Do you need this Test? If so When?

   In the same week that the American Cancer Society released its report on the trends of cancer related death, I read an article from Medscape regarding the percent of women who are being screened for cervical cancer according to the current recommendations. 

   Recommendations for the pap smear have changed in the past few years.  Women are no longer to start them at age 18 and continue them yearly for the rest of their lives. Which is really nice!

   For most women, the start age is 21 and the exam is to be repeated every three years until the age of 65.  If a woman has had a total hysterectomy (cervix removed) there is no need for the screening.  If a woman has had exposure to HPV and an abnormal tissue sample was obtained (precancerous lesions), the pap smear might be conducted annually.

   The study I read found that most women were being screened appropriately EXCEPT women over the age of 65.  If you are a woman over the age of 65, three separate organizations independently suggest that you no longer need to be screened.

Read more in this document.  You may have to use the zoom or magnifier in adobe to read the text, its small!

   Also – in regards to less death from cancer – that is WONDERFUL – now lets work on less people getting cancer… because we may not be dying from heart disease and cancer as much as we used to be but we are most definitely living with those diseases at very high rates.  We are living SICKER not better.

HPV Vaccine

   In clinical research trials, scientists study the safety of a drug, medical device or vaccine and its efficacy.  Efficacy can be thought of this way:
   Under the ideal situation where a specific type of person uses the drug/device exactly as the researcher/developer intended at exactly the right dose, efficacy measures the extent to which the medicine or device does what the developer thought it would do.  Safety is more obvious.  The goal in the safety trial is for the drug or device not to kill anyone.  Nor should it cause serious harm or side effects that are greater than the positive benefit.
   Clinical trials tell us a lot about both safety and efficacy.  But they are better at uncovering side effects that the greater public might experience than at confirming effectiveness. 
   When you or I take the drug or use the device under less than ideal situations, its effectiveness is considered. Drugs and medical devices continue to be studied for several years after they come to market. They are studied in the overall population.
   Last week I completed a short continuing medical education activity (CME) on HPV vaccines.  It was offered through Medscape.  I learned that the real life common side effects occur in a small number of persons and are not severe.  They include same day fainting or dizziness and delayed skin rash.  In the same activity, I learned that there is no evidence that one cervical cancer case has been prevented by this vaccine.  That was a curious point to make and it wasn't followed up with a review of that research.  However, Medscape  is a peer reviewed website so I feel that the statement was true.  
   My take away was that the vaccine is not harmful, but also may not be effective.  It is likely that the efficacy (confirmed in the clinical trial) was based on the age of the person receiving the vaccine and that they received all three doses.   
   Whether or not you choose to get this vaccine, if you are a woman, a pap smear every 3 to 5 years is necessary.  The pap smear can detect changes in the cells around the cervix which might indicate a pre cancerous condition.

Cervical Cancer Screening

When I have discussed my concerns about the HPV vaccine, it has had more to do with the implied message in the marketing campaign.  The idea that the maker of the vaccine presents is that it could prevent cervical cancer (or now, oral cancer).  But the vaccine does not prevent cancer, it can prevent some, if not most, of the strains of the humanpappiloma virus that leads to cancer.
It is the pap smear, the testing of cells from the cervix, that can prevent the cancer.  
It seems that I started to hear conflicted recommendations on how often a woman should have a pap smear in recent years. What has remained consistent it that they are  recommended to begin at age 18 or when a woman becomes sexually active.  When I turned 18, the recommendation was for annual pap smears.  Within the last 5 years or so, some professional organizations began to tweak recommendations so that three and five year tests were acceptable in some situations.  It also was determined that after a certain age or a hysterectomy, the tests might not be necessary.
In the last year or two, another screening measure was tentatively and with some controversy, recommended.
This week the New England Journal of Medicine has a nice "perspective" piece on the varied recommendations.  
I believe it is best that you read it yourself and it is available here for free.  If nothing else, skip down to the table that makes suggestions based on the personal situation of the woman.