Friday, March 16, 2012

Study of the Week- Pap Smears

The US Preventative Services Task Force (USPSTF) has finally caught up with the American College of Obstetricians and Gynecologists.  In the past, guidelines recommended annual Pap smears.  In 2009, ACOG recommended that Paps be done only every 2 years in low-risk women and every 3 years in women who have tested negative for HPV.  I've been following those guidelines since 2009.  The USPSTF has finally updated their recommendations to reflect the newest evidence.  You can read the complete article here.

So, what is a Pap test?  A Pap smear (named for Dr. Papanicolau) is a test for cervical cancer.  A small brush is used to scrape some cells off the cervix (the tip of the uterus).  A pathologist then looks at the cells to determine if any are abnormal.  The Pap smear is an incredibly effective screening test for cervical cancer- one of the best screening tests out there.  It's rare to see a woman die of cervical cancer these days, thanks to Pap smears.

However, cervical cancer is slow growing.  It first shows up as abnormal cells, then progresses a bit to low grade and high grade lesions in several stages.  These lesions often regress on their own, as the body's immune system fights them.  Rarely, a lesion will actually progress to cancer.  The problem with yearly Paps is that they catch all these abnormal cells, and that leads to biopsies. These biopsies, if abnormal, might lead to an excision of the area- this can lead to complications.  The evidence shows that a time span of 3 years is fine to catch lesions that are likely to progress to cervical cancer.  Keep in mind- this recommendation is only for low risk people- meaning someone without a history of abnormal paps and without multiple partners (cervical cancer is caused by the HPV virus, which is spread by sexual contact).

A Pap test does not test for uterine cancer or ovarian cancer.

A Pap test is NOT necessary to get birth control pills.  Never has been, never will be.

A Pap test does not test for sexually transmitted diseases.

The NY Times also reported on the new recommendations.  I always get a kick out of the reader comments in the health sections.  It contains gems such as this:

The assault on women's health continues. These guidelines and this article reflect everything that is wrong with both healthcare and journalism today. The recommendations were made based on opinion only, there are NO DATA to support these revisions. The PAP smear has been and always will be THE single most cost effective caner screening tool, BAR NONE! It's value, like any good screening tool, relies on the test being performed at frequent intervals.

We need to stop playing into the HPV hype being foisted on us by Merck. Cervical cancer of the squamous type is rare in the US now because of the success of annual PAP smears. So much so that adenocarcinoma of the cervix, which is completely unrelated to HPV and much more aggressive and faster growing has replaced the regular (squamous) type of cervical cancer as the leading cause of cervical cancer deaths in the US.

The committee's own press release states that most women with cervical cancer in the US have either never been screened or have not had a PAP smear in the past 5 years. This has been true for decades, and flies in the face of the logic of their own recommendations. The purpose of the PAP is to detect changes BEFORE they become cancerous. It we wait five years, by the time the diagnosis is made, it's too late.

As journalists you have an obligation to due diligence. Please follow the money trail to discover what is really behind the new guidelines. Millions of women will thank you.

This is another good one:
Cervical cancer is cancer and a woman can get it at any age. A pap smear should be part of an annual exam period. Are Insurance Companies going to do away with annual exams as well to save money for themselves. Greed is going to kill us all.

And this one:

It's quite obvious that insurance companies are behind the effort to restrict cancer screenings for the public, once again putting profits before human lives. We've heard the same nonsense regarding mammograms and PSA tests. First they start out telling us we don't need cancer screenings as often, then their next step will be to deny coverage for tests done more frequently than they want. We all know that cancer can spread like wildfire and these assertions don't make any sense. Yet another example of disgusting corporate greed.

I love it when people make up their own facts to suit an agenda.  I promise you, these new recommendations are not part of some deep, dark conspiracy to undermine women's health.  It's not being foisted on the American public by greedy insurance companies or doctors.

It's just good medicine.  That's it.  Sometimes it is that simple.
 
 

6 comments:

  1. When breastfeeding for the first time baby’s body should be facing moms and it is best if there is skin on skin contact.
    female obgyn

    ReplyDelete
    Replies
    1. I can’t believe this. A great testimony that i must share to all patient of [HPV] in the world. i never believed that their could be any complete cure for HUMAN PAPILLOMA VIRUS or any cure for HUMAN PAPILLOMA VIRUS, Mrs JANE introduce me to DR.AKHIGBE a herbal doctor who lives in Africa who brought him back to life again. so i had to try it too and you can,t believe that in just few weeks i started using the herbal medicine he sent to me i was perfectly ok and . Right now i can tell you that few months now i have not had any symptoms of HPV and i have just went for text last week and the doctor confirmed that there is no trace of any HPV in my body system. Glory be to God for leading me to this genuine DR.AKHIGBE I am so happy as i am sharing this testimony. My advice to you all who thinks that their is no cure for HPV that is Not true ,just contact him and get cure from DR.AKHIGBE via his Email DRAKHIGBESPELLHOME@GMAIL.COM and you will be free and free forever, Try it and you will not regret it because it truly works. One thing i have come to realize is that you never know how true it is until you try...or you can whatsapp him +2348106618681, OR Email him DRAKHIGBESPELLHOME@GMAIL.COM OR if you need my assistant via mail:jamesava001@gmail.com...
      THIS IS THE TYPE OF HERBAL MEDICATION HE HAVE
      1 Cancer
      2 Hiv
      3 Low sperm count
      4 Barrenness
      5 Hvp
      6 Herpes
      7 Genital Wart
      8 Rare disease
      9 Hepatitis
      10 Syphilis
      11 Diabetes
      God bless you sir for your good work that you done.....

      Delete
  2. I'm trying to figure out how one can breastfeed with the child's body facing away from mom. I mean, I've got 2 years of breastfeeding under my belt, but never have I managed to do it with my kid's body facing away. How is that even possible? Unless you have an Exorcist baby, of course.

    ReplyDelete
  3. This is encouraging, a doctor who makes sense!
    Sadly, here in Australia women are pressured and advised to engage in serious over-screening and we test young women so have very high over-treatment/excess biopsy rates. I gave up on our doctors a long time ago who continue to spout misinformation and collect target payments, never disclosed to women.
    Our program is a decade behind the evidence.

    I found the best source of real information, not the official and insulting screening "stories" and scare campaigns they direct at women here...to be countries that have evidence based programs...women come first.
    The Netherlands and Finland are the ones to watch IMO...both have 6-7 pap test programs, 5 yearly from age 30 to 60 - they both refer far fewer women for colposcopy/biopsy and the Finns have the lowest rates of cc in the world and the Dutch no more than us...the Dutch are moving again with the evidence and a new program has been approved...5 hrHPV primary triage tests offered at ages 30,35,40,50 and 60 and only the roughly 5% who test positive and are at risk will be offered a 5 yearly pap test. The vast majority will be HPV negative, they cannot benefit from pap tests, biopsies etc and will be offered the HPV program...they are also already using a self test HPV device, the Delphi Screener, also being used in Singapore, Italy and elsewhere.
    Those negative and no longer sexually active or confidently monogamous can forget about further testing. This program offers protection for the vast majority of women who are not even at risk from cc, they will be spared unnecessary pap testing, excess biopsies and over-treatment and all the negatives that can follow, like damage to the cervix, cervical incompetence, cervical stenosis or scar tissue, premature babies, the need for c- sections and cervical cerclage etc This program will also save scarce health resources.

    We basically spend millions worrying and harming women not even at risk from cervix cancer and we miss too many of these rare cancers with our inefficient slash and burn program. Fortunately, our screening rates are falling as more women realize our program is excessive and harmful...hopefully, this will force long overdue change and finally focus the program on what's best for women.

    ReplyDelete
  4. I should also say the new Dutch program is likely to save more lives as it identifies the small number of women who are at risk, they're HPV positive, these women can be offered a 5 yearly pap test, they at least have a small chance of benefiting, although most will clear the virus. I assume they then fall into the HPV primary testing triage program. I despair at the worry and harm caused to huge numbers of women by our program and all of our doctors remaining silent and co-operating and profiting from this harmful program. So much damage to help so few...
    Great to see change happening in the States....excess is a major problem there as well. It is also shocking that women are still routinely denied birth control in the States until they agree to elective cancer screening...surely, that amounts to coercion. Our doctors would find themselves in serious trouble if they tried that one...the risk from an unplanned pregnancy, abortion, miscarriage or ectopic pregnancy is high and legally and ethically, all cancer screening requires our informed consent....it can only be elective, an option. Hopefully, the routine pelvic exam will also be scrapped...that's one battle we don't have to face, routine breast and pelvic exams are not recommended here.
    There are also concerns about breast screening...uncertainty of benefit and the significant risk of over-diagnosis, fortunately, one or two of our doctors have stepped forward to warn women. I'll never understand how anyone could think this is an acceptable way to treat adult women. I think we need to force a change in
    the paternalistic attitudes that still shape and control women's healthcare.

    ReplyDelete
  5. I can’t believe this. A great testimony that i must share to all patient of [HPV] in the world. i never believed that their could be any complete cure for HUMAN PAPILLOMA VIRUS or any cure for HUMAN PAPILLOMA VIRUS, Mrs JANE introduce me to DR.AKHIGBE a herbal doctor who lives in Africa who brought him back to life again. so i had to try it too and you can,t believe that in just few weeks i started using the herbal medicine he sent to me i was perfectly ok and . Right now i can tell you that few months now i have not had any symptoms of HPV and i have just went for text last week and the doctor confirmed that there is no trace of any HPV in my body system. Glory be to God for leading me to this genuine DR.AKHIGBE I am so happy as i am sharing this testimony. My advice to you all who thinks that their is no cure for HPV that is Not true ,just contact him and get cure from DR.AKHIGBE via his Email DRAKHIGBESPELLHOME@GMAIL.COM and you will be free and free forever, Try it and you will not regret it because it truly works. One thing i have come to realize is that you never know how true it is until you try...or you can whatsapp him +2348106618681, OR Email him DRAKHIGBESPELLHOME@GMAIL.COM OR if you need my assistant via mail:jamesava001@gmail.com...
    THIS IS THE TYPE OF HERBAL MEDICATION HE HAVE
    1 Cancer
    2 Hiv
    3 Low sperm count
    4 Barrenness
    5 Hvp
    6 Herpes
    7 Genital Wart
    8 Rare disease
    9 Hepatitis
    10 Syphilis
    11 Diabetes
    God bless you sir for your good work that you done.....

    ReplyDelete