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Format: 04/24/2014
Format: 04/24/2014


Pittsburgh Post-Gazette: Annual gynecologist exam is still advised

Friday, November 27th, 2009

By Pohla Smith

Pittsburgh Post-Gazette

Just because the American College of Obstetricians and Gynecologists has lengthened the period of time most women can wait between cervical cancer screenings doesn't mean they should feel free to see their gynecologist less frequently, too, local doctors warned.

The new ACOG guidelines, issued Friday, say that women 21 to 30 can be screened every two years instead of annually. Women 30 or older who have had three consecutive negative tests may be screened every three years with either the Pap test or a newer method known as liquid-based cytology.

"The average OB-GYN was not shocked or alarmed by this," said Dr. Eugene Scioscia, vice chair of clinical operations for obstetrics and gynecology for the West Penn Allegheny Health System. The professional group had been moving in this direction, he said.

Still, he added, "the one concern we've had is patients with these changes not coming in for their annual exam. That's not what this [set of guidelines] is telling you. Previous to this, one of the drivers to get the annual exam was the Pap smear.

"We don't want them to interpret this as they don't need to see their gynecologist or they're not required to have an annual gynecological exam."

Dr. Joseph Kelley, director of the gynecology and oncology program at Magee-Womens Hospital of Pittsburgh of UPMC, shared Dr. Scioscia's worry.

"I think a very reasonable but real concern is the message being sent out with regard [to gynecological] exams," Dr. Kelley said. "This does not mean they should not see their doctor.

"Clearly a woman who is sexually active should have annual exams." he added.

"As you look at the more mature patient -- they equate the Pap smear with the requirement for visiting their doctor, or they have a hysterectomy and then don't go for their gynecological exam."

And that's a mistake, the doctors said, for a good gynecological exam is as comprehensive in its own way as a yearly physical by a primary care physician.

"We screen for other cancers: breast, ovarian, colon," Dr. Scioscia said. "We look at their health and well-being, their lipids, cholesterol, their thyroid status ... their bone health ..."

There also are the issues "unique to women: incontinence, menopausal symptoms, sexuality," he added.

"Part of it is breast exams," Dr. Kelley said, "and gynecological health, including inspection of the vulva, vagina, the cervix, looking for abnormalities. There is palpation of the internal organs, as well as a rectal exam."

Still, Dr. Scioscia concluded, "For the most part, I would say the new guidelines are good [but] with this caveat: that they should be tailored to the specific patient."

Dr. Jan Silverman, chair of the department of pathology for West Penn Allegheny, also expressed concern for the individual who might fall through the cracks of the new guidelines.


To read more, visit the Pittsburgh Post-Gazette web site.

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