New guidelines by the American College of Obstetricians and Gynecologists say most women in their 20s can have a Pap smear every two years instead of annually to catch slow-growing cervical cancer.
The change comes amid a separate debate over when regular mammograms to detect breast cancer should begin. The timing of the Pap guidelines is coincidence, said ACOG, which began reviewing its recommendations in late 2007 and published the update Friday in the journal Obstetrics & Gynecology.
The guidelines also say:
Routine Paps should start at age 21. Previously, ACOG had urged a first Pap either within three years of first sexual intercourse or at age 21.
Women 30 and older should wait three years between Paps once they've had three consecutive clear tests. Other national guidelines have long recommended the three-year interval; ACOG had previously backed a two- to three-year wait.
Women with HIV, other immune-weakening conditions or previous cervical abnormalities may need more frequent screening.
Paps can spot pre-cancerous changes in the cervix in time to prevent invasive cancer, and widespread use has halved cervical cancer rates in the U.S. in recent decades. About 11,270 new cases will be diagnosed this year, and about 4,070 women will die from it, according to American Cancer Society estimates. Half of women diagnosed with cervical cancer have never had a Pap, and another 10 percent haven't had one in five years.
Cervical cancer is caused by certain strains of the extremely common sexually transmitted virus called HPV, for human papillomavirus. There is a new HPV vaccine that should cut cervical cancer in the future; ACOG's guidelines say for now vaccinated women should follow the same Pap guidelines as the unvaccinated.
But the updated guidelines reflect better understanding of HPV. Infection is high among sexually active teens and young adults. Women's bodies very often fight off an HPV infection on their own without lasting harm, although it can take a year or two. The younger the woman, the more likely that HPV is going to be transient.
Moreover, ACOG cited studies showing no increased risk of cancer developing in women in their 20s if they extended Pap screening from every year to every two years. As for adolescents, ACOG said cervical cancer in teens is rare ? one or two cases per million 15- to 19-year-olds ? while HPV-caused cervical abnormalities usually go away on their own, and unnecessary treatment increases the girls' risk of premature labor years later.
Low Cholesterol May Prevent Some Prostate Cancers
Men may protect more than their hearts if they keep cholesterol in line: Their chances of getting aggressive prostate cancer may be lower, new research suggests.
One study found that men whose cholesterol was in a healthy range below 200 had less than half the risk of developing high-grade prostate tumors compared to men with high cholesterol.
A second study found that men with lots of HDL, or "good cholesterol," were a little less likely to develop any form of prostate cancer than men with very low HDL.
Both studies were published Tuesday in Cancer Epidemiology Biomarkers & Prevention, a journal of the American Association for Cancer Research.
The two studies are not definitive and have some weaknesses. Yet they fit with plenty of other science suggesting that limiting fats in the bloodstream can lessen cancer risk.
"There might be this added benefit to keeping cholesterol low," said Elizabeth Platz of Johns Hopkins University. She led the first study, which looked at 5,586 men aged 55 and older who were in the placebo group of a big federal cancer prevention study done in the 1990s.
Cholesterol levels made no difference in the odds of getting prostate cancer except for the 60 men who developed high-grade tumors, the type that grow and spread fast. The chance of developing one of these aggressive tumors was 59 percent lower among men with cholesterol under 200.
That's "a striking reduction in risk," Eric Jacobs and Susan Gapstur, epidemiologists with the American Cancer Society, write in an accompanying editorial.
Now for the caveats: Researchers do not know how many men in the study were taking statin drugs such as Lipitor, Zocor or Crestor. That means some of the reduced cancer risk could have come from these cholesterol-lowering medicines instead of from low cholesterol by itself.
Previous reports also suggest that statins can lower cancer risk, but it's premature to take them for this reason until better studies are done, doctors advise. Statins have long been known to prevent heart disease, and nothing about the new research changes that.
The second study involved more than 29,000 Finnish men more than a decade ago. The men, all smokers, were testing whether various vitamins and nutrients could lower their cancer risk. Those with highest levels of HDL were 11 percent less likely to develop prostate cancer than those with lowest levels, said study leader Dr. Demetrius Albanes of the National Cancer Institute.
Prostate cancer is the most common cancer in American men. More than 192,000 new cases are expected to occur in the United States this year, leading to an estimated 27,360 deaths.
Skin cancer is the most common form of cancer in the United States. The two most common types are basal cell cancer and squamous cell cancer. They usually form on the head, face, neck, hands and arms. Another type of skin cancer, melanoma, is more dangerous but less common.
Anyone can get skin cancer, but it is more common in people who:
Spend a lot of time in the sun or have been sunburned
Have light-colored skin, hair and eyes
Have a family member with skin cancer
Are over age 50
As your physician, part of our job during your annual physical exam is to check your skin for abnormal moles. You can alert us at anytime if you are concerned about a mole's behavior. Here are some characteristics of a mole that could be worrisome:
A: asymmetry- round or oval is characteristic of benign (non-cancerous) moles. Any mole that is irregularly shaped should be examined by your family physician.
B: border- any mole with an irregular border should be examined by your family physician.
C: color- moles that have changed color or have more than one color or shade of brown should be checked out by your physician.
D: diameter- moles larger than 6mm or the size of a pencil eraser should be checked annually by your physician.
E: evolution- any change in the size, shape or color of a mole could be a worrisome sign that the mole has become cancerous.
Another helpful tip is that benign moles usually do not appear after you turn 30 years old. Any new moles after the age of thirty should be examined by your family physician.
If we are concerned about the nature of a mole, we may suggest a skin biopsy. This procedure can be performed at our office, usually in under 30 minutes. Sometimes we may consult a dermatologist if the biopsy report shows melanoma. Otherwise, your family physician will provide further skin monitoring.
When in doubt about a mole, make an appointment with your provider at Capital Family Medicine so we can check it out!
The Scoop On High Fiber Diet
Many people struggle with cholesterol and diabetes, or they worry about their family history of such diseases. One good approach to fight cholesterol, high sugar levels and obesity is a high fiber diet. Below are a few tips to maximize your effort:
Most people wrongly assume that "anything brown" has lots of fiber. Note though that the key ingredient you need to look for on the label is "whole wheat." If the ingredient label says "enriched wheat flour" or "enriched flour", put it back on the shelf. The best and highest content of fiber is found in "whole wheat" products. "Enriched" = bad. "Whole wheat" = good.
Not all oatmeals are created equal. Yes, oatmeal is a quick, easy, and convenient way to incorporate fiber. Aim for the ones that are "heart healthy" though. If you look at the back labels, you will see this is not an ad gimmick- rather, these oatmeals often have double the fiber (4 to 5 grams per serving instead of 2 grams).
Use the above tips to maximize your effort, dollars, and health.
(Author note: the above article is meant solely for medical information purposes. It does not constitute formal medical advice or a doctor/patient relationship.)
Emergency Room and Hospitalization After Care
Visiting an emergency room is an anxiety provoking situation. You are not feeling well and you are in a chaotic environment that often requires long wait times.
After being evaluated by an emergency room physician you will either be admitted to the hospital for further treatment or discharged home. In either case, upon release from the hospital you will be given instructions to follow up with your primary care physician (i.e. Capital Family Medicine or Wakefield Medical Care) and often times a specialist.
Sometimes the appointment with a specialist is necessary to improve your care, but many times seeing your primary care physician FIRST is in your best interest. Afterall, we know you better and can make more informed decisions about whether your care will be improved by involving a specialist after your release from the hospital.
So remember, if you have been instructed to see a specialist after being released from a hospital, BEFORE you do so, be sure to see your primary physician within 48 hours in order to discuss an aftercare plan. We will make every effort to see you within 48 hours of discharge from the hospital. An aftercare plan could safely help you avoid unnecessary specialty clinic visits and fees.
We care about your well-being as well as your time and want to ensure that our patients receive the best care without unnecessary testing or expense. So make an appointment to see your primary care physician within 48 hours of being released from a hospital.
The contents of capitalfamilymedicine.com website, such as text, graphics, images, and other material contained on the capitalfamilymedicine.com websiteite (“Content”) are for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on the Capitalfamilymedicine.com site.