Friday, April 20, 2012
To Pap or NOT to Pap?
Choosing Wisely is a wonderful campaign aimed at increasing discussions between doctors and patients about tests and procedures, and what is expected versus what has been shown to be effective. I am starting my focus on this campaign with highlighting the recommendations of my academy- the AAFP (American Academy of Family Physicians.) So far, I've discussed back x-rays, sinusitis treatment, bone density tests and EKGs, and today I would like to address Pap tests.
Pap tests do a wonderful job in helping us detect cervical cancer in early, very treatable stages. With our increased understanding of this disease being caused by HPV (the Human Papilloma Virus) as well as improving technology that allows us to detect the specific strains of HPV that are high risk for cancer, we are changing the recommendations for Pap tests on what seems like an annual basis. This recommendation focuses on two parts: Girls under the age of 21 and women who have had hysterectomies for reasons other than cancer (such as fibroids or heavy bleeding) do NOT need Pap tests. Evidence has shown that the vast majority of teens who are infected with HPV will not progress to cancer, but instead effectively "clear" the infection within a few years (meaning the HPV lowers to an undetectable level, though it still may be present.) Likewise, the incidence of cancer in women who have had their uterus removed for non-cancerous reasons is so small that there is little evidence for improved outcomes.
As a major proponent of sexually transmitted disease awareness, however, I want to be crystal clear that women under the age of 21 STILL NEED TESTING for STDs if they are having sex! No Pap does NOT equal no testing or no exam.
BOTTOM LINE: Pap testing recommendations are changing frequently- please talk with your doctor about the most current recommendations and do not be surprised if you do NOT need one this year!