Prevention Tip of the Month
Cervical Cancer
How long do I need to keep getting Pap and pelvic exams?
Pap tests (short for Papanicolaou – the name of the doctor who invented them) are a procedure where cells are swabbed from the neck or cervix of the uterus. Then the cells are examined under a microscope (cytology) to determine if they look normal or if they appear to have any changes that would suggest cancer. It has been a standard disease prevention technique over the past 30 or 40 years. It is strongly recommended for women who are sexually active and have a cervix. Why, you may wonder, does it matter if you are sexually active? Because over the last few years it has become clear that cervical cancer is a sexually transmitted disease cause by the Human Papilloma Virus (HPV for short). It may take years and sometimes decades to create the changes that lead to cancer. As many of you know, the cells are obtained by what can be a fairly uncomfortable process of being on your back, in stirrups, with a vaginal speculum in place that allows the doctor to swab the cervix. In some cases it can cause a small amount of bleeding if the tissue is thin and fragile as it tends to be on older women. Recommendations for preventive procedures come from several sources including the United States Preventive Services Task Force (USPST). Here’s what the USPST has to say:
· It recommends against routinely screening women older than 65 if they have had adequate recent screening with normal Pap smears and are not otherwise at high risk for the disease. The “yield” of screening (true positive findings) declines steadily through middle age. The American Cancer Society (ACS) recommends stopping screening at age 70. Most cases of cervical cancer in the United States occur in women who have never been screened, have not been screened within the past 5 years or who have not had adequate follow up after an abnormal result. Most organizations recommend that older women who do not have a track record of negative tests undergo Pap screening yearly until 2 or 3 negative results are obtained.
· It recommends against routine Pap smear screening in women who have had a total hysterectomy for benign disease such as uterine fibroids or endometrial (the lining of the uterus) problems. Women who have had a history of hysterectomy for cancer need medical follow up as determined by their physician.
· There are some new screening procedures but there is not sufficient evidence at this point to recommend their use over the standard Pap test.
· There is not sufficient evidence to recommend HPV testing as a primary screening tool.
A routine pelvic exam where the doctor checks the size and position of your uterus and ovaries is a slightly different matter. At present, cancer of the body of the uterus (the part above the cervix) is usually picked up on pelvic exam. Sometimes women have symptoms and sometimes they don’t. Other pelvic abnormalities may also be detected such as enlarged ovaries or masses and the doctor can examine the external and vaginal tissues for any problems. So, depending on your individual situation, you may want to continue pelvic exams indefinitely.
