Screening Tests May Not Be Answer to Health Care Woes

THE JOURNAL RECORD, December 29, 1993 | Go to article overview

Screening Tests May Not Be Answer to Health Care Woes


In our changing health care world, much is made of preventive medicine, health promotion and screening tests. Is this emphasis warranted as an answer to our health care crisis?

The fundamental shift in our health care system from specialty care to primary and preventive care is a change instigated by medical expertise and data, not economic or political theory.

Tremendous technological breakthroughs and medical discoveries have created an era of unprecedented opportunity to detect human diseases in their early stages and expand the effectiveness of intervention.

This is significant to each of us. Screening tests are front and center on the list of benefits included under the Clinton Health Security Act as well as other preventive services. Immunizations, pelvic examinations, mammograms, cholesterol screenings, Pap smears and prenatal care are all guaranteed with the Health Security Card.

The purported long-term impact of providing screening tests is the early detection of devastating human diseases and therefore a decrease in high-tech, expensive medical services. The political hope is that this will reduce our nation's overall health care expenditures.

Pap smears, cholesterol screenings and mammograms are being promoted as keys to our personal and national economic health. They will be accessible _ within the federally mandated regulatory boundaries _ to all Americans who seek them.

A brief discussion of these three tests will highlight their benefits and the major questions surrounding them. It will also help demonstrate an interesting point; while the move toward prevention is medically sound and very significant, screening tests may not be the answer to the financial woes of our health care system. The Pap Smear _ In 1941 Dr. Joseph Papanicolaou described the technique of sampling vaginal pool cells to screen for cervical cancer, the most common form of cancer for women today. This technique became known as the Pap smear and is one of the most effective screening tests today. The Pap smear has helped reduce the rate of cervical cancer in the past 40 years by over 70 percent.

Cervical cancer is a preventable disease with a long preinvasive curable stage. If diagnosed early, cervical cancer can be effectively treated.

The Pap smear is a painless and inexpensive test. Through microscopic examination of cells scraped from the uterine cervix, early detection of cancer is possible. The majority of invasive cervical cancers today occur in women who have not undergone regular screening.

So what is regular screening? While the benefits of the Pap smear are indisputable, there is no consensus on the ideal time interval between testings. The value of annual Pap smears for premenopausal women is widely embraced, yet this frequency may not significantly increase detection rates. Medicare coverage of Pap smears is restricted to every three years unless certain criteria for high risk exist.

The Working Group in Evaluation of Cervical Cancer Screening Programmes of the International Agency for Research on Cancer found that screening women ages 20-64 every three years would reduce the cumulative incidence of cervical cancer by 91 percent; annual screenings would reduce the incidence by 93 percent. …

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