Pap Smears Come with an Expiration Date: Who Knew?

Debbie says:

medical cross-section of female reproductive system

I was completely surprised to learn a couple of weeks ago that virtually all medical experts suggest that most women stop getting pap smears (vaginal tests for cervical cancer) at age 65. I had one last week at age 64, and it’s probably my last one.

The basic reason for the recommendation to stop is that very few women over 65  develop cervical, ovarian, or uterine cancer.  A review of several studies concluded that the risk is quite small:

According to this review, fewer than 1 in 1000 (and possibly as few as 2 in 10,000) women aged >60 years with a history of a normal baseline Pap smear will develop cervical intraepithelial neoplasia (CIN) 3 or cancer. By comparison, women being screened for the first time had rates of CIN 3 or cancer at 2.3 per 1000 for ages 50 to 64 years, and 1.7 per 1000 for women aged 65 years.

Because this is a literature review, all of the studies had different methodologies and participants, but it seems likely that the participants were not screened for level of sexual activity, because that would probably be called out if it had happened. Since I can’t find any studies that specifically did screen for sexual activity, each of us has to make our own decision without much data.

As I’ve dug further into this, I’ve been interested both in what I can find out, and what I can’t find out, which pretty much reflects what has been studied and published, and what has not.

Here’s what I’ve gleaned:

Cervical cancer specifically is caused by human papilloma virus (HPV). Ovarian and uterine cancers, which also become less frequent as women age, are not HPV-related. All three of these are slow-growing cancers, which means that if one begins to be detectable in your middle 60s, it may not become any kind of a problem until you are 80 or older, at which point many people decide against aggressive cancer treatment.

Some reputable groups and clinics specifically recommend stopping testing regardless of sexual activity. Some recommend continued testing only if you have new or multiple partners. In a New York Times story from 2011, a gynecologist relates a delightful anecdote:

Dr. Feldman was surprised to see an abnormal Pap result in an 80-year-old patient who had been a devoted caregiver for her husband of 55 years, who had dementia. “It seemed like an odd finding,” Dr. Feldman said, until she learned her patient was having an affair with a young man she had met at Starbucks.

You have to pause for a moment to be happy for her; what a way to balance a life with a demented husband! What’s more, both the article and the rest of the literature make it clear that an “abnormal result” is not a cancer diagnosis, though we don’t know what happened to this particular woman.

But back to pap smears. For myself, with no family history of gynecological cancers, and no abnormal pap smears, I’m just done. I can stop putting my heels in the stirrups and scooting my ass down to the edge of the table. And the evidence regarding sexual activity isn’t conclusive enough for me to change this if I suddenly find new partners.  Other women may, of course, make different decisions.

 

 

 

Body Impolitic’s 2015 Guide to Sane Holidays

Laurie and Debbie say:

This annual list is (mostly) for folks who celebrate the upcoming holidays, and are fortunate enough to have people and resources to celebrate with; if you don’t fit that group, skip to the bottom. If you do fit, then even if your family are your favorite people and you look forward all year to the holidays, you still may find useful hints here.

1 – You have a right to enjoy things in your own way. To the extent possible, do as much or as little holiday stuff as you want; it’s supposed to be a celebration, not an obligation.

2 – Spend time with people who know you’re awesome. If you must spend time with people who are toxic, remind yourself three times (out loud) in your last alone moments before seeing them that they are toxic. Then do something really nice for yourself the minute you are out of their presence. (If they are not just toxic but abusive, here’s some excellent advice.)

3 – Eat what you enjoy and don’t eat what you don’t enjoy. Desserts are not sinful, they’re just desserts, and relatives who push you to eat (or not to eat) are not in charge of your choices. If you have a history of eating disorders, or currently struggle with them, this may help.

4 – Wear what you think you look terrific in; accept compliments and ignore digs about your clothes.

5 – Plan your responses to inevitable comments beforehand. Try not to spend energy on the digs, because they probably aren’t going to stop. For example, if you know that your sister is going to tell you, “for your own good,” how unbecoming your hairstyle is, be prepared to say, “I appreciate your concern. Excuse me, I really want to catch up with Uncle Harry.”

6 – If you think kids are fun, they can be a great escape from the adult follies. If kids drive you crazy, keep your distance when you can, and try to keep your patience otherwise: they didn’t overstimulate themselves with sugar and toys.

7 – If you have enough to give to someone who has less, do it. If you know someone who is having a crappy holiday, even if you are too, taking a moment to do something for them that they will enjoy might make you feel better, if it feels right to you.

8 – If you hate the holidays, or they make you sad, you’re not alone. Participate as little as possible. They’ll be over soon. If you’re wishing you had someone (someone particular or folks in general) to spend the holidays with, treat yourself with special care. If you’re a volunteering type, that can work, but so can staying at home and taking a bubble bath.

9 – Be effusive about every gift you get; then be discreetly rude about the awful ones later to your friends. If they’re really awful, throw them off a bridge in the middle of the night.

If you are looking for interesting reading, here’s the 2015 version of the Best Culture Writing list we linked to last year, with lots of chewy, thoughtful essays on progressive topics. And here’s Longread’s best of 2015, another great resource.

If these aren’t your holidays, have a great Chinese meal and enjoy the movie!

We’ll be back in the beginning of the New Year.