Mammograms and PAP Smears: A New Ball of Confusion?
As an obstetrician-gynecologist, health care strategist and author, I find the recent mammogram recommendations of the U.S. Preventative Services Task Force to be concerning and, at this time, counterintuitive. How many times have I, and other, physicians found breast cancers in women in their forties? I once had a patient in her late twenties diagnosed with breast cancer, and we found it via the patient's breast self exam (she thought she "felt something different") and it appeared on her mammogram. It was confirmed by biopsy and she's alive to talk about it today.
In the same week we learned of the Task Force's recommendations for mammograms, women were tossed another curve ball about PAP smears. While the new PAP smear recommendation by ACOG has great factual merit, for many young people--especially young Black girls and women--I'd like to add a caveat as a point of consideration.
Pre-teen, and teenage, sex is rampant and indiscriminate; syphilis is on the rise, and HPV--a sexually-transmitted virus--is known to be a causative factor for cervical cancer. Early detection is still key, especially in minority populations. This is especially true for young Black and Hispanic women.
It's true that the presence of abnormal cervical cells on a PAP smear may prompt us physicians to perform tests and biopsies that might eventually weaken the cervix (and cause problems later in life). With that, some easing of acting on some findings may be in order, as long as the patient is compliant with getting her checkups. But I would not want any young girl or woman to go undiagnosed in the early stages of cervical cancer. No one should have to die from cervical cancer; unfortunately, some Black and Hispanic women still do.
I vividly remember a 16-year-old girl who had an advanced stage of pre-cancer, bordering on an early surface cancer of her cervix (what we call carcinoma-in-situ, or CIS). This happened to her because she had been sexually active since she was 14, and had experienced many sexual partners. [Trust me; I was flabbergasted with her sexual history!]
More research and analysis may be in order but, mainly, a full discussion with your personal doctor is advised. And remember, a "PAP" is only a part of your preventive care visit.
Also, be sure you have open communication with your young daughters. Many parents don't want to admit it, but young people are having sex--oral sex and intercourse. Don't be in denial.
While no medical procedure is perfect, mammograms and PAP smears have resulted in fewer deaths from both breast and cervical cancer. Let's not throw the baby out with the bath water.
Have a Blessed Christmas and Happy Holiday Season!
Melody T. McCloud, M.D.
OB-GYN and Author of BLESSED HEALTH: The African-American Woman's Guide to Physical & Spiritual Well-being [with a new book in progress!]
Dr. McCloud's book, BLESSED HEALTH, can be purchased at this online bookseller: Amazon.