Women celebrating the news test no longer needed annually - Daily Courier: Life

Women celebrating the news test no longer needed annually

Dr. Roberto Leon | Posted: Wednesday, July 27, 2016 2:15 am

There is some earth-shattering medical news about a very sensitive test that women have become accustomed to getting from their doctor on a yearly basis.

The much-venerated (or hated) Pap test is now required, hold onto your seat, only every three years.

And the first Pap is not required in women under 25. This is great news for a lot of women who feel particularly uneasy about it.

What is a Pap test for? It is a screening test for cervical cancer. Screening tests help identify people with increased risk for a condition or disease before they have symptoms or even realize they may be at risk, so that preventive measures can be taken.

The Pap should identify women with precancerous conditions in the cervix.

In the early stages, these lesions cause no pain or bleeding, but if detected, they can be removed successfully with small surgical procedures.

In our country, we see countless women with precancerous conditions, but hardly ever with the more advanced stage called invasive cancer for which the treatment is much less likely to be curative.

I saw thousands of women die needlessly of invasive cancer of the cervix while working in South America and South Africa, because the Pap test was not readily available.

Unfortunately, although the Pap test was designed to detect precancerous conditions, it can also pick up cell abnormalities that are not precancerous.

And it is often difficult to differentiate between the two. The majority of cell abnormalities will go away on their own, but if the test is unclear, it may lead to unnecessary surgical treatment. It is estimated there will be only about one case of invasive cervical cancer for every 1,000 abnormal Pap tests.

The B.C. Cancer Agency, which in charge of funding and interpreting the Pap tests, announced a new policy in June, which specifies that women should have their first Pap only after the age of 25 (it used to be 18, then 21).

And if the test is normal, the next one not needed for three years.

Research has found that getting Paps more often doesn’t offer much in terms of additional protection: annual screening protects about 90-92 per cent, whereas screening every three years still offers a 90 per cent protection.

Is the cancer agency trying to save money by doing this?

Not really. Screening may be harmful to patients, as the resulting treatment of removing a part of the cervix may double the risk of premature birth.

And this is on top of the stress of being told that something was found which could lead to cervical cancer.

Minor cervical abnormalities are common, and cervical cancer is exceedingly rare in women under the age of 25. So unless we find a better screening test, Pap smears can possibly cause more harm than good in these young women.

When are Pap smears not necessary? The cancer agency did not suggest any changes here: women who’ve never been sexually active, women over the age of 69, and women who had a total hysterectomy (with removal of the cervix) do not require Pap smears.

The agency emphasized that Paps should continue as usual in women who had received the HPV vaccine, who are in a same-sex relationship, and transgender with a cervix.

On top of the changes in the Pap screening initiation and interval, yearly breast and pelvic examinations are no longer recommended as screening tests for cancer either.

They don’t seem to help detect early breast or ovarian cancer at all. Breast and pelvic exams are only required in women who have symptoms, such as a lump or pain in their breasts or pelvis, or in selected cases where there is a hereditary cancer condition.

As the Pap smear is making an exit in women under 25, annual screening for chlamydia and other STDs is making an early entry. The Public Health Agency of Canada now recommends yearly testing for STDs in all sexually active women under the age of 25.

This is accomplished with special swabs, which can be self-administered by the patient or taken by the physician. The self administered swabs are more accurate.

We call them “the selfie” in the office. The urine test is the least precise test for chlamydia in women.

Chlamydia is common in Kelowna and Western Canada in general. If it goes undetected, it can move up to the fallopian tubes, and cause a lifetime of pain, infertility and other unpleasant conditions.

Luckily, it can easily be screened for (or prevented by using condoms, every time), and treated successfully long before it can affect the tubes.

So times are changing for women. Chlamydia testing under 25, Pap tests only for the over 25, and every three years thereafter, is the new world.

Be smart, go for your screening tests.

Dr. Roberto Leon is a Kelowna-based gynecologist who has delivered 10,000 babies (at least) over 35 years. Learn more at drleon.ca.