Saturday, May 24, 2008

Pap smears 'are a waste of time'

A CERVICAL cancer specialist has welcomed a drop in screening among young women, saying Australians had finally realised they are "wasting their time" getting pap smears every two years. New statistics from the Australian Institute of Health and Welfare (AIHW) show cervical cancer cases and death rates have dropped, but testing rates among younger women were slipping. Health officials say the drop, by as much as 15 per cent in the past decade, was a concern and called for women to be vigilant about biennial screening even if they have been immunised with the new cervical cancer vaccine.

But Dr Gerry Wain, former director of the NSW cervical cancer screening program, said the results showed women and doctors were understanding cervical cancer prevention better than the policy makers. "They know from going back time and time again for smears that it's just not necessary to get them that often," said Dr Wain, a gynaecological oncologist at Westmead Hospital in Sydney. "It's wasting their time and it's putting pressure on the screening program that it just doesn't need."

Dr Wain said he supported changing guidelines to three-yearly screening as recommended by the World Health Organisation, and called for women aged 20 to 24 to be removed from the program all together. "They have the vaccine, and statistics show their infections invariably go away on their own anyway," he said.

The new report, Cervical Screening in Australia 2005-2006, showed that in the two years to 2006, about 56 per cent of women in their late 20s got a pap smear compared to 65 per cent a decade earlier. A similar drop was seen among women in their early 20s and 30s.

The statistics were gathered before the introduction of Gardasil and Cervarix, Australian-developed vaccines which protect against two types of human papillomavirus that cause 70 per cent of all cervical cancer cases. Universal vaccination is expected to dramatically decrease rates of disease for the under 26-year olds who get it, but AIHW officials say all women still need to get screened.

"The need for women to have regular pap tests remains as important as ever, despite the significant advance of the new cervical cancer vaccination," said the institute's medical adviser Dr Paul Magnus.

The report showed Australia had one of the highest screening rates in the world. Both the number of new cases and the death rate had more than halved in the past decade.


Patch form of HRT may pose less clotting risks than pill does

Good to see that proper caution about the results is included and that the very low probablity of harm is mentioned. The small number of studies chosen for inclusion in the survey seems rather surprising, however. Are we seeing biased data selection here?

Previous studies have found an increased risk not only of blood clots, but also coronary heart disease and breast cancer among postmenopausal women who take hormone replacement therapy (HRT). But, according to background information in the paper, no one has assessed how high the increased risk is, or whether the risk varies with the type of therapy.

Scarabin and his colleagues reviewed data from eight observational studies and nine randomized controlled trials on HRT and venous thromboembolism (VTE), a potentially fatal blood clot in the vein. Pool results indicated that the risk of VTE was 2.5 times higher in women taking oral estrogen compared to women taking no estrogen. The risk was most pronounced during the first year of treatment and in women who were overweight or predisposed toward developing blood clots. By contrast, women currently using the patch had only a slightly elevated risk compared to women taking no estrogen. Women who had stopped taking HRT saw their risk return to normal.

According to the authors, the increased risk translates into an additional 1.5 events per 1,000 women per year. Most of the data came from existing observational trials, however, not the gold-standard randomized trials, so the findings should be interpreted with caution, the authors warned.

Other experts agreed. "It's observational and very interesting, but clearly more studies need to be done," said Dr. Suzanne Steinbaum, director of women and heart disease at Lenox Hill Hospital in New York City. "Maybe this opens the door for a way to give hormones more safely to those who need it."


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