DEAR DR. GOTT: I’m a 49-year-old female. I have given birth to three children ages 19 to 24. There is no known history of ovarian or breast cancer in my family. My brother and I both had our thyroid glands removed due to cancerous tumors.
For the last 25 years, I have had annual PAP smears and vaginal/anal exams, with great results. Last month I went to my internist for an annual physical. This was the fourth year I have seen him. He’s done my gynecological exams and PAPs. This year he said that regulations have changed and because I have had three successive normal PAPs, I do not need one for three more years. I questioned whether this was due to new research or new regulations. He said “new regulations.” I told him I wanted one anyway. My insurance will pay, and I’m not concerned about the cost if the procedure isn’t covered. I am concerned about cancer.
So he had me undress and put on a gown. When he came back to the exam room he pulled up the “regulation” on his computer to show me, saying there was no need to do the exam. I was dumbfounded and agreed. My research has told me that passing on the PAP is OK but that I should have a vaginal and anal exam to look for ovarian cancer, which he did not do. Nor did he do a breast exam. He just told me that I should perform self breast exams.
Should I go to an OB/GYN for a proper exam or do you agree with him?
DEAR READER: I don’t know what you had done as part of your annual exam or what it cost, but it appears to me some things might have been left out. He didn’t perform a breast exam. Did he check your blood pressure, do an EKG, listen to your heart, talk about the importance of a colonoscopy in the near future, coordinate possible necessary lab work or X-rays and ask relevant questions about your past medical history?
Pap tests and pelvic exams are an important part of an examination for women because they can detect cancer and other abnormalities that could lead to cancer of the cervix. If abnormalities can be detected early, they can be treated earlier, before cancer has had time to develop.
Of the 55 million PAP tests performed every year in the United States, approximately 3.5 million of them are abnormal and require follow-up. While not all testing is accurate, false positives (as well as false negatives) can be reported. About half of the false negative reports are because of inadequate specimen collection. The other half occurs because of misinterpretation on the part of the individual examining the specimen. Newer methods being instituted have made it easier to collect and analyze.
Digital rectal exams are done to check for potential problems in the pelvic area, uterus, ovaries, lower abdomen, vaginal bleeding, pelvic pain and more.
As a guideline (and there is no hard and fast rule), women between the ages of 40 and 65 should have their blood pressure checked every one to two years; cholesterol levels checked every five years; an annual dental exam; eye exam every two years; physical exam between one and five years; self-breast exams monthly with exam by a health care provider annually; mammograms every one to two years; PAP smear (according to the National Cancer Institute) every two to three years; and a rectal during gynecological examinations. If a woman has undergone a complete hysterectomy, she will not need a PAP unless the reason for the procedure involved cancer or pre-cancer; and a pelvic every two years unless extenuating circumstances enter the picture for closer follow-up on any of the above conditions.
Recommendations have been modified. Some people may look on this fact as favorable, while others are concerned because of potential consequences for waiting. If you feel strongly that you want specific testing performed and your physician has voted against it, the answer is to find a gynecologist who is willing to do what you want — even if this means paying out of pocket.
To give you related information, I am sending you a copy of my Health Report “Medical Specialists.” Other readers who would like a copy should send a self-addressed, stamped No. 10 envelope and a $2 check or money order made payable to Newsletter and forwarded to PO Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print out an order form from my website www.AskDrGottMD.com.
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