Dr. Deb

New guidelines for cervical and prostate screens are actually recommending less screening as oppose to more and not everyone agrees, myself included. While I have done a lot of testing for cervical cancer and grant it, probably too much, I will never forget the patients that I diagnosed with cancer.  While some change is needed, many docs will not follow the new recommendations.

Who should NOT get a pap smear according to the new U.S. Preventive Services Task Force recommendations ?

U.S. Preventive Services Task Force recommends AGAINST Pap Smears

- Under age 21

- Older than 65

-Women that had a hysterectomy*

*(Unless they had a history of high-grade precancerous changes)

The task force did not recommend pap smears in women under 21 as the majority of sexually active young women will acquire some form of HPV,  (Human Papilloma Virus) or the virus that may cause many types of cervical and vulvar cancer, but will clear them without treatment.

The risk of cervical cancer in adolescents is about 1 in 1,000,000. Many painful and expensive procedures are used in this age group to treat precancerous lesions that are unlikely to progress to cancer according to the task force. These procedures have some risk of preterm labor however there is not a significant risk of NICU admissions or perinatal mortality.

It is important to remember that while a pap test is not recommended, an annual exam may still be needed.  A pap test is sampling of the cervix looking for precancerous cells. It does not check for other types of cancer such as the uterus or ovaries. It is also not checking for STDs or sexually transmitted diseases, which should be screened annually in sexually active teens and with new partners.  These years are critical in helping girls find self empowerment to enable them to stand up to sexualized media stereotypes and peer pressure. A strong doctor relationship can be of great benefit and I would hate for girls to think that just because they don’t need a pap, they shouldn’t see their doctor.

Women who have had a hysterectomy should talk to their doctor to see what type they had. Most of the time the cervix is removed but if it is left in then paps should be continued.

How are the USPSTF recommendations different than other organizations?

The USPSTF recommends a pap every 3 years for women ages 21-65. Currently other organizations such as ACOG (American College of Obstetrics and Gynecology) recommend testing with a pap smear every other year from age 21-29 and every 3 years in women over age 30 with a negative HPV  (Human Papilloma Virus) test in low risk women.  HPV is the virus that causes most cases of cervical cancer so a negative test is reassuring. Many women have HPV and never get cancer so testing HPV alone is not a specific enough test, meaning that too many women that don’t have cancer would need follow up. The USPSTF does not recommend using HPV testing at this time but many doctors will still use it to decide who should be followed more closely.

How frequently should women that have received 3 HPV vaccines have a pap smear?

Right now there have not been any changes to pap smear screening for vaccinated women. This may change with longer-term studies but the vaccine does not prevent all forms of cervical cancer.

Why was there a recommendation yesterday that all boys should be vaccinated?

HPV can cause warts and penile and anal cancer in men and obviously since most girls are getting HPV from boys it makes sense to vaccinate them too. There is new compelling evidence that other types of cancer including cancer of mouth, tonsils and throat are caused from HPV likely transmitted though oral sex. These types of cancers are increasing with over 7000 cases per year so boys should be vaccinated before they are exposed.

How important is USPSTF’s recommendation against PSA screening for prostate cancer?

The USPSTF recommended against PSA screening since prostate cancer is slow growing and most men diagnosed over 75 years old will die from something else The complications from the treatment including urinary problems and sexual dysfunction are often worse than the cancer itself in older men. The problem is we have no other screening test at this time and many people, including myself, know of men whose lives have been saved from the PSA test. Men with a family history of prostate cancer should consider getting the test even starting in their 40s. .

The bottom line is talk to your doctor about your risk factors to help decide what screening tests you should receive. For example, I will follow smokers much closer for cervical cancer as it is such a strong co factor than I would a non-smoker.  Any screening test has risks but many people are willing to undergo the risks of those tests to prevent what could be a fatal disease.

Dr. Deb

Every morning I make 6 neat little piles of vitamins for my family. A multivitamin with calcium, omega 3’s and CoQ10 for each of us. A new study showed that supplements increased death rates in older women.  With over 50% of American taking supplements like we do, does this mean we should we stop? I’ll explain.

Does this new study show that we should stop taking vitamins?

This study was very limited in that only white women with an average age of 62 recalling what vitamins they were taking were studied. The study did not a have  “cause and effect’” design. They did look at 40,000 women, ages 55-69, over 19 years and found a 2.4% increase in death in those taking multivitamins. The most significant increase was seen in those taking iron with a 3.9% increase risk of death. What we don’t know is if those taking these supplements had underlying medical problems that may have influenced taking supplements. Only Calcium showed a decrease risk of death by 3.8%.

Dr. Deb’s Tips in Taking Supplements

1. Never take Iron supplements unless you are Anemic

Extra iron intake has been linked to heart disease, liver disease, diabetes and most recently Parkinson’s disease.

As little as 200mg of iron can cause poisoning in children.

Hemochromotosis is an iron storage disease that affects 1 in 250 people of European descent. Complications from this common disease can be prevented by frequent blood donation. In medical school I tested high for iron stores without having hemochromotosis so I do give blood frequently.

Unless you have a blood test that proves you are anemic, then do not take an iron supplement.

2. Consider a Calcium Supplement

This study did show a decrease in death with calcium supplements ans most are not meeting the daily recommended dose. Teenage girls are most likely to be deficient in Calcium and would therefore benefit.  Take a supplement if you are not getting 1200 mg calcium per day with 600iu of Vitamin D.

3. Less is More

The most important thing this study shows is too much of a good thing may be bad. Don’t take extra iron unless you need it and don’t take megavitamin doses. A study published in JAMA yesterday showed that high doses of Vitamin E may actually increase prostate cancer. Vitamin D was seen as the wonder drug a few years ago but excess Vitamin D can cause problems too. Vitamins and supplement are not regulated by the FDA but can have major health consequences. What the company says is on the bottle may not be the case. Consumer reports found great disparity in what was actually in many supplements and also found many “natural” supplements” to have health risks.

4. Make half your plate fruit and vegetables

The food pyramid was recently replaced with the food plate as study after study has shown the most health benefit is found in a diet rich in vegetables and fruits which are still lacking in the American diet as only 3% of Americans are following the food plate. This one simple rule may be the most beneficial to your health. The old adage an apple a day keeps the doctor away has more and more data to back it up with apples showing a decrease in cancer, diabetes and asthma while helping with weight loss. You can track your nutrition on this link.

5. Talk to your Doctor

Many patients neglect to tell their doctor what supplement they are taking but it is critical as supplements may interfere with other medications. Supplements are drugs with consequences both good and bad and need to be discussed with your health professional.

This study will not change my supplement routine yet but does reinforce that no supplement can replace proper nutrition.