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Do I Need a Pap Smear?
Controversy is swirling about what age a woman no longer needs to get a pap smear.
Lets face it. It's not the most enjoyable experience to have in a Doctor's office. So the sooner one would not need to get one, the better.
Like many things in medicine, there is controversy surrounding the guidelines as to when a woman no longer needs to subject herself to a pap smear.
Many "traditional" and HMO doctors will say that paps are no longer needed after the age of 65.
Why is this confusing? This should be so straight forward.
One of the issues is that previous studies looking at rates of cervical cancer in women were not "corrected" for hysterectomies.(In other words, they did not remove the women with hysterectomies from the data base. Obviously these women could not have cervical cancer as they didn't have a cervix)
Why this wasn't done is mind boggling to me. Nevertheless, when the data was corrected for hysterectomies the cancer rate went up from 11.7 per 100,000 women to 18.6. And, the most dramatic increase in incidence occured in the 65-69 age group. The incidence of cervical cancer in this age group when corrected for hysterectomies, was 27.4 per 100,000 women, with a dramatic increase in black women as the rate of hysterectomies in black women steadily increases with age. (That is more than one in four women age 65-69 will have cervical cancer)
The 65-69 age group when corrected for hysterectomies is actually the highest incidence of cervical cancer in any age group, and much more dramatically so for black women.
The authors have a paradigm-altering hypothesis.
"Our data suggest that the decline [at menopause] appears to be an artifact resulting from, at least in part, failure to correct for hysterectomy prevalence," they write. There is a "potential role of aging in the natural history of cervical cancer," they argue.
The screening process drops a group of women right at the moment of their greatest need, suggested senior author Patti Gravitt, PhD, from the Johns Hopkins Bloomberg School of Public Health in Baltimore.
The authors point out that cervical cancer rates have declined in black women in the United States over the past 30 years, but disparities in incidence "may be even greater than previously recognized, especially among older women."
So if your Doctor tells you that at your age you no longer need a pap smear, I would RUN !
He or she is obviously not up on the current literature about this.
If you are not up to date on your Pap smear, this is a good time to schedule it. I am happy to help,as usual.
I perform Pap smears in my office at no additional charge if performed with the pelvic ultrasound.
If you are on Bio-identical hormone replacement, I recommend getting both the Pap and pelvic ultrasound on a yearly basis.
Call the office if you would like more information.
And of course, if you like, just go ahead and schedule your appointment.
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