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

My youngest daughter lost her first baby tooth this week. I started to tear realizing my baby was growing up. She looked at me and said ”Don’t cry Mom, I’ll grow a new one.”

In a blink of an eye, she really will be grown up and I’ll be packing her up for college like so many parents are this week. In addition to the books, lamps and rugs, it is important to keep your children healthy in and out of the classroom so here are Dr. Deb’s 5 College Health Tips.

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Many parents still have a lot of questions about giving their daughters the Gardasil vaccine.  I understand why.
First, We really don’t want to accept that our 10-year-old babies will be faced with the sexual onslaught, now known as Middle School. It is the land of Lollipop parties where girls give oral sex to multiple boys for stature and attention.
Not only are Middle Schoolers engaging in high risk oral sex behaviors, they are not afraid to invite or broadcast it on the internet via their cell phones. I had a patient tell me, “Well you can thank Bill Clinton for that!” At the time, I thought it was absurd but he did introduce the mainstream to the belief that oral sex is not a big deal or even recognized as sex with the infamous,” I did not have sexual relations with that woman!” Teenagers will report that kissing is more intimate than oral sex. My how things have changed!

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So many scary reports out there about vaccines. As a Mom, it can be terrifying hearing about vaccines not being safe. As a physician I know that data supports the safety of vaccines and the incredible prevention of life threatening diseases. I still have some unanswered questions about the scheduling and number of vaccines given at one time since we have so many more vaccines today.

One of the latest questions is about Gardasil. It is a vaccine introduced in May of 2006 to help prevent cervical cancer and genital warts. It helps the body produce an antibody to 4 types of Human Papilloma Virus or HPV. (more…)