Birth Control Pills Recalled
Pfizer has recalled a total of 28 lots of Lo/Ovral and its generic equivalent because of a packaging error that may result in inadequate contraception. The affected lots of norgestrel and ethinyl estradiol tablets (Lo/Ovral 28 and Norgestrel 0.3 mg/Ethinyl Estradiol 0.03 mg) may include some blister packs with inexact counts of inert and active-ingredient tablets, and tablets that are out of sequence, a statement from Pfizer said. The packs contain 28 tablets, including 21 with active ingredient and 7 inert tablets, which provide contraception when dispensed in a correct dosing schedule. The packaging error may place the daily dosing regimen out of order and, as a result, may put patients at risk for unintended pregnancy, the statement said. Such an error does not pose an immediate health risk, Pfizer added, but patients using the product should switch to a nonhormonal form of birth control. A full list of affected lot numbers is available in the recall notice, and includes 14 lots of brand-name product and 14 lots of generic product. Patients with an affected product should consult a healthcare professional and return the product to a pharmacy. The contraceptives were manufactured and packaged by Pfizer and marketed and labeled by Akrimax Rx Products.

Canadian Panel Nixes Mammograms for Women in Their 40s
Women ages 40 to 49 do not need routine breast cancer screening with mammography, according to a Canadian preventive care task force. Breast cancer screening for women of average risk in that age group results in a "relatively small" mortality benefit, which may be countered by an increased risk of overdiagnosis and unnecessary treatment. In the final analysis, however, the decision to undergo screening mammography should remain with the individual patient and treating physician, who should thoroughly discuss the tradeoff between benefits and harms, as well as patient preferences, the guideline authors wrote.

"We have recommended a screening interval of every two to three years for women 50 to 74 years of age using available evidence from randomized, controlled trials," Marcello Tonelli, MD, of the University of Alberta in Edmonton, and co-authors from the Canadian Task Force on Preventive Care wrote in conclusion. "The concept of individualizing the interval for screening with mammography based on breast density or other risk factors is appealing but requires further study." "Finally, given the importance of patient preferences for appropriate decision-making, further studies are needed to determine the best way to communicate information about the potential benefits and harms of mammography." In an accompanying editorial, a Danish physician urged elimination of breast cancer screening altogether.

Citing evidence of overdiagnosis and unnecessary testing and treatment resulting from mammographic screening, Peter C. Gotzsche, MD, of the Nordic Cochrane Center in Copenhagen, wrote, "If screening had been a drug, it would have been withdrawn from the market." The Canadian guidelines add another log to the opinion fires that have flared off and on since the U.S. Preventive Services Task Force (USPSTF) made similar recommendations in 2009. Debate over the need for screening mammography in women ages 40 to 49 continued through 2010, with multiple individuals and organizations taking sides. The debate has shown no signs of losing steam. At various times during 2011, MedPage Today has reported studies showing that mammographic screening in women 40 to 49 offers a worthwhile mortality benefit and others that have found only a trivial benefit. Last summer, the American College of Obstetricians and Gynecologists came out in support of mammographic screening beginning at age 40. The Canadian task force found no evidence to support screening before age 50 for women at average risk. Members of the task force made the decision after updating and evaluating the systematic review the USPSTF performed before recommending age 50 for the start of routine mammographic screening. The analysis showed that 2,108 women ages 40 to 49 would have to be screened every two to three years to prevent one breast cancer death. Screening that younger age group would lead to 690 false-positive mammography results and 75 unnecessary breast biopsies, the task force members wrote. In contrast, the number needed to screen (NNS) dropped to 721 for women ages 50 to 69. Those women would incur 204 false-positives and 26 unnecessary biopsies.

Among women ages 70 to 74, mammography had an NNS of 451, false-positive results in 96 cases, and 11 unnecessary biopsies. The task force made no recommendation regarding mammographic screening in women 75 and older, citing a lack of data to guide decision making. Consistent with its U.S. counterpart, the Canadian task force recommended against routine use of MRI for breast cancer screening and against routine clinical breast examinations, and recommended that clinicians not advise women to perform breast self-examination on a routine basis. Authors of the guidelines emphasized that the recommendations apply only to women with an average risk of breast cancer. In the editorial, Gotzsche lauded the guidelines as "an important step in the right direction, away from the prevailing attitude that a women who does not undergo screening is irresponsible." He cited the following recent studies suggesting "that it may be most wise to avoid screening altogether, at any age":

• A Danish study showed that women ages 55 to 74 who had regular mammography had a 1% annual decrease in breast cancer mortality, as compared with a 2% decrease each year in an unscreened population (BMJ 2010; 340: c1241)
• A study covering much of Europe that showed a 37% decline in breast cancer mortality from 1989 to 2005 that began before many of the countries had organized screening programs (BMJ 2010; 340: c4480, c3620)
• An analysis of six European countries that introduced breast cancer screening 10 to 15 years apart and showed no relationship between the start of screening and breast cancer mortality. In fact, all of the countries had similar breast cancer mortality (BMJ 2011; 343: d4411)

More Blood Clots Seen With Newer Birth Control Pills
Newer forms of progesterone in combination hormonal contraceptives carry higher venous thromboembolic (VTE) risk than older forms, a population-based study affirmed. Women on the pill with the older, levonorgestrel version were at three times the risk of VTE as those not on any hormonal contraception, said Ojvind Lidegaard, MD, of Rigshospitalet at the University of Copenhagen, Denmark, and colleagues. But oral contraceptives containing desogestrel, gestodene, drospirenone, or cyproterone boosted the risk six to seven times over that of non-users.

The number needed to treat with levonorgestrel instead of the other progesterone forms to prevent one VTE in one year was about 2,000. These findings from national registry data in Denmark from 2001 through 2009 -- after the launch of the newest synthetic progesterone, drospirenone, in that country -- largely matched results of their earlier analysis from 1995 through 2005. Other studies over the decades also have found almost universally elevated VTE risk with hormonal contraception, with the estrogen and progestogen (synthetic progesterone) components both appearing to play a role. But the absolute risks remain small, at about 10 in 10,000, for current users of even the newer pills, noted Philip C. Hannaford, MD, of the University of Aberdeen, Scotland, in an accompanying editorial. The risks appear real and may lead many clinicians to prescribe a combined oral contraceptive with levonorgestrel whenever possible, he wrote. "It is crucial, however, not to exaggerate the risk -- oral contraceptives are remarkably safe and may confer important long term benefits in relation to cancer and mortality," Hannaford cautioned. The updated analysis included more than 1.2 million non-pregnant 15- to 49-year-old women in Denmark without a history of thrombotic disease. Data came from national vital status, inpatient, cause of death, and pharmacy registries. From 2001 to 2009, 4,307 first-ever VTEs occurred in this cohort. Most were deep vein thrombosis only (63.6%) or pulmonary embolism with or without deep vein thrombosis (26.2%). Compared with women not taking hormonal contraception, confirmed venous thromboembolism was elevated for users of oral contraceptives containing 30 to 40 μg ethinylestradiol plus the following:

• Levonorgestrel, with a relative risk of 2.9 (95% confidence interval 2.2 to 3.8)
• Desogestrel, with a relative risk of 6.6 (95% CI 5.6 to 7.8)
• Gestodene, with a relative risk of 6.2 (95% CI 5.6 to 7.0)
• Drospirenone, with a relative risk of 6.4 (95% CI 5.4 to 7.5)

With levonorgestrel-containing pills as the comparator, rate ratios of confirmed venous thromboembolism adjusted for length of use were:

• 2.2 with desogestrel (95% CI 1.7 to 3.0)
• 2.1 with gestodene (95% CI 1.6 to 2.8)
• 2.1 with drospirenone (95% CI 1.6 to 2.8)

Progestogen-only pills (low-dose norethisterone or desogestrel alone) or hormone-releasing intrauterine devices didn't have any impact on VTE risk compared with non-users. Lower estrogen doses were associated with modestly lower VTE risk for oral contraceptives with norethisterone, levonorgestrel, desogestrel, or gestodene but not with drospirenone, the investigators reported. Phasic combined oral contraceptives with levonorgestrel slightly, but not significantly, increased VTE risk compared with levonorgestrel plus 30-μg of ethinylestradiol (relative risk 2.28 versus 2.19), which the researchers suggested "could be due to the slightly higher total dose of estrogen in the former group." The results appeared stable through the study period. The researchers noted that their results wouldn't have been affected by recall bias or "left censoring," but lack of data on body mass index and family disposition may have contributed to some residual confounding.

Pap Tests Needed Only Every 3 Years, Task Force Says
Healthy women younger than 65 need a Pap test only every three years, the U.S. Preventive Services Task Force said. The recommendation is meant to address the concern that many women were being tested too frequently, which could lead to overtreatment of low-grade lesions that might not prove to be cancerous. The task force "found no direct evidence that annual screening achieves better outcomes than screening every three years," wrote the authors of the recommendation. "Modeling studies suggest little added benefit of more frequent screening for most women." In addition, too frequent screening can result in increases in cost and in women having needless anxiety because of false positive results. The task force also recommended that screening begin for all women at age 21 regardless of their sexual activity levels, which reflected a change from the task force's 2003 recommendation stating that screening should begin at age 21 or within three years of the initiation of sexual activity. "Although there is little value in screening women who have never been sexually active, many U.S. organizations recommend routine screening by age 18 or 21 for all women, based on the generally high prevalence of sexual activity by that age in the U.S. and concerns that clinicians may not always obtain accurate sexual histories," the task force noted. It has become clear that invasive cervical cancer is rare among women younger than 20, as the authors explained in a recent article in the Annals of Internal Medicine. As for which screening methodology to use, the recommendations stated that newer FDA-approved technologies, such as liquid-based cytology, "may have improved sensitivity over conventional Pap smear screening, but at a considerably higher cost and possibly with lower specificity." In the absence of studies that address cervical cancer outcomes, the available data on the accuracy of new technologies "were insufficient to determine whether they are more effective than conventional cervical cytology for preventing invasive cervical cancer," the task force noted. The task force also reported that little evidence exists supporting continuation of screening for women older than 65 if their recent Pap smears have been normal and they are not at risk for cervical cancer. Similarly, screening is unnecessary in women who have had a hysterectomy for benign disease. They cautioned that "clinicians should confirm that a total hysterectomy was performed (through surgical records or inspecting for absence of a cervix); screening may be appropriate when the indications for hysterectomy are uncertain." The recommendations also emphasize that more efforts should be made to identify and reach out to women who have not undergone screening.

Oral Contraceptives Pulled Over Packaging Error
Generic drugmaker Qualitest Pharmaceuticals pulled several lots of a number of oral contraceptives due to a packaging error that obscured the products' lot number and expiration date. Affected products contained a blister that had been rotated 180 degrees on the card it was packed on, thereby reversing the weekly tablet orientation and hiding the expiration date, a company statement issued Thursday said. Qualitest's statement added that the error may cause the contraceptive regimen to be incorrect and may result in unintended pregnancy. The recalled products include:

• Cyclafem 7/7/7
• Cyclafem 1/35
• Emoquette
• Gildess FE 1.5/30
• Gildess FE 1/20
• Orsythia
• Previfem
• Tri-Previfem

A full list of affected product lots is available online HERE. Patients with affected product should use non-hormonal contraception and consult a healthcare professional about the issue. The statement noted patients with affected product are not at immediate health risk beyond potential lack of hormonal contraception.

FDA Approves Roche's HPV Test For Identifying Women At Highest Risk For Cervical Cancer
The FDA has approved the cobas HPV (Human Papillomavirus) Test which identifies women at highest risk for developing cervical cancer. This test will help physicians make early, more accurate decisions about patient care, which may prevent many women from developing this deadly disease.The cobas HPV Test is the only FDA-approved cervical cancer screening test that allows HPV 16 and 18 genotyping concurrently with high-risk HPV testing. It individually identifies genotypes 16 and 18, the two highest-risk HPV genotypes responsible for more than 70 percent of cervical cancer cases, while simultaneously detecting 12 other high risk HPV genotypes. The approval was based on data from the ATHENA study involving more than 47,000 women in the U.S. Results demonstrated that 1 in 10 women, age 30 and older, who tested positive for HPV 16 and/or 18 by the cobas HPV Test actually had cervical pre-cancer even though they showed normal results with the Pap test."The FDA approval of the cobas HPV Test demonstrates the value of simultaneous HPV 16 and 18 genotyping in cervical cancer screening," said Daniel O'Day, Chief Operating Officer of Roche Diagnostics. "We look forward to working with laboratories and physicians to introduce the cobas HPV Test into routine cervical cancer screening."More than 55 million Pap cytology ("Pap smear") tests are performed in the U.S. annually. Current guidelines for screening allow for either cytology or cytology plus HPV testing to determine the risk of cervical cancer. However, HPV testing, and 16 and 18 genotyping in particular, identifies more women at risk earlier than Pap cytology testing alone."Screening for high-risk HPV genotypes provides important additive information to Pap testing, and screening for the two highest risk types, HPV 16 and 18, can provide predictive information about a woman's risk for having cervical pre-cancer or cancer," said Mark H. Stoler, MD, Professor and Associate Director of Surgical Pathology and Cytopathology, at the University of Virginia Health System. "The cobas HPV Test provides physicians with a validated tool that helps them make early and more informed decisions regarding patient care."About the cobas HPV Test and cobas 4800 SystemThe cobas HPV Test is a qualitative in-vitro test for the detection of Human Papillomavirus in patient specimens. The test utilizes amplification of target DNA by the Polymerase Chain Reaction (PCR) and nucleic acid hybridization for the detection of 14 high-risk (HR) HPV types in a single analysis. The test specifically identifies types HPV 16 and HPV 18 while concurrently detecting the other high risk types (31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68). It is now available in the U.S. and all countries accepting a CE mark.The cobas 4800 System is designed to deliver new standards in laboratory testing efficiency and medically relevant diagnostic information. The system offers true walk-away automation and can run up to 282 tests in less than 12 hours, providing rapid analysis of screening tests for HPV infections meeting the needs of the majority of clinical labs.

Women Living, Working in Smoke-Free Environments Have Lower Breast Cancer Rates
Women in smoke-free homes and workplaces are less likely to develop or die from breast cancer, according to a study in the journal Tobacco Control. Researchers compared rates of non-smoking homes and workplaces with state-specific rates of breast cancer incidence and death and found that states with higher numbers of smoke-free homes and workplaces had significantly fewer breast cancer deaths, particularly among younger premenopausal women. The study authors estimated that about 20% of the change in breast-cancer death rates is due to changes in smoke-free home and workplace policies.

FDA Approves Generic Birth Control Pill
The FDA has approved a new generic oral contraceptive called Emoquette, a daily tablet that combines the hormonal compounds desogestrel and ethinyl estradiol to prevent pregnancy in women. Made by Qualitest Pharmaceuticals, Emoquette is a generic of Ortho-McNeil Pharmaceutical's oral contraceptive Ortho-Cept and Organon USA's Desogen. Because Emoquette is a generic drug, it wasn't subject to the same type of approval process as is a brand-name oral contraceptive. It was approved through the FDA's abbreviated new drug application process, which requires only that the drugmaker prove it is comparable to an innovator drug in dosage, route of administration, quality, performance, and intended use. Emoquette is the therapeutic equivalent of four other birth control pills currently on the market.

FDA Approves Second Oral Contraceptive With Folate
The FDA has approved a second oral contraceptive fortified with folate - Safyral - containing drospirenone, ethinyl estradiol, and levomefolate calcium. The agency's backing of Safyral follows approval of the similarly-formulated Beyaz in September. Both drugs are manufactured by Bayer HealthCare Pharmaceuticals.

Number of Females Suffering Knee Injuries Reaching "Astronomical Levels"
The number of overuse injuries among females has reached astronomical levels. In fact, more than 20,000 high school girls suffer a serious sports-related knee injury each year in the"US, with girls being seven times more likely to injure their anterior cruciate ligament (ACL) than boys in similar sports. Although the reason for the increased susceptibility is not clear, many orthopedic surgeons seem to agree the underlying reasons are at least five-fold: 'year-round participation without time for rest' and repair; the lessening of the gap between young men and women participating in athletic sports; girls tending to have less neuromuscular control of knee motion than boys while performing certain athletic tasks; the dramatic increase in the speed, power and intensity with which female athletes are playing, and the numerous anatomical and hormonal differences between men and women.

FDA Approves New Oral Contraceptive
Warner Chilcott announced that the FDA has approved LO LOESTRIN™ FE (norethindrone acetate and ethinyl estradiol tablets, ethinyl estradiol tablets and ferrous fumarate tablets) for the prevention of pregnancy. LO LOESTRIN FE is a novel oral contraceptive that offers women the lowest dosage of estrogen (10 mcg) of any oral contraceptive currently available in the U.S. market. The company anticipates the commercial launch of LO LOESTRIN FE in early 2011. About LO LOESTRIN FELO LOESTRIN FE is indicated for the prevention of pregnancy in women who elect to use oral contraceptives as a method of contraception.

Company Halts 'Female Viagra' Development
Pharmaceutical company Boehringer Ingelheim announced it is halting development of flibanserin (Girosa), a pill to treat female hypoactive sexual-desire disorder (HSDD). The decision to stop development of the drug dubbed "female Viagra" or "pink Viagra" follows an June meeting of an FDA advisory committee during which the panel voted 9 to 2 that flibanserin doesn't seem to work any better at increasing female sexual desire than placebo. The committee also voted 11 to 0 that the company failed to demonstrate that the benefits of flibanserin outweigh the risks, which include fainting, accidental injury, insomnia, and fatigue. Boehringer Ingelheim said in a statement that it will complete its two most advanced studies in order to "add knowledge for the scientific community and women suffering with HSDD" but it will discontinue the rest of its flibanserin development program. "The need for a better understanding of HSDD and its possible treatment continues, and we hope the scientific and medical communities will build on the knowledge that Boehringer Ingelheim's research has provided to find solutions for women who suffer with this disorder," said Michael Sand, director of clinical research at Boehringer Ingelheim. While the FDA's advisory committee felt flibanserin isn't ready for prime time, it agreed that HSDD -- the existence of which has itself been called into question -- is a legitimate medical disorder that deserves an FDA-approved treatment. Boehringer Ingelheim originally submitted to the FDA two prospective, randomized, double-blind North American trials that compared two doses of flibanserin with placebo in premenopausal women with HSDD for 28 weeks. In both trials, the groups that used flibanserin showed a significantly greater number of satisfactory sexual events than the placebo groups. About 30% to 40% of women in the flibanserin group reported a greater number of satisfactory sexual events, compared with 15% to 30% in the placebo arm. But those differences, although statistically significant, are not big enough to be "compelling," wrote FDA staff reviewers in briefing documents released in advance of the advisory committee meeting. Both studies failed to demonstrate a statistically significant improvement on the coprimary endpoint of sexual desire, as measured by e-diaries. In addition, flibanserin appeared linked with side effects, including dizziness and nausea. About 15% of women on the drug stopped taking it because of a side effect, compared with 7% of women in the placebo group. Although it has been referred to as the "female Viagra," the drug works through an entirely different mechanism than the selective vasodilators now used for male erectile dysfunction. Flibanserin is a serotonin 2A receptor antagonist and an agonist of the serotonin 1A and dopamine D4 receptors. The drug was originally developed as an antidepressant. Although animal experiments had suggested it might have a more rapid effect than serotonin reuptake inhibitors, it failed to substantially reduce depression symptoms in men and women in a clinical trial. However, the potential to increase female sexual desire became apparent during the study. Reportedly, trial participants were reluctant to return unused pills when the study was over. The company said it remains convinced of the "positive benefit-risk ratio of flibanserin for women suffering with HSDD," but that it would begin to reallocate its money elsewhere, including stroke, diabetes, and cancer research.

Folate-Fortified Birth Control Pill Approved
The FDA has approved an oral contraceptive containing folate to help prevent birth defects after women go off the pill. Called Beyaz, the product contains the same estrogen-progestin combination as the contraceptive pill Yaz -- plus 0.451 mg of levomefolate calcium. Levomefolate calcium is a metabolite of folic acid. Supplementation with this B-vitamin is recommended for all women of childbearing age because low folate levels are associated with neural tube defects such as spina bifida, the FDA said in a release announcing approval of Beyaz. The Yaz product is approved for preventing pregnancy and treating symptoms of premenstrual dysphoric disorder or moderate acne in women wanting to use an oral contraceptive. Those approvals also apply to Beyaz, along with the new indication of raising folate levels in oral contraceptive users for preventing neural tube defects in offspring conceived while using the product or shortly after discontinuing it, according to the FDA press release. The product's manufacturer, Bayer HealthCare Pharmaceuticals, pointed out that both products are 99% effective in preventing pregnancy when used as directed. As with other oral contraceptives based on hormone combinations, Beyaz should be avoided by women older than 35 who smoke because of increased risk of cardiovascular events. The FDA said clinical trials with Beyaz indicated the same overall safety profile seen with Yaz.

New Morning After Pill Approved By FDA
A new morning after pill, also known as an emergency contraception pill, called Ella (ulipristal acetate) has been approved in tablet form by the US Food and Drug Administration (FDA). It has been approved as a prescription-only-product, and prevents pregnancy if taken within five days after unprotected sexual intercourse or contraceptive failure. As a progesterone agonist/antagonist, Ella's main likely effect is to inhibit or delay ovulation. It is known as EllaOne in Europe, where it has been on the market since May 2009, the FDA informs. Possible side effects, reported from the clinical trials, include nausea, abdominal pain, headache, dysmenorrhea (menstrual cramps, period pains), and dizziness - similar to those found in other FDA-approved levonorgestrel emergency contraceptives.The product label says that women with known or suspected pregnancy, as well as breastfeeding mothers should not use Ella.

Female Study Participants Prefer Testing For Sexually Transmitted Infections At Home
By a large margin, women preferred to test for sexually transmitted infections at home, rather than at a clinic, Washington University researchers found after interviewing 462 women enrolled in the Contraceptive Choice Project. And those who chose a home test were twice as likely to complete the test as those who said they'd prefer to go to a free clinic or their healthcare provider. Even so, more than 40% of the women in the study did not follow through on annual screening for Chlamydia trachomatis and Neisseria gonorrhoeae, a trend that illustrates the difficulty of getting young women to adhere to certain recommendations.

Women May Be More Likely Than Men to Have Exclusively Noncalcified Coronary Plaques
Women are more likely than men to have exclusively noncalcified coronary plaques and are less likely than men to have calcified or mixed-composition plaques, which may in part explain why women are at lower risk of cardiac events, according to a study published in the American Journal of Cardiology. The research demonstrates that women have a lower calcified and mixed plaque burden, but no differences in noncalcified plaque compared with men across all age groups. Additionally, despite the similar overall noncalcified plaque burden, women had a greater proportion of noncalcified plaques to total plaques.

Breast Imaging Experts Recommend ammograms at Age 40
According to new joint guidelines from the American College of Radiology and the Society of Breast Imaging, experts are now saying that women who run an "average" risk of breast cancer should begin screening for the disease at age 40, while those who are deemed to be at "high risk" for breast cancer should begin screening at age 30. The guidelines run contrary to controversial guidedance in November from the U.S. Preventive Services Task Force, which recommended against routine mammograms for women in their 40s.  "The significant decrease in breast cancer mortality, which amounts to nearly 30 percent since 1990, is a major medical success and is due largely to earlier detection of breast cancer through mammography screening," says Carol H. Lee, MD, of Memorial Sloan-Kettering Cancer Center's radiology department."For women with the highest risk of developing breast cancer, screening technologies in addition to mammography have been adopted," said Lee, who co-authored the guidelines.

FDA Okays Low-Dose Local Estrogen
The FDA has approved a low-dose local estrogen therapy, a 10 mcg formulation of the estradiol vaginal tablet Vagifem, for atrophic vaginitis. The therapy was first approved in a 25 mcg dose in 1999. In studies, the most common side effects among patients using the estradiol tablets were vulvovaginal mycotic infection, back pain, and vulvovaginal pruritus. Side effects associated with estrogen treatment in general include increased risk of uteral cancer, including vaginal bleeding associated with cancer, stroke, blood clot, headache, breast pain, irregular vaginal bleeding or spotting, stomach and abdominal cramps, bloating, nausea, hair loss, fluid retention, and yeast infection. Patients taking estrogens with progestins may face an increased risk of myocardial infarction and breast cancer. Patients 65 and older may be at increased risk of developing dementia while on estrogens with or without progestins.

Senate Affirms Screening Mammography for Women in Their 40s
On Thursday, Senators voted on an amendment that would require insurers to cover mammograms for women ages 40-49, essentially deciding to disregard the U.S. Preventive Services Task Force’s recent recommendation that women under 50 shouldn't undergo routine mammograms. This deals a significant blow to the power and credibility of the USPSTF. The amendment would increase coverage and eliminate copays for more women's preventive services. The USPSTF recommendations on any given procedure are important because the healthcare reform bill that was passed by the House and the bill being considered by the Senate would require insurance companies to cover all medical services that receive a grade of "A" or "B" from the USPSTF. In its recent recommendations, the task force downgraded mammography in women under 50 to a "C" grade, which means there is limited evidence to support its use. That would mean that insurance plans wouldn't be required to cover screening mammography for those women, unless the secretary of Health and Human Services (HHS) used her discretionary power to require plans to cover services with lower grades.

New Guidelines for Pap Smears
The American College of Obstetricians and Gynecologists says that women in their 20s can have a Pap smear every two years instead of annually. The recommendations are based on scientific evidence that suggests more frequent testing leads to overtreatment, which can harm a young woman's chances of carrying a child full term. Dr. Thomas Herzog of Columbia University in New York, who is chairman of an ACOG subcommittee on gynecologic cancers stated that "Overtreatment of minor abnormal pap tests in young women and adolescents can lead to consequences such as preterm labor in some cases." The guidelines also say: Routine Paps should start at age 21. Previously, ACOG had urged a first Pap either within three years of first sexual intercourse or at age 21. Women 30 and older should wait three years between Paps once they've had three consecutive clear tests. Other national guidelines have long recommended the three-year interval; ACOG had previously backed a two- to three-year wait. Women with HIV, other immune-weakening conditions or previous cervical abnormalities may need more frequent screening.