Posts Tagged ‘cervical cancer’
When to stop cervical cancer screening?
There’s on-going debate about when cervical cancer screening should be stopped. Current UK recommendations suggest that those over 50 should have screening every 5 years, whereas those between 25 and 49 should be screened every 3 years. This is much less frequent than in the US, where screening is every year. This decreases to every three years if you are over 30, have never had an abnormal smear, and in a monogamous or low-risk relationship. If there is a change in the relationship, it is recommended to undergo screening yearly until stable. Women over the age of 65 and have never had an abnormal smear are given the option of not having any more tests.
But UK researchers are worried about calls to end screening in women over 50. They found that although few women have abnormal smears, about 1% will show abnormalities. They did not comment on the severity of the abnormality or whether it required intensive treatment. Statistics show that most cervical cancer occurs in young women, under 35 years of age. Most of the cases are due to infection with HPV, which is sexually-transmitted. However, the HPV may remain dormant and cause problems later in life, so some cancers may occur in those older than 35.
It’s interesting to note that they would consider ending the programme of screening in women over 50. After all, you cannot say that women over 50 suddenly stop having sex. In fact, many of them are still very active. Some have entered into late-life relationships with new partners. Some of these partners may be much younger themselves. I remember attending an infection control seminar where it was reported that some older women were coming home from cruises, where they had “one-night stands” with a fellow passenger, with sexually-transmitted diseases, including HIV.
There is this public perception that older people do not engage in sex. Perhaps, it’s like denying your own parents having sex. So, until someone is free and clear of the act, they should probably continue to be screened for cervical cancer.
On the flip side, I can never understand why some women insist on having smears done when they’ve undergone complete hysterectomies. Is it because their doctor is trying to get extra payment? I would not be in a hurry to have it done unnecessarily.
US doctors pushing to increase circumcisions
Once again, the US is pushing for circumcisions. There had been ongoing debate for years and even urologists had not reached a consensus regarding circumcisions in terms of reducing rates of urinary tract infections (UTIs). Circumcision rates were high at one point, but have recently dropped off. Now, the doctors in the US are urging people to consent to circumcisions for their sons in order to reduce infection rates of sexually transmitted diseases such as herpes, HPV and even HIV.
Reports state that circumcision rates are lowest amongst blacks and Hispanics – the groups with the highest rates of HIV, herpes and cervical cancer. Of course, since cervical cancer only occurs in women, this statement assumes that black women are either getting it or giving it to black men and Hispanics. Though no one understands why the extra flap at the end of the penis would make such a difference in terms of infection, the hypothesis is that the wet skin allows more viruses to stick or that the wetness can lead to ulcerations, which can then allow viruses to enter.
US scientists are pointing to a research done by their colleagues from Johns Hopkins, a well-renowned teaching and research institution. However, the research was carried out in Uganda and only investigated the role of circumcision in HPV and herpes transmission. Apparently, previous research had shown that circumcision led to a “sharp” risk reduction of HIV transmission – the “sharpness” was not revealed in terms of numbers. But, according to this latest research, HPV transmission was reduced by a third while herpes was reduced by 25%.
As with the argument in UTIs, would the reduced risk be nullified if proper hygiene was practiced by uncircumcised males? But, of course, one of the biggest arguments against this research is that a study amongst a group of African males in a country rampant with sexually transmitted diseases cannot be applied across all races in all countries.
Cervical cancer screening for lesbians
There is new concern that lesbians have been given misleading information regarding cervical cancer screening. Because most cases of cervical cancer result from infection with HPV, which is sexually-transmitted, many lesbians have been under the impression that they are not at risk. The fact is, they are at low risk, but not at ‘no risk’. Remember, most but not all cervical cancer are caused by HPV. Also, studies have revealed that many lesbians have had sexual contact with men. It is not enough, however, to say that lesbians who have had no sexual contact with men are not at risk. Their partners may have had contact with men, or even further up the ladder, their partners’ previous partners. Though the risk of transmission of the HPV virus is much lower between women and women compared to heterosexual contact, it can still occur.
UK should lower age of cervical cancer screening
I was surprised to hear that the UK does not screen for cervical cancer until age 25. Previously, I had mentioned that Pap smears are recommended at 18 or when the woman first becomes sexually active. This is the case in the US. Apparently, the NHS does not feel there is enough evidence to support screening for the disease earlier than 25. The NHS now fear that Jade Goody’s case will scare women into thinking that they need it earlier. That seems to be the case as many health charities are pleading with the NHS to change their stance on this. The NHS has pointed out that many young women have abnormal tests which turn out to be nothing, but which can cause unnecessary emotional distress. On such grounds, they oppose having the tests earlier. Are they saying women can’t cope with the distress? Shouldn’t it be up to the woman to decide whether she wants that distress or not? If she wants to take that risk, the NHS should allow it to her and pay for the test. Sexual promiscuity is a leading factor in cervical cancer. Not necessarily that the woman has multiple partners (although that can be the case), but that she is sexually active at a young age. HPV, the human papillomavirus, is a sexually-transmitted virus that comes in many forms. Many of these forms can cause changes in the cervix as a result of the infection, which can lead to cervical cancer. The more sexually active, the more likely you will get the infection. We know that not all women remain virgins until they marry at the ripe old age of 30. So, why not have the test available to those women who are sexually active but younger than 25? It might save their life in the long-run.
Jade Goody brings cervical cancer to forefront
Jade Goody has been getting a lot of attention due to her metastatic cervical cancer. I never watched Big Brother, so I was completely unaware of her celebrity status. And although I resent these minor celebrities getting more than their 15 minutes worth of fame, I do feel for this woman’s pain. Most of all, I feel for her children. Just as I would if I had known her story personally, rather than publicly. As one commentator noted in a recent paper, if she could give attention to a serious medical condition, for which many women would like to ignore, then Ms. Goody’s life has been worthwhile. I hope she realises that.
Getting a Pap smear is extremely humiliating and uncomfortable for most women. In fact, I do not know anyone who looks forward to it. It is worse than the digital rectal exam – and men really deplore that. But the Pap is absolutely necessary for every woman, starting when she becomes sexually active or age 18, whichever is first. Though there is a vaccine for HPV, the virus that is responsible for many cervical cancers, it is not absolute protection, and young women need to be aware of this. For those who are not sexually active or at low risk of cervical cancer, experts recommend that they do not need annual Paps, but may decrease it to every 3 years. That is welcome news. However, if there is ever any abnormality, the frequency needs to be increased.
Unfortunately, when there is even a hint of bad news, most people like to run shy. It appears Ms. Goody is like many other women in this respect. But, hopefully, others will now learn that they need to investigate potential problems and face up to the consequences earlier than later. I admit that I’m one of those who have avoided getting a Pap for years. However, I have been lucky that I have never had an abnormal one. Still, it’s time I take the step and get back into the doctor’s office.
