June 1, 2012

Do I need an annual exam/Pap smear?

The American Cancer Society has released new guidelines. I think they are confusing to clinicians as wells as for most women. First of all, Pap smear screening should begin at age 21. Does this mean women don’t need an exam until they are 21? No. It means that cervical cancer develops slowly over 7-20 years so a pap smear will not show anything until that time. Most cervical cancer is caused by the Human Papillomavirus (HPV). It is a sexually transmitted infection. There is now a vaccination for HPV. Most women who are exposed to HPV will not develop cervical cancer, but a percentage will develop precancerous changes or invasive cancer. Because the interval between HPV infection and development of cervical cancer may take years, it is unlikely that a healthy woman with a previously normal Pap smear will develop a cancer between screenings. This is also why we don’t screen for HPV before age 30. Most younger women will clear the infection and never develop cervical cancer. However, if a woman develops persistent irregular vaginal bleeding, especially after sexual intercourse, or unexplained vaginal discharge or pelvic pain between gynecology visits, she should consult with her physician sooner, as these may be signs of a cervical abnormality or female cancer.
 
If a girl is sexually active, or thinking of becoming sexually active, she should be seen for birth control counseling and to increase her awareness of preventing sexually transmitted infections (STIs). If she is sexually active, she should have periodic screening for STIs and to make sure she is using her birth control properly.
 
Pap smears are recommended every 3 years for women 21-29 years of age, if all Pap smears have been normal. Again, this is only the test for cervical cancer. This does not mean that she would not benefit from seeing the gynecologist every year for blood pressure, birth control, STI detection and a discussion on nutrition and exercise to prevent cardiovascular disease and for healthy pregnancies.
 
Pap smear technology is much better now than a decade ago. Therefore, it is much more sensitive in its ability to detect cervical abnormalities. Addition of the HPV co-test to the Pap smear has further increased the sensitivity of cervical cancer screening. So with better, more sensitive screening tests, it is safe for healthy women to undergo fewer tests overall without compromising their health.
 
Healthy women 30 to 65 need a Pap smear only once every 3 to 5 years, if combined with a test for human papillomavirus, or HPV. There are still questions about the age to stop doing Pap smears. If a woman has been in a monogamous relationship for over 20 years, she is probably safe to stop. However, with today’s divorce rate, many women are having new relationships into their 70’s and over. Each woman must be honest with her health care provider so she can be properly screened.
 
As for annual exams, we do much more than a Pap smear. In my office, we care about your entire body. It is important to discuss your diet, exercise, sleep habits, bowel movements, appetite, weight, libido, sexual comfort, leaking urine, depression, etc. Most insurance companies allow women to see the gynecologist every year. I know I am biased but I feel it is important to see the health provider that does the most female exams. Our bodies are complicated and it is difficult to feel the ovaries. I want someone who has the most experience with pelvic and breast exams doing my exam. We also order the appropriate lab work with checking lipids, Vitamin D, Vitamin B-12, anemia, liver, kidney, thyroid, bone density, mammogram, etc.
 
Pap smears are important. The number of deaths from cervical cancer have been reduced tremendously since we have been doing Pap smears. Like colon cancer screening, we have learned that we can still be effective in treating even if we don’t do an annual test. However, you still need an annual exam and health discussion for optimal health throughout the year.

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