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Q: I'm 71 years old. Do I need Pap tests at my age?
A: The early detection and treatment of cervical cancer is a remarkable medical success story.
After the introduction of regular screening by Pap smears, cervical cancer rates began to go down steadily. And rates today are about half what they were 30 years ago.
Most cases of cervical cancer happen only after exposure to one of several types of the human papilloma virus (HPV). Screening today can include tests for HPV, as well as Pap smears.
In addition to better tests, we also have a greater understanding of how cervical cancer impacts women in different age groups. So we can now apply screening programs more effectively.
The guidelines for when and how often women should have Pap smears have recently changed. Still, the guidelines must be applied carefully to each woman, taking into account her unique risk factors. So discuss cervical cancer screening with your doctor to decide what's best for you.
Infection with HPV is fairly common. Fortunately, almost all women clear the infection and never go on to develop cervical precancer or cancer. In women who do not successfully clear the HPV infection and develop pre-cancer, it usually takes several years for it to become a cancer, if at all.
Based on what has been learned about HPV and cervical cancer, screening guidelines based on age and risk make more sense than ever. For women after age 65, routine Pap smears are not necessary as long as prior screening tests have been adequate and negative.
Adequate testing is:
-- 3 consecutive negative Pap smears within the past 10 years, or
-- 2 consecutive negative Pap smears, and 2 negative HPV tests within the past 10 years (the most recent test being within the past 5 years).
Women over 65 who've had abnormal testing should not stop getting Pap smears until additional testing is done under their doctor's direction.
(Joan Marie Bengtson, M.D., is assistant professor of obstetrics, gynecology and reproductive biology at Harvard Medical School and a member of the Department of Obstetrics, Gynecology and Reproduction at Brigham and Women's Hospital, Boston, Mass.)
(For additional consumer health information, please visit www.health.harvard.edu.)