Tag Archives: ovarian cancer

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.




Ovarian Cancer Chemo: Another Way Medical Profession Kills Fat People

Laurie and Debbie say:

We had a completely fun post planned for this afternoon, but it has been pushed aside by an urgent public service announcement (which has Debbie literally shaking with rage).

You may have read studies that say that fat people have shorter lifespans after certain cancers and chemo treatments.

Want to guess why?

Because chemo doses are based on “ideal weight,” that’s why. And SURPRISE! When chemo doses are calculated based on actual weight,

Obese and non-obese patients had similar progression-free survival (17 versus 11 months, P=0.14) and overall survival (48 versus 40 months, P=0.37) following primary cytoreductive surgery that resulted in similar rates of optimal debulking, Kellie Matthews, M.D., of the University of Alabama at Birmingham, and colleagues reported online in Gynecologic Oncology.

(This study is limited to ovarian cancer, and included 304 people. Some of the results, like why underweight women didn’t live as long, are not statistically significant. Nothing about other cancers was involved. At the same time, it’s not a 15-person junk study either.)

In plain English, this means that in general the doctors decide what you “should” weigh and calculate your chemo accordingly. Most likely, this means that they take your height and calculate your non-overweight BMI, but there are lots of other things it could mean. It may well mean that tall people are underdosed as well as fat people, and that short people get chemo overdoses. It may well mean that men and women get dosed differently regardless of their body weight. And you can bet that this applies to other cancers as well.

What it clearly means is that people die.

It means that, on the long list of ways you have to defend yourself in the doctor’s office (or get a family member or friend to do it for you), you have to add “Is this chemo dosage based on my actual weight?” and then you have to fight dauntlessly to make sure that it is. And you have to tell every one of your friends and relations to do the same. And you have to watch out for the people you know who might be less skilled at protecting themselves in the doctor’s office due to personality, or class, or education level, or anything else, and do that for them.

And you have no choice, because the medical system is not there to protect you on this, it’s there to decide what you should be like and medicate that person instead of you.

Debbie says: I’m deeply sick of having to carry all these burdens. I want to hand them off to the people who get paid inordinate sums of money to take care of me and mine. But that’s not happening any time soon, now is it?

Very very wry thanks to bearsir (S. Bear Bergman) for the pointer.