1069

Most (all?) other industrialized nations have national health care, and most are now recommending that women without a history of abnormal PAPs associated with dysplasia have PAP smears only once every three to five years, rather than annually, as women do in the US.

The justification for this is that invasive cervical cancer is an extremely slow-developing cancer that typically takes at least ten to twenty years to develop; even if you only get screened every couple of years or so, problems will be caught well before they reach the malignant stage.

It has been claimed by medical professionals that women in the US are gynecologically overtreated; about 80% (or more, in teenagers) of mildly to moderately abnormal PAPs resolve on their own without treatment in six to eighteen months; about 50 to 30% of severely abnormal PAPs resolve on their own.

Nevertheless, many women in the US have been aggressively, surgically treated for Atypical Cells of Undetermined Significance (ASCUS)- in other words, a low-grade abnormal PAP, which is so common that 2 to 3 million women in the US recieve this diagnosis each year, and in Canada, fully 25% of PAPs elicit this result (in the US, it's only about 5-10%).

Doctors are becoming more informed about the nature and progression of cervical cancer, and adopting a more conservative "watch-and-wait" approach toward ASCUS results (which is the lowest grade considered "abnormal", and also the most common), especially in teens, among whom they are so common as to be meaningless.

The American Cancer Society now recommends the women not have a PAP smear until age 21, or until they've been sexually active for three years, whichever comes first (because low-grade cellular changes are a foregone conclusion in the first years one is sexually active, and because cervical cancer is nonexistent in teens, and because these incredibly common ASCUS results nearly always self-resolve in women under 20).

On the other side of the equation, the justification for having yearly PAPs:

On the pro-annual PAP side, there's this: PAPs are not particularly accurate as far as cancer screening tools go; they have a false negative rate of about 10% (meaning dysplasia or even cervical cancer reads as a "normal" PAP result about 10% of the time).
The theory is that if one gets screened every year, one's chances of getting several false negatives in a row are reduced to almost nil, and the abnormality will still be caught in plenty of time, even if it was missed for a year or two because of false-negatives.

On the other hand, if one is only getting screened every 3 to 5 years and one receives an inaccurate "normal" result... well. One will probably still be okay. But if one gets two false negatives in a row, then one is headed in to dangerous territory, possibly.
That's the theory, anyway.

Recent studies have shown virtually no difference, however, in the cervical cancer incidence rate of Americans (7 or 8 out of 100,000) and Europeans such as British, Belgians, or Australians, who have routine PAPs only every 3 to 5 years.


In the US, cervical cancer was once the leading cause of cancer death in women; now it's been all but eradicated.

Approximately 10,000 cases a year are diagnosed in the US, the majority of those in underprivileged minorities, HIV positive women, and women whose immune systems are otherwise compromised (by Lupus, by transplant organ anti-rejection drugs, etc).
10,000 may sound like a lot, until you realize that in the US, over 50,000,000 women per year get PAP smears.
Fewer than 4,000 American women per year die of cervical cancer.

Contrast that to the over 200,000 women who will be diagnosed with breast cancer this year, and the over 50,000 who will die of it.
Yet mammograms are not routinely recommended for women under 40.

I think lately cervical cancer has been hyped big-time in the media, because Merck has been preparing the market for Gardasil for the past three years or so.

Gardasil- which purports to protect females, for an unspecified period of time, from four strains of the ubiquitous human papilloma virus, including two strains that are implicated in about 70% of cervical cancer cases- is the most expensive vaccine yet marketed ($360 for the course of three shots), and Merck holds the exclusive patent, although Glaxo is currently seeking FDA approval for an alternative hpv vaccine, Cervarix; I'm not sure if it's been approved as of this writing.

If Merck had been successful in their campaign to get state legislators to agree to mandate Gardasil for all girls and young women, what a coup that would've been.

And they almost were successful; they had me and all other outraged liberals on their side for awhile, furious that "fundamentalists" were denying their children an "anti-cancer" vaccine, because they feared it would lead to promiscuous sex.
If not true, it would've been in Merck's best interest to start that particular rumor themselves. It certainly gained them a lot of support and sympathy from the center and Left.

Here's the thing: I was all for Gardasil when I first heard about it.
But now, after intensive research, I'm a little skeptical.
Merck itself now admits that they're not sure how long Gardasil will prevent HPV; at least five years, though, they assure us.
Oh boy.
So for $360, a nine year old girl can now be protected from an all-but-obsolete disease (that never-or next to never- strikes women under 30) until she's 14.

And they stress that Gardasil will not negate the need for vaccinated girls to have annual PAP smears.
It's like, WTF good is it, actually?
And what's the big rush?

It's not like cervical cancer is destroying America, here. We've got all of a couple of thousand people a year dying from it, mostly immigrants and elderly minority women from rural areas, who have lived in poverty- without adequate nutrition or access to heath care- for their entire lives.
It's one of the rarest cancers out there. Brain cancer- another rare cancer- is twice as common (15-20 cases per 100,000 people in the US); but how many women are running around worrying about contracting brain cancer?


The incidence of cervical cancer in the US is approximately 10,000 new cases per year, or about 7 in every 100,000 women (that's a national average, risk varies by state and region, and is slightly higher for minorities: 10 in 100,000).

The incidence of high grade abnormal PAPs- most requiring surgical interventions such as LEEP or cryo- is 500,000 per year (yes, you heard right).
The incidence of low-grade abnormal PAPs is between 2 and 3 million per year.

These are some of the things I know about cervical cancer and screening.


This subject is of interest to me, because it's one that seems to be an almost primal fear among many women, especially those who have previously been diagnosed with or treated for cervical dysplasia (which is 20 to 25%- in some demographic populations, as high as 40%- of all American women), and also because it is a situation in which I feel the government and big business interests are using the media to 1. play into women's primal fears, and 2. manipulate public opinion at the expense of female health and well-being.

I think that a lot of women who were teenagers before 1990- when the sheer normalcy of ASCUS results in teenagers and young adults was less understood than it is now, and when the medical community was more inclined to take a radical approach to a common and typically self-resolving phenomenon- were traumatized by the treatment they received back then, and are still inclined even now to dread PAP screenings, still convinced to this day they are living under some unavoidable cervical-cancer death sentence, that it's only a matter of time.

I'm glad that teenagers today are rarely screened at all.

I think less frequent screening would minimize the risk of women being terrified by and overtreated for insignificant PAP "abnormalities" (which, it turns out, are not "abnormal" after all, in women under 20).


So, anyway, this is what I know.

Most of the stats in this post came from The American Cancer Society, the American College of Obstetricians and Gynecologists, and various state and government agencies.
I'll be happy to reference and link to any fact that is in doubt.

This information is from imminently credible sources; it's markedly different from the misinformation being propagated by the popular media. One can only assume that the popular media has a vested interest in making women believe they are at greater risk of cervical cancer than they actually are, and are using alarmist spin to accomplish this.
It's been pretty clearly demonstrated that Merck has attempted to bribe state legislators into mandating Gardasil for children.

One alarmist tactic used by the media is the oft-trumpeted fact that cervical cancer "was the #1 cancer killer of women in the US before the advent of the PAP fifty years ago, and still kills massive numbers of women each year in third-world countries where women are not routinely screened".
However, they neglect to add that...
Folic acid deficiency has been identified as a major- if not the major- risk factor in cervical cancer; fifty years ago, commercial grain products were not fortified with vitamins, and most women in the US were deficient in folic acid to one degree or another. Women in third-world countries still are.
Another thought-provoking factoid: an estimated 60- 80% of all sexually active adults in the US harbor one or more strains of the hpv virus, including the common strains implicated in about 70% of cervical cancers.
But only 10,000 women a year actually get cervical cancer (and most of those are immuno-compromised to begin with).

Anyway, these are my thought.
Questions? Comments? Anecdotes? Rebuttals? Angry tirades about how I'm full of sh!te?

Footnote:
Please don't think I'm encouraging anyone to forego annual PAPs, or hpv vaccines for their daughters.
Skipping routine PAPs is certainly not recommended by any reputable medical authority.
The only debate is over whether annual screening is necessary, or whether every 3 to 5 years would be sufficient.
I'm just throwing out some facts, and rambling about how those facts make me feel.

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mikhail

Yea women go to the doctors too much

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1069

Okay cool, but did you read the thread title?
Grow a vagina, or butt out.



Seriously, though... I just don't think guys will be able to understand much- at least not on a visceral level- of what I've just written, and I can't imagine that they'd have much relevant input to add.

But I suppose if guys want to participate in this thread, go for it.
You can talk about your wives and girlfriends, and their abnormal PAP experiences.
You won't be able to talk about how it made them feel, however, because you can't know that.

mikhail

I am sorry to hijack this thread but im just saying because i live in a country with an NHS and I think and im sure its true that by the attendence(and ive worked in a Doctors sugery inputing medical records)that women are paranoid about their health and and the way the media goes on you would think women are somehow far more likely to get cancer etc.

talloulou

My gyn recommends I come in every two years for a pap. I had my second child and didn't see a gyn for apx 3 years. They told me to come back in 1-2 years and I saw him again just this year. Basically I'll try my best to get in there every 3-5 years or so but really if you're married and everything seems on the up and up I don't see much point in going in yearly. Everything I've read about this HPV stuff suggests that most women clear it out of their system all on their own without any consequences or cancer down the line. However I have heard and seen stories on TV (Oprah) where very young women in their early 30's drop dead of cervical cancer. I'm sure that's rare but I imagine it sucks if its you none the less.

I went to the gyn more regularly before I was married and thats probably not a bad idea in general. As far as the vaccine I hardly see the point in giving it to young girls who don't even know what sex is and especially if it only lasts 5 years. If the stuff works though its probably not a bad idea for sexually active teens and adults though if they are having safe sex they probably aren't going to get HPV anyway. When the HPV hype was at its peak my mother called me all worked up because so many women are supposedly walking around with this and apparently she believes I was slutty enough in my past that I most defintely probably had it. So to calm her hysterics I went in, got checked, alls well that ends well. My gyn did say that HPV is fairly common and usually not a big deal and rarely leads to cancer in most people. She also said though that cervical cancer that presents in young women can be very aggressive so that's something to think about.

1069

Yeah, well... that's valid. That's not a hijack.
I think women are "paranoid" around this issue; hell I'm paranoid (less so since I did this research). I think the medical community encourages this paranoia- perhaps inadvertently, out of genuine concern that no woman die needlessly from a preventable illness.
I think 500,000 surgical procedures per year (albeit minor, outpatient surgical procedures- LEEP and cryo) to eradicate "precancerous cells" that are only marginally likely to ever progress to cancer and might well resolve on their own is preposterous; on the other hand, for many, the peace of mind is worth the physical and financial cost. But then it's not unusual for the dysplasia to come back and have to be treated again, either immediately or eventually. So how much peace of mind do these procedures offer, really?

There's no question of not having them; if you're one of the unlucky annual 500,000 recipients of a HGSIL PAP result (High-grade squamous intraepithelial lesions, ie severe dysplasia), there's little doubt that you will have cryo, or LEEP, or a cone biopsy, or something.
And there's virtually no doubt that this procedure will take care of it (if not the first time, then the next time, or the next) and that you won't, ultimately, become a statistic.
Frankly, you're twelve times more likely to die of breast cancer than you are to die of cervical cancer.
We focus myopically, I think, on an insignificant risk, whilst ignoring the elephant in the middle of the living room.
Mammograms are not routinely administered to women under 40 because neither the government nor private insurance companies want to pay for it.
PAP smears are recommended- practically mandated- for young women, despite the fact that breast cancer is more commonly diagnosed in young women than cervical cancer, and that more women under 40- and under 35, and in fact at every age- die of breast cancer than of cervical cancer.

It's a complicated issue.
Nobody is currently marketing a vaccine for breast cancer, or for pre-cancerous breast tissue changes.
That's probably part of the reason we're not focusing on it much, despite the fact that our lifetime risk of developing breast cancer is one in eight... and that, while women have a 1 in 30 chance of dying of breast cancer, we simultaneously have a 1 in 3 chance of dying of heart disease.
Our chances of dying of (or ever even contracting) cervical cancer is miniscule indeed.
8/100000 = one in 12,500?

I think our (and the media's) preoccupation with sick cervixes is dangerously diverting our attention from more important things, more pressing risks.

rivrrat

I was all for mandating the HPV preventative. Not only because it can reduce or eliminate the risk of certain cancers, but because the virus that causes those cancers is transmittable. So if I protect my daughter from it, I'm also protecting anyone she has sex with in the sense that they won't get it from HER. It's not only trying to keep my child healthy, but to help stop the spread of a cancer. To me, that's a good thing.

As far as PAPs go, I've had my share of abnormal ones. I've had to have repeat tests every 6 months for years in order to finally get three in a row that were normal. I also had one that detected an abnormality that the doc had to biopsy and found that the cells were indeed cancerous. It was a HUGE scare, but the doc didn't seem overly concerned. She seemed to think it would "clear up" on its own and that the cancerous cells wouldn't "take hold". Fortunately, she was right. My sis had to have her cervix scraped though, to remove the cancerous cells that did not go away when she was in the same situation.

The cervical cancer thing is one of several reasons I stopped taking the pill for awhile. I've since gone back on it temporarily until I am able to find something that works as well and has less risk of cancer (which I'm already at risk for), and fewer horrible side-effects.

So, in my experience, I don't think we get check-ups too often.

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