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Monday, October 31, 2016

Experts Advise Caution In Fewer Pap Smears

A revolution in pap smear testing has occurred, women are being told they do not need yearly pap smears, but some experts are advising caution. Long term studies that were well done still leave gaps in knowledge based on the fact of how many pre-cancers are detected. Cervical cancer takes years to develop and it is not possible to follow women until they do get cancers. The new calculations indicate that there are additional women who will be diagnosed and some will even die during the extra years without a pap smear. Cervical cancer detection is more than just a pap smear, it's getting regular pelvic examinations, following up episodes of bleeding or pain, and having a personal gyno to consult regarding how to lower your cancer risks. But, ultimately, most women rely on regular pap smear testing to determine their risk for cervical cancer. Pap smears are a sampling of the cervical cells to determine whether the cells are normal, inflamed, infected, precancerous or cancerous. Based on the look of the cells more testing is indicated before formulating a treatment plan for those that are abnormal. Since pap tests don't treat cancer, but seek it, as in a simple screening test. Pap smear testing is highly reliable. An overall abnormal rate of pap smears is on the order of 5-8% of all tests. Because of false positive tests pap smears cannot detect all cancer of the cervix, just most of it. Although for decades we have been testing women yearly, who to test, and exactly how to test, and how often to test has been under debate as we try to further eliminate any risks in screening for cervical cancer, identify as many cases of cancer and be mindful cost for American women. Many organizations have produced pap smear guidelines. American Cancer Society recommendations can be found at this link  .The American Society for Colposcopy and Cervical Pathology can be found at this link, where they discuss the guidelines that were put in place in 2012. Gynecologic Cancer Foundation.  Under age 21 routine pap tests are not indicated. The guidelines say that under age 30: Get a regular pap  and many add the HPV test  ever 3 years, keep getting pelvic exams, and some physicians believe in beginning HPV testing over the age of 25. Over age thirty? Add a HPV test to your pap, or alternatively begin with an HPV test. Over the age of 30 some have even said extend intervals even longer than 3 years to 5 years.  Previous abnormal pap smears will change what your gyno recommends for pap test screening? You may have recurrence risk for over 20 years.  And you and your gyno know more about your risks, and the absolute costs and potential for harm the test would have in your case. Drs. Chelmow, Waxman, Cain and Lawrence writing a commentary on this topic in Obstetrics and Gynecology in April of 2012 have said that the 'yearly' plan was 'chosen arbitrarily.' It's important to keep track of your previous results, to maximize your gynecologic health, avoid infections, do not smoke, and those things can help you avoid cervical cancer. We also suggest using condoms for STD protection, although it is not perfect HPV protection. We know that Gardasil vaccination will affect this as well, but currently whether you have been vaccinated against HPV disease doesn't change when we recommend pap smear testing. Very specific factors in your case have to be discussed with your individual gyno. She may not have even had time to digest all the technical information in these guidelines. They are published on line for those who are interested in the details.The NIH expressed their views on cervical cancer screening at the
New Pap Testing Recommendations March 2012 The CDC information. So for women over the age of 30, even with a normal pap test, if you haven't had HPV testing, it is now covered by most plans, and will be covered by all plans with in the year. For more specific information regarding what the Affordable Health Care Act covers for women check their website.

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