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Harvard Health Blog
Expert panel says healthy women don’t need yearly pelvic exam
- By Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing
As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.
Any content can be spun-out
Any content could be spun
this is alternative medicine hernia
“5 HPV primary or women can reliably self-test”
I should have mentioned the 5 HPV primary tests or self-tests under the new Dutch program will be offered at ages 30,35,40,50 and 60. Pap testing does not benefit those under 30, but this group produce the most false positives. Not one country in the world has shown a reduction in the incidence or mortality of cc in those under 30, despite extensive screening. (but young women produce the most false positive which can lead to excess biopsies and over-treatment which can damage the cervix and lead to miscarriages, premature babies, the need for c-sections and cervical cerclage etc.)
The Finns have the lowest rates of cc in the world and refer FAR fewer women for biopsies etc. Since the 1960s they’ve offered 7 pap tests, 5 yearly from 30 to 60, so this is not new evidence. The HPV test should not be used by those under 30 as about 40% would test HPV+… transient and harmless infections that will clear by age 30. It’s the 5% who test HPV+ at age 30 or older that have a small chance of benefiting from a 5 yearly pap test.
Actually I’d also, question the need for pap tests, most women are HPV- and cannot benefit, but can certainly be harmed by false positives, excess biopsies and over-treatment. As an Australian women the routine pelvic exam was scrapped long ago, I always refused it anyway, it didn’t take much research to see it was of poor clinical value and carried risk.
I don’t have pap tests either, an informed decision. It’s shameful that women are pressured and coerced into this elective screening test. Informed consent is a legal right. (coercion negates all consent and is a very serious matter) Too many make a fortune trying to drag all women into pap testing (and often serious over-screening) and all the excess that follows false positives. Here the lifetime risk of cc is 0.65%, always rare here and in natural decline before testing even started, while the lifetime risk of referral for colposcopy and usually at least a biopsy under our program is a hidden and horrifying 77%.
The Dutch follow the evidence and put women first, they’ll scrap their 7 pap test program, 5 yearly from 30 to 60 and offer instead 5 HPV primary or women can reliably self-test with the Delphi Screener, and only the roughly 5% who are HPV+ will be offered a 5 yearly pap test. (until they clear the virus)
This will save more lives (including cases of adenocarcinoma) and take most women out of pap testing and harms way.
The awful over-screening we see in the States, Australia and elsewhere is a great business model, but bad medicine. Using the pap AND HPV test together simply generates the most over-investigation for no additional benefit to women. The continued need to control women needs to be addressed, the Pill should be taken off script, unnecessary barriers to access carry far greater risks to our health. (and lives)
This consult has been used to take advantage of women, to mislead, coerce or pressure women to screen, that needs to stop. Are men “required” to have a rectal exam or colonoscopy before they can buy condoms or get a script for Viagra?
Women need to be so careful, we cannot trust a system that puts their profits ahead of our health and legal rights. The routine rectal, recto-vaginal, breast and pelvic exams are not evidence based and are far more likely to harm us. I would never permit any of them, none are recommended here anyway.
I have also, declined breast screening, in my opinion, the risks exceed any benefit. The Nordic Cochrane Institute, an independent, not-for-profit, medical research group, has produced an excellent summary of all of the evidence, it’s concerning. About 50% of screen detected breast cancers are over-diagnosed and any benefit of screening is wiped out by those who die from lung cancer and heart attacks after treatments.
Too many are protecting screening and excess for their benefit, when we should always put the patient’s welfare first. What was the motto? First do no harm. How did we get so far away from that?
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