Oy vey, did the newsreel trip the light fantastic over women's healthcare last week, or what? Separated by a matter of days were two important recommendations pertaining to feminine health, both of which are dramatic shifts from that which American women know and expect and to which we've been trained to adhere.
On Friday, the American College of Obstetricians and Gynecologists (ACOG) announced a recommendation that women not receive their first pap smear until age 21. The new guidelines are aimed primarily at reducing an “over-treatment” of HPV, a common sexually transmitted disease that can cause cervical cancer. The ACOG rationalized not testing young women for HPV today because of supposed and potential harm the treatment of the virus might bring to babies they'll have someday.
According to the press release on the ACOG website, “Moving the baseline cervical screening to age 21 is a conservative approach to avoid unnecessary treatment of adolescents which can have economic, emotional, and future childbearing implications.” While the immune system takes care of an HPV infection within one to two years for most adolescents, this no-pap-policy seems sort of like the what-you-don't-know-won't-hurt-you of sexually transmitted diseases. Oh, and that fetuses come first, even when they're decades away from existing.
Two days before the ACOG announcement, the U.S. Preventive Services Task Force (USPSTF), an independent, government-appointed panel, upped the age (from 40 to 50) when they think American women should begin getting regular mammograms. This panel, with at least three insurance-industry specialists and not one oncologist or breast-cancer expert, and whose members have been as close to touching my breasts as my primary-care physician, warned against the harms of mammography, dangers that include discomfort and anxiety.
Hackles went up all across the country with this news: The collective shudder nearly caused my car to veer off a cliff. Or the erratic driving could have been the result of my general stupor upon hearing the next part of this “expert” panel's recommendation: The USPSTF is recommending “against clinicians teaching women how to perform breast self-examination.”
(Insert pounding of fists on steering wheel here.)
That the new ACOG guidelines followed so closely the recommendation from the USPSTF is an interesting coincidence. Dr. Cheryl B. Iglesia of ACOG called it “an unfortunate perfect storm.” Because the ACOG is an organization of actual doctors, and not a panel of lobbyists, and because it's basing its (also hair-raising) decision on actual science, I'm inclined to believe Iglesia was being sincere.
I do not, however, extend the same benefit of a doubt to the USPSTF. It's likely they knew the ACOG was publishing its update in the December issue of The Journal of Obstetrics and Gynecology and, in a politically calculated move, released their controversial recommendations first. Certainly, it would explain their baffling choice not to inform the National Institutes of Health and, therefore, the president, who, to the lip-smacking joy of the anti-health-reform crowd, was caught off-guard.
But more than any of this political raw hamburger being gobbled up by GOP operatives—town criers who act as if they actually give a fly's wing-beat about anyone's health care, let alone a woman's—is what these recommendations say about contemporary attitudes toward women and our ability to make choices about our bodies and our health.
Since when have doctors ever advocated not diagnosing an STD? Would it not be better for sexually active women to get pap exams and know their test results? Wouldn't it make more sense for healthcare professionals to change the way they approach the treatment of HPV and use the knowledge gained from testing to help their infected patients be aware of spreading the disease?
And why shouldn't women have a clear baseline image of their breasts at age 40? Why shouldn't we, at the very least, have the choice to decide whether the risk of exposure to small amounts of radiation inherent in a mammogram is one we are willing to take? Barring that, why shouldn't all women be taught what their normal breast tissue feels like? It's not like it's costly or complicated: I learned how to do it from the back of a flier I got at Planned Parenthood during college.
If we know what our normal breast tissue feels like, we will know what abnormal breast tissue feels like. Certainly, I knew abnormal when I felt it, and I can count three friends off the top of my head whose lives have been saved because they knew, when their doctors didn't have time to.
While I'm sure there is more to each of these recommendations than what's being revealed in the current news cycle, none of them sits well with me. Taken all at once, it feels like there is one very clear message for women and it goes something like this:
There, there, little girls, you can't handle the truth and, really, why should you have to? Why should you—sweet, gentle petunia—be burdened with a silly little thing like information? Empowerment is so overrated. And too many choices is, well—it's just confusing! You go back in there to the kitchen and make your big strong man a nice dinner and don't forget to represent all the food groups. Then breastfeed your babies with modesty, preferably not in public, thank you. You love those babies, cuddle them and then have some more. And don't you worry your pretty head about your breasts or that thing down there between your legs.
But perhaps I'm just being a silly, overly emotional, dramatic, temperamental girl who needs to smile demurely, speak only when spoken to and not concern myself with what's happening inside my body.
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