Important News About Pap Smears

“If it ain’t broke why are we fixing it?”

This week the United States Preventative Services Task Force (USPSTF) published a recommendation statement in the Journal of the American Medical Association (JAMA)

They made updated recommendations for screening for cervical cancer using Pap smears (which they call cervical cytology) and high risk HPV testing or both in combination.

I have some real problems with these kinds of recommendations. Their goals are to prevent cervical cancer and reduce the mortality from this disease. Obviously these are desirable goals. However, I have a slightly different agenda for you as my patient. For instance if a woman, done with her childbearing, were to have a total hysterectomy for a very advanced pre-cancerous lesion of her cervix, the Secretary of Health and Human Services would consider that a victory for the system. She never developed invasive cancer and thus the whole process of screening was successful. I have very different goals for you as my patient. If one of my patients, under my medical supervision, were to develop such an advanced pre-cancerous lesion that required a hysterectomy I would feel that I had failed her miserably. My goal is to prevent the development of lesions that cannot be easily taken care of for instance here in an office setting with something as simple as an outpatient laser treatment.

As I have told many of you, guidelines are created for populations not individuals. I still believe that patients should be cared for one patient at a time with their individual risk factors, personal history, and family history taken into account when decisions are made for her health care regardless of the medical situation that we may be discussing.

Unfortunately so many women believe that they are only coming to the gynecologist for their “Pap Test”. Nothing could be further from the truth. In my practice although obviously I am concerned that no one develop an advanced abnormality of their cervix, that is a very small part of what I do gynecologically. For instance, in women who are menopausal, bone health, breast health, vaginal health, and what’s going on in their pelvis with my transvaginal ultrasound in terms of their ovaries and their uterus are of the utmost importance.

In women prior to the menopause issues like abnormal uterine bleeding, abnormal findings on pelvic examination, painful periods, pelvic pain, fertility, vaginitis, urinary tract issues, birth control are just a few of the many areas that we constantly want to deal with in addition to Pap smears and/or HPV testing.

While we are at it, let’s talk about HPV testing: there are over 100 strains of HPV virus. It is ubiquitous. It can be passed by skin to skin contact and does not come out in semen. Thus condoms don’t necessarily protect against it. Virtually all sexually active individuals will be exposed to various strains of HPV virus. Unfortunately, the medical establishment seems to be turning HPV into the disease. The disease is cervical cancer and the precursors of cervical cancer. In my opinion the Pap smear, done in a reputable lab like NYU, is still among the best ways to screen for and protect against the development of advanced pre-cancerous lesions.

As always if you have any concerns about this for yourself or members of your family, feel free to call me and discuss this.

I remain yours in health,

Dr. Goldstein