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Pap Smears, Guidelines, & “Churning”

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Skeptical Scalpel

Skeptical Scalpel is a recently retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last two years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog averages over 900 page views per day, and he has over 5400 followers on Twitter.

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Skeptical Scalpel (click to view)

Skeptical Scalpel

Skeptical Scalpel is a recently retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last two years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog averages over 900 page views per day, and he has over 5400 followers on Twitter.

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According to a CDC report, 60% of women who have undergone a total hysterectomy continue to have Pap smears done. Cervical cancer is not going to occur when the cervix is in a jar in the pathology department.

A friend called me to say that his wife had just received a rather concerning message after a visit to her gynecologist. They had been away and returned to find this registered letter.

Dear Patient,

We have previously contacted you or attempted to contact you regarding follow-up of your abnormal test results. As we have not heard from you, we are writing to urge you to seek medical attention if you have not already done so.

It is very important that you contact us at your earliest convenience. If you have any questions or would like an appointment, please call between the hours of 8:00 AM through 5:00 PM.

Very truly yours,

They were not too upset because many years ago she had a false positive Pap smear (a test done to detect cancer of the cervix) and received a similar letter. On that occasion, the repeat test was normal.

They made the appointment. During a 3-minute visit with the gynecologist, they were informed that the Pap smear was normal. My friend asked the doctor why the letter was worded in such an ominous way. He was told that was their standard letter and that the doctor “would look into it.”

My friend wondered why the normal result couldn’t have been been simply told to them by phone. I replied that the purpose of the registered letter was to generate an office visit.

During the phone call, my friend told me that his wife was having Pap smears every 6 months. He asked if that was routine. I said I had never heard of anyone doing it that often, especially with no history of abnormal Pap smears in the past.

Did I mention that his wife was 71 years old?

All guidelines say that women over 65 without risk factors don’t need a Pap smear at all, so every 6 months seems a bit excessive.

Regarding the office visit and the too frequent Pap smears, the stockbrokers have a word for this sort of thing. It’s called “churning.” To boost his income from commissions, a broker will churn by unnecessarily buying and selling a lot of stocks for his clients.

It’s not unique to this gynecologist. According to an article about a CDC report, 60% of women who have undergone a total hysterectomy, a procedure that involves removal of the cervix, continue to have Pap smears done. In case you aren’t familiar with this topic, cervical cancer is not going to occur when the cervix is in a jar in the pathology department.

And even more amazing is that the article says in 2010, “About two-thirds of women 65 and older who hadn’t had a hysterectomy reported having a recent Pap test. That’s down from nearly three-quarters in 2000, but it’s not a huge improvement.”

“It’s not a huge improvement”? That’s quite an understatement.

It’s Medicare, so we’re all paying for it.

Things like this make me really worry about the future healthcare of my children and grandchildren.

Skeptical Scalpel is a recently retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last two years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog averages over 900 page views per day, and he has over 5400 followers on Twitter.

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