Women are notorious for putting their own health behind the well-being of their families, their work and other pressing demands. For many women I know, booking an annual checkup for themselves is the one big concession they make. As a family doctor, I see patients who have gone to significant lengths to free up a few hours just so they can get up to date on important immunizations, screening tests and the latest recommendations for disease prevention. Small wonder they find it confusing when I tell them that yearly Pap tests and mammograms are no longer recommended for most women — and that when it comes to their health, this is actually a good thing.
As medical knowledge advances, we see that more is not always better when it comes to tests and procedures. Whether it’s prostate testing for men, over-prescribing medications to seniors or inappropriate CT scans, physicians in many areas of medicine are trying to start a conversation with patients about reducing the harm of too much medical intervention.
The purpose of Pap tests, for example, is to identify signs of cancer, so women can be diagnosed and treated as early as possible, hopefully saving lives as a result. But cervical cancer is very slow-growing, and frequent screening increases the risk of finding mild abnormalities that your body would have healed by itself over time between less-frequent exams. The risk is that once these abnormal cells are discovered, it can lead to further testing, unnecessary anxiety and more invasive procedures, such as cervical biopsies.
It’s better for women — and it takes pressure off the health care system — to screen often enough to identify cervical cancer when it’s still 100 percent treatable, but not so often as to pick up fleeting abnormalities that will disappear on their own. The best way to do that is to screen not every year, but every three years.
Likewise, the shift in guidelines for breast cancer screening reflects our growing understanding that screening saves the most lives — and the benefits most outweigh the potential for harm — for women between 50 and 74. For those in their 40s, breast cancer risk is much lower, and they are at a much higher risk of a false positive result (an abnormal finding that turns out not to be cancer but can lead to invasive procedures, such as biopsies and even surgery).
Then there’s the fact that mammography involves radiation, although at a very low dose. The small exposure shouldn’t alarm women who need mammograms, but it’s still better to minimize radiation exposure as much as possible.
So when I tell the woman in my office that she doesn’t need a mammogram this year, it’s not about cost cuts or lowered standards of care. It’s about an updated, evidence-based approach to preventive health: doing what you need and avoiding what you don’t. That’s the best thing you can do to prioritize your health — and you deserve nothing less.
Testing: when should you go?
75 or older
70 or older
To learn more, visit Choosing Wisely Canada.
Dr. Danielle Martin is a family physician and vice-president, medical affairs and health system solutions, at Women’s College Hospital in Toronto.