{"id":1817,"date":"2010-01-28T15:52:21","date_gmt":"2010-01-28T20:52:21","guid":{"rendered":"http:\/\/girlwpen.com\/?p=1817"},"modified":"2010-01-28T15:52:21","modified_gmt":"2010-01-28T20:52:21","slug":"bedside-manners-new-pap-smear-guidelines-no-thank-you-part-ii","status":"publish","type":"post","link":"https:\/\/thesocietypages.org\/girlwpen\/2010\/01\/28\/bedside-manners-new-pap-smear-guidelines-no-thank-you-part-ii\/","title":{"rendered":"BEDSIDE MANNERS: New Pap Smear Guidelines — \u201c No, Thank You (Part II)"},"content":{"rendered":"

<\/a>\"File:Cervical<\/a>January is <\/span>Cervical Health Awareness Month<\/span><\/a>, making it the perfect time to post a follow-up to <\/span>Part I<\/span><\/a> which featured my concerns about\u00a0potential unintended consequences of <\/span>new Pap test guidelines<\/span><\/a> (from ACOG, the American College of Obstetricians and Gynecologists). To recap, it is vital that we do not<\/strong> confuse a recommendation of less frequent Pap tests with the unchanged recommendation of annual pelvic\/sexual health exams (see the <\/span>National Cancer Institute<\/span><\/a> for explanations of both).<\/span><\/p>\n

\u00a0<\/p>\n

So, let’s look back at\u00a0<\/span>a letter dated November 20, 2009<\/span><\/a>, in which the President of ACOG clarified:<\/span><\/p>\n

\n

Cervical cancer screening should begin at age 21 years (regardless of sexual history). Screening before age 21 should be avoided because women less than 21 years old are at very low risk of cancer. Screening these women may lead to unnecessary and harmful evaluation and treatment. <\/span><\/p>\n<\/blockquote>\n

Medically speaking, why should this recommendation disregard an individual woman’s sexual history? His letter continues on to state:<\/span><\/p>\n

\n

Cervical cytology screening is recommended every 2 years for women between the ages of 21 years and 29 years. Evidence shows that screening women every year has little benefit over screening every other year.<\/span><\/p>\n<\/blockquote>\n

Doesn’t this depend on how many new sexual partners a woman has in a given year? Are the revised guidelines assuming monogamy (or at least long-term, serial monogamous relationships) which decrease odds of a woman contracting a new cancer-causing strain of HPV in less than a 2-year period? Where are the conclusive findings of large-scale sexual-behavior surveys to support this assumption? <\/span><\/p>\n

\u00a0<\/p>\n

ACOG’s November 2009 <\/span>press release<\/span><\/a> featured these quotes from Alan Waxman, M.D.<\/span>: <\/span><\/p>\n

\n

Adolescents have most of their childbearing years ahead of them, so it’s important to avoid unnecessary procedures that negatively affect the cervix. Screening for cervical cancer in adolescents only serves to increase their anxiety and has led to overuse of follow-up procedures for something that usually resolves on its own.<\/span><\/span><\/p>\n<\/blockquote>\n

I agree with GWP reader anniegirl1138<\/em> who commented on my previous post that over-treatment is no joke. However, we have not been presented with\u00a0data that a Pap test —\u00a0the test, itself, not <\/strong>over-treatment based on test findings — is directly linked to significant increases of any negative health outcome. <\/span><\/p>\n

\u00a0<\/p>\n

Cervical HPV infections can be detected by Pap tests: ACOG <\/span>acknowledges<\/span><\/a> that, “the rate of HPV infection is high among sexually active adolescents, but counters with, “the large majority of cervical dysplasias in adolescents resolve on their own without treatment.”<\/span><\/p>\n

\u00a0<\/span><\/p>\n

Why should that smaller group of girls and young women (whose pre-cancerous lesions do not<\/strong> resolve without treatment) miss the annual opportunity to receive an early diagnosis? Early-stages of cervical HPV infection can often be resolved with <\/span>less-invasive treatment options<\/span><\/a>. <\/span><\/span><\/span><\/p>\n

\u00a0<\/span><\/p>\n

More-invasive treatment options, such as the “excisional procedures for dysplasia” that have been <\/span>linked to increased risk of premature births<\/span><\/a>, are one of several\u00a0medical treatments for cervical HPV. <\/span><\/p>\n

\u00a0<\/p>\n

And, what about the possibility\u00a0that an increased risk of premature births may not be the paramount concern for every female patient? Not all women want to<\/em> or can<\/em> biologically become mothers. What if an individual female patient would rather seek medical treatment for a HPV infection that has resulted in <\/span>cervical dysplasia<\/span><\/a> so that she has greater peace of mind in knowing that she has reduced her risk of cervical cancer and reduced the likelihood of transmitting HPV to her sexual partner(s) and\/or future babies? <\/span><\/p>\n

\u00a0<\/span><\/p>\n

Call me a feminist, but I still believe that knowledge is power and that every sexually-active girl and woman should be encouraged to consider the benefits of annual Pap tests. When Pap smear results show “abnormal” cellular changs,\u00a0then healthcare practitioners should explain the potential for false-positives and discuss the pro’s and con’s of moving forward with different diagnostic and treatment options.\u00a0\u00a0<\/span><\/span><\/span><\/p>\n

\u00a0<\/span><\/p>\n

ACOG <\/span>acknowledges<\/span><\/a> that, “HPV also causes genital and anal warts, as well as oral and anal cancer.” A Pap test may be a girl\/woman’s first chance to learn of a cervical HPV infection, which can result in\u00a0her having a <\/span>colposcopy<\/span><\/a> exam. This\u00a0procedure helps a practitioner find HPV-infected cells not only on the cervix but also in other anogenital areas (the vaginal canal, the labia, the perineum). Beyond the cervix, a Pap test that is positive for HPV may be a wake-up call\u00a0to get a thorough oral screening for <\/span>serious oral cancers which have been linked to sexually transmitted HPV<\/span><\/a>.<\/span><\/p>\n

\u00a0<\/span><\/p>\n

In addition, <\/span>my research<\/span><\/a> and others’ studies have found that\u00a0STI diagnoses can lead to attitudinal and behavioral changes which can decrease risks<\/strong> of contracting other STIs, including HIV. For all of these reasons, a Pap test that leads to a diagnosis of a sexually transmitted cervical HPV infection can bring unintended positive<\/em> consequences.<\/span><\/p>\n

\u00a0<\/span><\/p>\n

\"\"In light of the new Pap smear guidelines, I hope that U.S. girls and women who get less frequent Pap tests will more frequently ask their healthcare practitioners to educate them about <\/span>cervical cancer<\/span><\/a>, about the full range of <\/span>STIs<\/span><\/a>, and about FDA-approved vaccines against viruses that can be sexually transmitted (<\/span>HPV<\/span><\/a> and <\/span>Hepatitis B<\/span><\/a>). <\/span><\/p>\n

\u00a0<\/span><\/p>\n

For\u00a0the medical facts about HPV and HPV vaccines,\u00a0check out the book The HPV Vaccine Controversy<\/em>\u00c2\u00a0by\u00c2\u00a0<\/span>Shobha Krishnan, M.D<\/span><\/a>., a member of\u00c2\u00a0the Medical Advisory Board of the <\/span>National Cervical Cancer Coalition<\/span><\/a>.\u00a0 <\/span><\/p>\n

\u00a0<\/p>\n

The Bottom Line<\/strong>: a recommendation for less frequent Pap tests does not mean you should forgo your annual pelvic exam. In our busy lives, e-reminders can make the difference:\u00a0 PromiseToMe.com<\/span><\/a> allows you to schedule an annual email reminder. [Note for boys\/men:\u00a0make sure to get an <\/em>annual sexual health exam<\/em><\/span><\/a>, too!]<\/em><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

January is Cervical Health Awareness Month, making it the perfect time to post a follow-up to Part I which featured my concerns about\u00a0potential unintended consequences of new Pap test guidelines (from ACOG, the American College of Obstetricians and Gynecologists). To recap, it is vital that we do not confuse a recommendation of less frequent Pap […]<\/p>\n","protected":false},"author":1918,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[21094],"tags":[21130,2443,21248,21395,33,2862,21445,21673,21679,21680,665,1528,21800,21925],"class_list":["post-1817","post","type-post","status-publish","format-standard","hentry","category-bedside-manners","tag-acog","tag-cervical-cancer","tag-cervical-health-awareness-month","tag-girls","tag-health","tag-hpv","tag-hpv-vaccine","tag-oral-cancer","tag-pap-smear","tag-pap-test","tag-science","tag-sexism","tag-shobha-krishnan","tag-womens-health"],"jetpack_featured_media_url":"","_links":{"self":[{"href":"https:\/\/thesocietypages.org\/girlwpen\/wp-json\/wp\/v2\/posts\/1817","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/thesocietypages.org\/girlwpen\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/thesocietypages.org\/girlwpen\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/thesocietypages.org\/girlwpen\/wp-json\/wp\/v2\/users\/1918"}],"replies":[{"embeddable":true,"href":"https:\/\/thesocietypages.org\/girlwpen\/wp-json\/wp\/v2\/comments?post=1817"}],"version-history":[{"count":0,"href":"https:\/\/thesocietypages.org\/girlwpen\/wp-json\/wp\/v2\/posts\/1817\/revisions"}],"wp:attachment":[{"href":"https:\/\/thesocietypages.org\/girlwpen\/wp-json\/wp\/v2\/media?parent=1817"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/thesocietypages.org\/girlwpen\/wp-json\/wp\/v2\/categories?post=1817"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/thesocietypages.org\/girlwpen\/wp-json\/wp\/v2\/tags?post=1817"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}