-care physician regularly to monitor your overall health.  The number one cause of death in America is heart disease, and you still need to monitor your risk factors and “know your numbers" in order to decrease your risk of heart disease and stroke. 

I know you may be thinking that if your primary-care physician spends only about 5 minutes with you that they can’t possibly accomplish adequate preventative care.  I am not denying that this is an issue.  The current structure of the health-care system in the United States makes it difficult to receive the primary care that you deserve.  Take charge of your own health and demand the care that you need.  Know which screenings you need and when--and "know your numbers."  Go to your primary-care physician prepared to ask for what you need.  If your primary-care physician is threatened by your assertiveness, then you can exercise your right find another physician.  A good physician will be supportive and impressed with your efforts to take charge of your health to prevent future disease. 

So are annual physicals necessary and to they improve health outcomes?  

I believe that preventing disease is one of the best gifts that you can give to yourself and your family.  Keeping that once a year appointment can serve as a reminder of your commitment to your health and early detection leads to better outcomes.  So, continue your annual physicals and continue to eat healthy, exercise, and enjoy your life! 

What is the bottom line?  Even though the latest recommendations allow for less vigorous screening for cervical and breast cancer it does not mean that you should stop seeking annual medical care.   Keeping your yearly appointment is a commitment to preventing future disease and is a gift to all of those who love and depend on you!

Keep Sparking, everyone!

What do you think about the new recommendations?

Dr. Birdie Varnedore, M.D., is happy to offer her expertise to the SparkPeople community; however, she cannot offer specific medical advice to dailySpark readers. Please do not share confidential medical information here. If you have a personal question or a concern about your health, please contact your health-care provider.

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Please don't stop examining your breasts. Technically, the doctor here is correct, but she should have gone further to give more complete advice. The rest of the recommendation is ". Still, the American Cancer Society says all women should be familiar with how their breasts normally look and feel and report any changes to their health care provider right away.”
( https:// www.cancer.org/latest-news/american
Thank you for the information Report
i would like to suggest a blog about questions we should be asking the doctor, which the doctor is not “allowed” to bring up as a topic... like one doctor told me I had ore-diabetes but then clammed up. I found out later so should have asked specific types of questions, but I didn’t know to ask them (partly I suppose the whole “don’t question authority” mindset...). Report
My doctor told me of the changes last month at my physical. Report
I am very saddened and shocked by these new recommendations. My grandmother found her own breast cancer lump when it was about the size of a Sweet Pea in her breast. I believe these new changes are to cut cost for insurance companies not to prolong life or benefit women in general. I will continue to be my own number one advocate and monitor my body and do what I feel is best. I do not trust insurance companies to make adequate policy for me or other women Report
I have changed to having a mammogram every 2 years. Yesterday was the day! The technician still thought that I needed a yearly. Report
I guess I'm wondering how influential our insurance companies were in making these recommended changes that are small changes for a huge number of individuals. It's a tricky situation when a for-profit company finds it cheaper for you to die than to live. Report
Great science-based article. Thanks, Dr. Varnedore! Report
I think the recommendation to forego monthly breast self-exams is wrong-headed. My mother discovered a lump while conducting a self-exam -- a lump that was missed on the mammogram she'd had 6 months earlier! It proved indeed to be cancer, and because she caught it early, she's still alive 21 years later. Had she NOT diligently checked herself, she might have missed it till it was too late. Report
I think that women need to be very careful in considering these guidelines. I had breast cancer at age 52. I'd had lumps and multiple biopsies from age 21 that were benign before the one that was cancer. I'd skipped a year with my mammograms just before the tumor was found, I'm sure that the tumor would have been less advanced when I had treatment if I had not waited 2 years between mammograms. i find this statement disturbing, "The risks (women harmed by invasive testing prompted by false-positive screening tests) outweigh the benefits (the number of deaths prevented by yearly testing is relatively low)." That's all well and good unless you or someone you love is one of the "relatively low" deaths. My advice to all women is found out what your risk factors are, unfortunately they are different for every woman, and decide for yourself how often you want to be screened. I hate to say it but this feels like "research" that will allow health insurance companies to deny payment for health screening that falls outside the guidelines, no matter what your physician says (the person who knows best what you need) Report
ABSOLUTELY DO NOT AGREE, i am just disgusted with this article - if i followed these new recommended guidelines - there is a very good chance i would not be here now Report
I'm sorry, but I can't agree with this article. I started at age 30 going to my doctor and asking for a physical with blood tests. I wanted to see where I was with blood sugar, iron, cholesterol, etc. I plan on continuing this every 5 years as well as continue with my yearly PAPs. As I get older, I plan on having physicals more often and also having mammograms and other preventative tests. It angers me at the amount of money healthcare in this country costs when I think a lot of health problems can be eliminated or minimized in a person through healthy diet and exercise. It seems that those of us who want to help prevent health problems are not treated fairly by health insurance when we need it or try to use it in a positive way. While I'm blessed to not have any health issues, my BP is low (always has been), my blood sugar is low, my cholesterol is good, etc., having the physical done was very helpful in showing where my numbers were and what areas I can improve. And it's pushed me to be healthier so I can stay healthy. And I believe the same goes for PAPs, mammograms, etc. Having my yearly PAPs have actually caught 2 issues for me that were immediately resolved and could have gotten worse if I hadn't gone for my exams. Our country tends to be reactive rather than proactive and I think by being proactive and watching our healthy is much better in the long run, both financially and health-wise. Report
In addition to the "rant" I left earlier, I now wish I couldn't but feel I should add that my 47 year old sister JUST got diagnosed with Breast Cancer. How did it get found?? By her monthly self check. And she had a baby 6 months ago. It's not like she hasn't been "under care"!!

Also, it is true that The U.S Preventative Services Task Force is the one putting out these standards, but you would be surprisied how much insurance money goes into their pockets. Don't fool yourself. This is ALL about money. Report
My aunt found a lump in her breast that WAS cancer, thanks to her self exams, so I'm not sure about that reccomendation.

As for pap smears, well I had a pap that came back abnormal, went for a colposcopy, turned out it was highly abnormal; had a cone biopsy, and have been clear ever since. If I hadn't had that original pap, I may not have known for 3 years, and then I would have had to wait even longer to get it dealt with, so I am totally against that reccommendation.

Granted, I live in Canada, and all these tests & procedures are paid for through my taxes so I don't have the financial issue to consider. However, just from personal experience, I will continue having paps on a regular basis, and when my dr reccomends it I will start having mammograms. Report
I think instead of focusing on guidelines we should be focusing on being our own health advocates. We, as humans, should learn more about what healthy means and understand that we should love ourselves to CARE about our healthCARE. If I hadn't become my own health advocate I might be dead already because it turns out the conditions I'm dealing with I've probably had most or all of my life but doctor after doctor ignored it or thought I was a hypochondriac. I've had to learn about the conditions and teach several doctors what the conditions mean IN ME.
Too many people take better care of their cars and their electronics than they do their own bodies. We should listen to our bodies when we see/feel something go wrong and learn about it instead of expecting overworked doctors who are humans that make mistakes to fix it with a little pill or a quick shot.
As for the guidelines, we should talk with our doctors about what the guidelines really mean and make informed choices. We are all unique - I'm one in more than a million - so guidelines are not law for any of us. Report
I am so glad they did not show any correlation between monthly breast exams and any useful data. There are so many fluctuations with how the breasts feel that even trying to remember to do it the same time each month wasn't enough to make a mental map and always seemed useless to me. I think the detection of of lumps was a great goal, but that most women were ill-equipped to find true lumps.

So I am most glad that the monthly breast exams are KAPUT! Now we can focus on other helpful indicators for health concerns. And I am glad that the mammograms are scaled back. Not only were they costly, but traumatic for some.

Thanks so much for the updates! It will be nice when everyone is on board with the recommendations. Report
Ladies, like most guys I was totally ignorant about "girl stuff" (mammogram/pap smear, etc.), and my DW was very reticent to speak of same - "very reticent" as in changing the subject, to ignoring the question or decide to go shopping.

Being on Spark these past six years has inadvertently led to my coming across a discussion on more than one team about "girl stuff".

Armed with some basic information, I went to the Internet for information. Why in blazes was none of this discussed in college level A&P classes?

Most guys are at least three years behind ladies in social training (and many Never catch up), and in some of that training we are encouraged not only to not ask questions, but to run, not walk, whenever anything even remotely associated with "girl stuff" is overheard in any conversation.

To guys, the words "pap smear" usually mean..... not much at all. I mean, it doesn't sound like 'kidney stones' or 'heart attack' or any other thing bad. It's just something girls do.

Likewise, the term 'mammogram' doesn't sound painful or uncomfortable at all. I assumed it was just some sort of x-ray, probably like a chest x-ray.

I now know what you ladies put up with, and think the innocuous term 'mammogram' should be replaced with something related to medieval torture devices.

I have apologized already to my DW (of nearly 41 years) about being so ignorant - and I apologize to you, too, just for guys in general.

BUT..... you need to help. Talk to your husbands and sons realistically and don't make it appear that your trips to your OB/GYN are just "routine" or "no big deal".

I know many young men, when asked by their wives to pick up feminine hygiene products while at the store, cringe and blush when they get to the counter and have to pay for them.

My wife is considered "low-risk" for breast cancer as there has been none diagnosed with cancer of any type going back 3 generations on her mom's side of the family and 5 generations on her dad's side.

Even at 66, she gets a breast exam much more often than once every month. Report
Way to go DRB13-1! I'm in complete agreement! Report
I was diagnosed with breast cancer at the age of 39, and I found the lump myself.
I had my first and only mammogram then; I no longer have mammograms because I had a bilateral mastectomy without reconstruction.

Unfortunately though, my cancer returned in 2007, I'm now stage IV with bone mets. Report
For those of you who want to put the blame on the insurance companies, let's get the facts straight. It is The U.S Preventative Services Task Force that is recommending these changes and it is comprised of specialists from Family Medicine, internal medicine, obstetrics, gynecology and pediatrics. it is supported by scientific staff at The Office of Disease Prevention and Health Promotion in Washinton D.C.

Insurance companies do offer coverage for birth control. Think of it like a menu. Employers look over the menu that is presented to them by the insurance company and decide what they are willing to pay for. If you do not have coverage for birth control talk to your employer.

What a relief. The new guidelines certainly take some stress out of my life. I always felt guilty like I was cursing myself if I didn't make it in annually so this is much more manageable. I just had a Pap yesterday (yah for me!) and have a mammo scheduled in 2 weeks. Report
I so agree with the annual check ups and mammograms. There are just to many examples of friends we know finding out in the early stage and surviving! Report
My mother had breast cancer when she was 37, the same age I am now. She found the lump herself. We are constantly told to listen to our bodies, to know what is normal for us and what is not. So why shouldn't we do breast self exam - I daresay that we know our own bodies pretty well. Report
Here are the TRUTHS about “Obamacare”:
*If you have insurance, consumer protections help you get the most out of your plan.
*If you need insurance or have been rejected for preexisting conditions, new programs may provide coverage.
*Medicare is strengthened, provides more access to preventive services and prescription drug discounts for seniors.
*Addresses the coverage gap know as the “donut hole” for prescription medicines for seniors 65 and older, and has already initiated a 50% discount for name-brand drugs in this category.
*Tax credits and new programs are available to small businesses to make health care more affordable for employers, employees, and early retirees.
*Insurance companies can no longer limit or deny benefits to children under age 19 due to a preexisting condition.
*Children can remain on their parents’ policy until age 26.
*Aims to reduce gender disparities in policy costs – women are currently overcharged compared to men.
*Breast Cancer Mammography screenings every 1 to 2 years for women over 40.
*Allow the woman and her physician to decide her contraceptive options – protect women from having these options decided by pharmacists, your boss, religious institutions or the government by having the insurance companies provide contraception coverage in their policies.
Contraception does NOT include abortifacient drugs, i.e. RU-486.

Access and use of contraception is practiced by 98% of women in this country at some time in their lives, and although no method is 100% effective having the choice reduces unintended pregnancies and therefore the decision of abortion in the first place.
Florida has already documented an increase in the deaths of women from ectopic pregnancies due to lack of access to health care and early diagnosis and treatment.
So get the facts, people.
Without national health care, illness will bankrupt more and more families in this country.
With national healthcare, we can have a healthier, more productive workforce.
Here is the link for preventive care for women
Oh, I get it, Obamacare! Make sure we can't survive! These are outrageous! Report
I found my own breast lump. It was invisible on mammograms. That was 20 years ago! So I disagree with statements that say breast self exam does not have any influence in survival rates! Report
I don't mind going yearly for the woman stuff. I like to be informed. I don't want any surprises as to what my body is doing. Report
My mom, who has NO insurance, and cannot afford mammograms (in spite of two generations of breast cancer in her family) is just finished her final chemo treatment. She's still got to go through radiation. Her prognosis is good, because it was caught early.



I don't *care* if it "doesn't reduce breast cancer mortality" - it saved my mother's life, who probably would NOT have been checked because of her lack of insurance. Advising women not to do breast self-exams, which are FREE and EASY to do is irresponsible, and likely would have KILLED MY MOTHER if she'd followed that advice.

As a fourth generation in a family of THREE GENERATIONS of breast cancer (my mother, grandmother, and great-grandmother) I WILL continue to do my breast exams... because doing saved my mother's life, and it could very well save mine.

Not everyone has insurance... not everyone can afford regular mammograms, nor has the access to low cost/free programs that offer them. For the million sof people who have no insurance, and those who have it but do not follow adequate preventative care for whatever reason, this is irresponsible advice, and I hope for those like my mom, they IGNORE IT. Report
Thanks for the update Report
Thank you for sharing these new details. Hopefully we can choose to take these new guidelines if we wish AND those that want to keep with the annual routine CAN and INSURANCE COMPANIES will STILL PAY for them. When we as patients get educated, it is so important that our choices matter! Report
I definitely disagree with self breast exams being unnecessary. One of my best friends found a lump doing a self exam and her cancer was caught at a very early stage and was able to be cured much faster than it would have been if she had not done it! Report
Definitely will add to this list of topics to discuss with my doctor on my next visit! Report
As a 44-year-old breast cancer survivor, I heartily disagree with the recommendations in this article. I am alive and healthy today because of early detection. I would not have lived to see 50 if I decided to wait until then to get my first mammogram. Report
Very informative.
I had my yearly physical already this year, it is one of the things I always make sure to do early on so I don't put it off.
I am surprised that the breast self-exam has been nixed.
I'm thrilled to see the new guidelines...but I have no family history or other reasons to worry. Let's just view them as what they are - guidelines, not blanket rules for everyone - and make sure our doctors explain why they do/n't apply to us. Thanks for an informative post. Report
I disagree wth this totally. I was just diagnosed with Breast Cancer this year and it was found on my yearly mammogram. No lumps or anything to else to show I had breast cancer. Because it was caught at an early stage I didn't have to have radiation or chemo. Both Big Pluses for me. Report
Unbelievable! A good friend was just diagnosed with invasive breast cancer at 38. She found the lump doing a self exam. No family history. She is otherwise healthy and we are optimistic for her. But following these guidelines? Wow... Report
I tend to disagree with all of this. We were able to diagnose my cervical cancer by doing a yearly pap smear. Had it been every three years as this suggests I most likely would not be here to write this. It is your body ladies and unless the insurance companies deny your request to have these done yearly then I encourage you get it done as previously. Your health and well being is worth it even if the insurance company doesn't pay. Alot of programs in your communities like Susan B Koman for the Cure or Breast & Cervical Cancer Programs (BCCP) Use them... that's why they are there especially if you are lower income or have a family history of cancer as I do. Donna Report
Sorry but no. This sounds too much like insurance companies setting the standards to save money, not concern over women's health. Too many stories of women finding lumps during monthly self breast exams and cancer being caught early. I don't have numbers to quote but would like to see how many early cancers are caught on pared to how many false positives actually result in harm. Report
Yeaaa too Report
My OBGYN still thinks I need to get pap smears annually because I am still on the pill. Also, she has me do a mammogram and blood work annually to rule out diabetes and other things. I think she is a smart doctor even if the tests seem tedious! Report
I have found breast cancer is affecting many younger women. Now they are saying not have your base until way after 40? I have also known women at my church who have battled BC in their early 80's. I guess we women are considered expendible after 75. Why should male run companies have to pay for us to have anything really? This is the way things seem to be going in this country on a daily basis. Yes, look at all the money the insurance companies can save by changing these standards!! The amount of BC in males is on the rise, too. They have a looooooong way to go to be anywhere near women, but they do have it. When it gets to where it gets to lawmakers and insurance board members, then perhaps ALL of us will benefit by what becomes recommended and acceptable! Report
Great. What that really means to me is that the insurance system just forced the medical society to lower the level of care they will pay for. Since it's recommended only 2-3 years, they only have to pay for it once 2-3 years. Way to go for our better health.

I completely disagree with the women on here saying they knew they didn't need it yearly and it's unethical for doctors to have "forced" us to have them. REALLY? Pap smears, as others have pointed out, are NOT just about cancer. There are a heck of a lot of conditions and illnesses that are found that way, some that can kill you and/or cause horrible deformities should you become pregnant and YES you CAN become pregnant ON birth control. Also CERVICAL IS NOT the ONLY cancer. They quote cervical but the instances of UTERINE cancer are much higher to MY EXPERIENCE. Number of women I know who've had cervical cancer? ZERO. Number of women I know who've had UTERINE cancer? Oh, lets seeee... about 7!!!! Including MY MOTHER. If my BFF hadn't been diagnosed when she was and my mother as well they'd have been dead. And they GOT YEARLY EXAMS. IMHO it's NOTHING but a money maker for a mysoginistic insurance system. Report
I go regularly meaning yearly. I want to stay informed. Report
I had a hysterectomy 8 years ago and I no longer get pap smears. I don't feel they are necessary after a hysterectomy. I took my gynecologist an article from the American Cancer Society that concluded there were thousands of women having unnecesssary tests. Report
Healthcare is really one of those areas where women get shafted. As women, we should get 2 annual checkups: our yearly physical and our yearly gynecological exam. Regardless of whether or not I need a yearly Pap, I'm sure I still need my yearly gynecological exam. That exam isn't just about getting a Pap smear. I wonder if these guidelines were brought about by insurance companies who don't want to pay for this. *sigh* If I need these tests less often, so be it. I just hope that women who do need them more often or at a younger age don't get penalized by their insurance companies. Report
I stay on point with all of my exams, because if something is wrong I want to know early so it can prayerfully be fixed. Report
I am good about following the yearly mammo and my pap smear has been q3 years since a hyster 14 years ago. I'm still gonna do self-exams, though but not stress if I don't do one every month. I target the first of the month... Report
Interesting info, but don't family history, personal habits and other health issues all need to be factored in? Report
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