THE NEW PAP SMEAR PROGRAM

by

Dr. Lance Tallmage, MD

Women have been encouraged for years to have an annual Papanicolau smear for early detection of cervical cancer.  Along with the Pap they have been counseled on diet, mammograms, safe sex, contraception, immunizations, and preventive health issues. Women typically dislike the examination becauseit is invasive, somewhat uncomfortable and crosses privacy boundaries. In addition having weight, bad habits and possible health problems discussed is perceived as an invasion or our private space. Recent changes have been proposed which will change the frequency and technology of the Pap smear. If
the recommendations are properly followed it will save millions in health care costs. The downside is the fear that women will have less incentive to have their yearly evaluation. It is easy even now to skip or delay the exam because it isn't much fun.

It is important that women understand the new guidelines and the new tests. Some physicians will be uncomfortable with the changes because theyare concerned their patients will stay away even longer. They also fear that someone will be the exception to the rule and develop a major problem in a short interval. The doctor - patient relationship must involve open communication and firm commitment to make the system work.
    
Women should read about Human Papilloma Virus (HPV) so that they and their daughters (and sons too) understand what it does and where it comes from. It is so common in our society that anyone who has had more than one sexual partner, or a partner who has been with other partners, has been exposed. That virus causes virtually all of the abnormal Pap smears. Many men and women under 25 can eventually drive the virus out of their body or cause it to be inactive. Before that however they can pass it to others and problems can occur. The new Pap smears can detect the virus as well as the
changes it causes.

With good communication and attention to the information available the doctor and patient can decide the best care plan. This includes future Pap smear intervals and minimum treatment required for the degree of change and age of the patient. The new tests allow less risky and expensive treatments. Sometimes it is only necessary to repeat Pap smears every six months to assure the condition clears on its own.

The most important issue is the trust of the physician that the woman will follow up when asked.  In return, women should expect a detailed explanation of treatment options. Cervical cancer takes eight to ten years to develop. There is time from the first abnormal Pap smear to be deliberate and conservative. Communication about Pap smears is a key issue just as good communication is the key to a happier and less stressful life.

 

Lance Talmage M.D.

Academy of Medicine of Toledo and Lucas County