This story was generally clearly written and delivered an important reminder to women that screening too often isn’t harmless – and that there’s a reason for evidence-based screening guidelines.
Unfortunately, the story is confusing in a way that could mislead women about how often Pap smears are recommended. The story cites scenarios of TWO negative Pap smears and asks what the next step should be. “…a woman age 30 to 60 has had two consecutive normal Pap tests but no HPV tests; two normal Paps and a negative HPV test; or a negative HPV test but no recent Pap tests. In all of those cases, guidelines recommend waiting three years before screening the patient again..” But the standard recommendation is THREE negative Pap smears before moving to every 2-3 year screening. The study’s scenarios stipulated that a woman has “a current normal Pap smear result” in addition to the past history above. Readers could be misled, since the story implies that only 2 negative smears are needed (or a single negative HPV) before adopting less frequent testing.
The story ended with some sound advice for women: “We need to shift toward the wellness visit as opposed to, ‘You have to come in here every year for a Pap,'” (one expert) said. There are other important preventive interventions that happen during a visit “just for a Pap smear,” such as counseling about smoking cessation, diet, and exercise, and screening for other problems such as sexually transmitted disease and depression. Doctors may be slow to adopt new Pap smear guidelines because the public health message about the benefit of routine preventive visits (what is confusingly termed here a “wellness visit”) has not been strongly articulated.
The story referred to “extra costs women may incur to get childcare and make it to the doctor’s office — plus the costs to a strained healthcare system of ordering more tests.”
Not applicable. The story wasn’t about benefits, but rather, the suggested lack of benefit from screening too often.
The story did a good job explaining that there can be harm from screening too often – something that often isn’t explained in screening stories:
“…any extra screening increases the chance of getting a “false positive” result on a test — meaning the test finds something that doesn’t turn out to be cancer. In that case, women would need more invasive tests to rule out disease, Roland said, and risk “undue harm” from those procedures.
“Some of it is, don’t go looking before you need to go looking because you’ll find stuff that you’d rather not find,” said (one observer), who was not involved in the new study.
The story did not make clear who was surveyed. Family practitioners? Ob-gyns?
There were other issues. The story never fully described the evidence behind the recommendations that “generally call for a three-year wait after normal tests.” Reuters may have thought that was outside the scope of the current news on the current study, but it would have better informed readers about the quality of the evidence.
Then, of course, there’s the confusion over the screening intervals that was addressed in the review summary above.
An independent expert from the American Society for Clinical Pathology was interviewed – someone not involved in the study.
Comparison of screening intervals was at the heart of the story: “There’s really no advantage to annual screening compared to screening every two or three years,” lead author Katherine Roland told Reuters Health.
The entire story was about cervical cancer screening being made TOO available too often.
The story reminded readers that this type of survey – and its findings – don’t stand alone:
“Results from a survey of the same doctors have shown that many also give the HPV test alongside Pap smears to women under 30 — which is not recommended, because HPV is common in young women and often goes away on its own (see Reuters Health story of July 4, 2011.)”
It’s clear the story didn’t rely on a news release.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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