All women can benefit from an annual visit that includes a general medical history and examination, infection screening, breast examination, and a pap smear. For most insurance plans, a well woman visit is covered with no deductible or co-pay.
Preventative care takes many forms. Women under 25 or who are not yet sexually active can benefit from a vaccine called Gardasil that protects from HPV, the virus that causes cervical cancer. Women over 40 years of age need an annual mammogram and rectal examination including a test for occult blood in the colon. They also should be tested periodically for thyroid problems, diabetes, and high cholesterol. Consideration of the contraceptive method or hormone status is included, as well as general health issues including smoking status, alcohol use, and domestic violence or abuse. All of these services are included in the well woman visit.
There is a great deal of controversy concerning the annual pap smear at different stages of life. It is generally agreed that women under the age of 21 do not benefit from a pap smear, since their risk of undetected cancer is virtually zero if they are not sexually active. Young women do however need an annual screening for sexually transmitted diseases that could threaten their lives or their future fertility. These tests can be performed on a urine sample if the young woman does not wish to have an internal examination.
Women who have had the Gardasil vaccine against cancer causing Human Papilloma Virus and have had several normal pap smears can safely space pap smears to every other or every third year. Dr. Holley recommends an annual pap smear to all women who have not had the vaccine, even though government agencies have said annual pap smears are not necessary.
If pap smears were 100% effective in detecting precancerous cells, every two to three year pap smears might be reasonable, but they are not 100% effective. The risk of cervical cancer is 3/1000 among women who get an annual screening pap smear. The risk increases to 6/1000 if pap smears are done every two years. It increases further to 8-9/1000 if paps are done at the government recommended interval of every three years. In Sweden, where women are only allowed one pap every three years, the incidence of cervical cancer has increased every year for the past 12 years. This risk is unacceptable in a nation with the resources this nation has.
Government agencies have said that women over the age of 65 do not need pap smears at all. These agencies say that cervical cancer occurs only in women who are not screened. They then decree that women over 65 should not be screened. This recommendation is unsound, irresponsible, and unscientific and Dr. Holley does not follow it. So far, as of 2013, Medicare pays for women over 65 to have a screening pap every other year.
The one area in which Dr. Holley agrees with the government agencies and their cost cutting measures is in the area of pap smears after a hysterectomy for benign indications. Vaginal cancer is exceedingly rare in women who have never had cancerous or precancerous cells in the cervix prior to hysterectomy. An annual visual examination is acceptable, with pap smears reserved for patients with evidence of infection, bleeding, or a visible lesion. But many patients have difficulty getting a doctor to even look inside their vagina.
Additional screenings may be indicated depending on your personal health history and family history. Colonoscopy, chest x-ray, EKG, urinalysis, and additional blood work may be indicated for those at risk for problems in those areas. Dr. Holley will work with you to determine the appropriate testing and interval that is best for you. However, if a problem is discussed, particularly if it is a new problem, a significant problem, one that requires additional testing or a prescription, that visit is no longer a well woman visit, but a diagnostic visit, which is subject to co-pays and deductibles. We are required by law to code and document your visit honestly and appropriately.