June 2007 · Vol. 19, No. 06It’s time to re-tool the annual exam: Here’s how
Capitalize on patients’ habit of visiting your office once a year to implement appropriate services
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Fast Track
Create templates for the annual well-woman visit that are age-specific and that include check boxes for the history, physical, testing, and counseling
I tell patients not to ignore an obvious change in the breast—but also that they should not feel it’s necessary to perform a standardized breast exam monthly
Flexible sigmoidoscopy may be less useful in women because polyps and cancers are more likely to present on the right (ascending) side of the colon
Initiate screening for osteoporosis for most women with a test of bone mineral density at 65 years
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Barbara
S.
Levy,
MDMedical Director, Women’s Health Center, Franciscan Health System, Federal Way, Wash. Dr. Levy is a member of the OBG Management Board of Editors and serves on ACOG’s Coding and Nomenclature Committee. She is also ACOG’s representative to the AMA’s RBRVS (resource-based relative value system) Update Committee.
Recent advances in the understanding and detection of cervical cancer have resulted in a recommendation to increase the screening interval with a Pap smear from annually to every 2 or 3 years for low-risk patients. We know that cervical cancer requires the persistence of high-risk human papillomavirus (HPV) types to develop, and this knowledge has provided high-level evidence that annual cervical cancer screening is not beneficial for most women.
Where does this shift in the surveillance strategy for cervical cancer leave us? Implementing new screening intervals gives us a wonderful opportunity to reevaluate the annual exam, and to educate ourselves and patients about interventions that make an impact on health.
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