Apparently “standards of care” (the medical model’s sacred cow) are shifting. The NY Times recently published a good article about PAP screenings.
Is this a sneak preview of government rationing of healthcare dollars? Even in advance of providing universal coverage? Well guess what? Healthcare must be rationed. The endless deep pocket attitude is what is driving the system to rapid bankruptcy. That being said, the issue of PAP guidelines now recommending delayed screening completely misses the target.
One of the problems with the new guidelines is that age has minimal relevance in determining which woman should receive a PAP screen, and when.
The purpose of a PAP (short for Dr. Papanicolau, the test inventor) is to find cervical cancer as soon as possible, before it progresses. This is what any good cancer screening test is for.
In the PAP test, cells are gently scraped off the cervix (which is the muscular neck at the base of the uterus) for analysis by a pathologist. Cervical cancer is caused by human papilloma virus (HPV). The virus causes very specific cell changes. Macroscopically, cells damaged by HPV will blanch (turn whitish and slightly powdery) with a vinegar application. This pre-test is often done by the savvy gynecologist or primary care provider to help begin to localize the area of infection. Microscopically, HPV causes a characteristic crinolation (edges of the cells get crinkled looking) which can be quantitatively measured for degree of infection.
Here is a very important point, often not divulged to the patient: MOST HPV infections are low grade and thus, by definition, self-resolving. Low grade HPV must be watched, not treated. Repeat the PAP in 3 to 6 months. Patients with low grade HPV may benefit from anti-viral therapy (Vit A, Lomatium (Osha), zinc, maybe Echinacea, maybe in vaginal suppository form as well as oral dosing). Only some of the HPV strains (16, 18, 33,35, 69, 72) are high grade or high risk and may progress to cervical cancer if left untreated.
Patients with high grade HPV in the naturopathic physician’s office are offered a very effective therapy called escharotic treatment which is basically a slow, herbal burn of the infected outer cells of the cervix, resulting in fresh, healthy tissue. This option requires at least 8 office visits. Another option is a referral for a LEEP, a surgical procedure which slices out a cone of tissue in the cervix, which may compromise future vaginal deliveries, so of concern to younger women still wanting children.
This article is purposely avoiding discussion of the Gardasil vaccine because this particular vaccine has caused so many problems and the issue is fraught with political and financial malfeasance.
Here is the main point: Every time a woman has a new sex partner, she needs a PAP. Her age doesn’t matter. This is because HPV is an STD (sexually transmitted disease) which does not arise spontaneously, but needs to be acquired, by sexual contact with an infected partner. HPV is almost always silent in men. It is relatively rare to find healthcare providers, even urologists, to screen, much less treat, a man for HPV infection. However, men can, and should, be screened and treated if a sex partner of theirs turns up with high grade HPV.
Once a woman is settled in to a mutually monogamous sex partnership and has 3 normal PAPs with that partner, she doesn’t need chronic screening UNLESS she starts to use tobacco, or uses hormones (such as birth control pills or HRT) which are both risk factors for potentiating latent HPV. Many women diligently present to their doctor’s office wanting their annual PAP. This may not be necessary, but, and hopefully the physician will explain that, and also take time to check their blood glucose, blood pressure, and look for new/strange moles on their backs. Unless the above parameters apply (new sex partner, tobacco or hormone use) chronic PAP screenings are not a good use of healthcare time and money.
However, starting around age 40 an annual pelvic exam is advisable for women with a strong family history of ovarian cancer. A bimanual exam of the uterus and ovaries should be performed every 2-3 years for women over age 40 without known risks for ovarian cancer. Also, women should get a baseline CA-125 (as yet imperfect, but in the process of improving) which is a blood screen for abnormal ovarian activity, by age 40. Unfortunately, most ovarian cancers are found too late.
By the way, long-term hair bleaching and taking anti-depressants are both established but little known risk factors for ovarian cancer. So is using talcum powder in the genital area (talc grains are very hard and will irritate the uterus, fallopian tubes and ovaries if it migrates up through the cervix. Other known risks for ovarian cancer, besides genetics, is taking fertility drugs, such as Clomid, for more than 6 rounds.
References
http://www.collegian.psu.edu/archive/2008/09/09/cdc_gardasil_vaccination_safe.aspx
http://www.thehpvtest.com/About-HPV.html
http://www.medhelp.org/NCI/CancerNet/CDR62822.html#