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Pap smear guide

Pap smear guide






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    Pap smear guide Pap smear guide Presentation Transcript

    • The NEW pap guidelines
    • What is the pap smear and what does it do for me?
      • Screening test for cervical cancer cells.
      • Proposed in 1950s. Originally there were several ‘classes’ which were broad.
      • Generally a very good screening test, since it can detect precancerous cells in time to treat them, thus preventing actual invasive cervical cancer.
      • It is subject to errors in collection (not getting enough cervical cells, mislabeling) interpretation (pathologists looking at slides can disagree) and follow up ( doctor can’t find patient, patient is afraid and doesn’t follow up or doctor doesn’t know what to do)
      • But it is better than: flouroscopy, waiting for symptoms.
      • In countries where access to pap smears in minimal, death from cervical cancer is still much, much more common than in the developed world.
    • What is cervical cancer and what can it do to me?
      • Previously the most common gynecological cancer, now the third most.
      • Number of cases peaks in the mid forties.
      • Strongly associated with “HPV” a small sexually transmitted virus.
      • Weaker associations with smoking, impaired immunity, other STD’s, DES exposure in utero.
      • Almost never found in women under age 21, due to long “latency” period.
      • “ Early” disease can be cured by surgery and/or radiation. Sometimes can even preserve pregnancy options.
      • “ Late” disease is incurable, causing death by renal failure, bleeding, sepsis, etc. A terrible waste, since these are preventable cases!
    • What is this vaccine against cancer, and do I need it?
      • Gardasil is a vaccine against the four most common types of HPV. Two cause genital warts but usually not cancer, the other two are associated with over 70% of invasive cervical cancers. A series of three shots, it stimulates your immune system to “recognize” these 4 types. So if you are exposed to these, your immune system fights them off, and you are not infected.
      • It does not contain any actual virus- live or killed- so cannot cause infection.
      • It does not protect against all other types of HPV.
      • It does not help those already infected to “clear” their infections faster or more completely.
      • Currently recommended for girls and women aged 10 (!) to 26, though ages can vary depending on lifestyle.
      • Would be better if given to ALL adolescents. Why not guys and men? Don’t get me started.
    • What was wrong with the old guidelines?
      • They were based on old technology (slides, no computerized systems). We have better methds of looking at cervical cells now.
      • They did not take into account what we now know about HPV, and the latency times.
    • What is the biggest change in the new guidelines
      • First pap smear at the age of 21. (!!!) Pap smears for teenagers were resulting in massive overtreatment. Mild infections that could have cleared were treated, leading to an increase in reproductive risk later, and fear/anxiety now.
      • Teenagers certainly need: abstinence/contraceptive counseling/seat belt use/suicide prevention. They may need STD testing and pelvic exams. They need love, guidance and people to turn to for help. But they probably don’t need pap smears.
    • What are the other changes
      • For women in their 20’s, who have normal immune systems, and no previous abnormal paps, paps can be done every 2 years. ( I would add nonsmokers who did not have multiple partners or a history of sexual abuse as a child)
      • In your 30’s , same provisions as above, every three years.
    • But I ALWAYS come, every year, isn’t it good for my health?
      • You are more than just your cervix. Your doctor should be talking to you about specific health issues. Specific to YOU- your exercise, diet, lifestyle, mental health. All those boring things that, really, make the difference in your TBH (Total Body Health).
    • Questions ????