I like the pill very much, because it makes my period almost disappear. I haven’t been on it for several months though, because I just can’t face going back for another pap smear. It was so awful, it took three of the nurses at the school clinic to do it. Once I was on the table they wouldn’t let me leave, every time I said that I had changed my mind they started talking about women my age who had died of cervical cancer and other diseases. They also insisted on going back in with a second swab after taking the one for the pap smear. The second one was to test for venereal diseases, and I knew I didn’t need it, but they kept telling me that I never know what my boyfriend might be doing when I’m not home (he’s a geek, I know what he does when I’m not home: plays computer games and dances to anime music).
I’m going to law school in the fall, and I’m planning to see if I can get the pill at the health center there without a pap smear. Is that ever possible? Or do some doctors maybe give local anesthesia before a pap smear? My brother says he’ll find me a few valium that I can take before the next exam, but I don’t like the thought of taking medicine that’s not prescribed for me. On the other hand, I don’t like relying on just condoms for protection.
Ironically, it turns out that in most instances this is exactly what you should do in the interest of the greater good. Every medical test (even physical examinations), no matter how good, will have some incidence of falsely positive and falsely negative results. If we’re talking cancer, falsely negative tests may have disasterous outcomes and lead to late treatment and poorer survival.
But consider the damage that falsely positive tests can do. Breast cancer is a good area to discuss with regard to this topic. A falsely positive breast cancer screen (self-exam, physician exam, or mammogram) creates unnecessary worry for the patient, and subjects them to unnecessary, invasive medical procedures, such as incisional biopsies and lumpectomies.
Perhaps you’d say, “well, better safe than sorry.” And maybe you’d be correct IF your screening test caught enough early tumors to make a difference in outcomes and didn’t cause lots of women without cancer to undergo biopsy for a falsely positive test. So the key questions are what constitutes “enough” cancer detection and what factors influence the relative ratios of true positives to false positives for a given test. The first question complex and probably is more suited for GD. The second, however, is easily answered and pertains to why it can be a really bad idea to (for example) test young women that have no risk factors for breast cancer.
Take a population of 1000 women in their 20-30s with no familial history of breast cancer and study them for 1 year. This group will have a very low breast cancer incidence (for the sake of this discussion, lets make it 1 in 1000 per year). We test them all for breast cancer using a physician breast examination once during the year. No exam is perfect, and sometimes the MD will feel something they think may be cancer, but on biopsy (or lumpectomy) these turn out to be benign. Lets say that in 5% of women without breast cancer, the MD was suspicious it was on exam. In this example, at the end of the year, we’d have worked up 1 woman with breast cancer (assuming our exam was sensitive enough to catch her) but we’d also work up 0.05(1000)=50 women without breast cancer, causing them needless worry and exposing them to costly, disfiguring, and potentially dangerous medical procedures.
Now let’s discuss a different population: 1000 women 50-60 with a first degree relative that has/had breast cancer. The incidence of breast cancer in this population is drastically higher. Let’s say 1 in 20 per year. If we screen this population with the same test, we find 50 women with breast cancer (assuming 100% sensitivity), and we also pick up 0.05(950)= 48 women without breast cancer for further work-up. The key difference between the examples is that in the second, at least you do a significant amount of good in the way of early detection. In the first, you spend a lot of health care dollars, put many people at risk, and create tremendous anxiety all for a relatively small good.
The only difference between the examples is the percentage of women with the disease. The higher that percentage, the better any test works. Test a low risk population, and you’re more likely to cause harm than do good.
**
IAAAD (I am almost a doctor–in 1.5 blessed weeks), and can tell you, unequivocally that women that have never had intercourse and are otherwise healthy do NOT need Pap smears. Pap smears detect early cervical cancer. Cervical cancer is caused by a sexually transmitted virus (human papilloma virus). No sex means no cervical cancer means no need for Pap smears. Would such a woman get a Pap if she went to a Gyn? Probably, medical economics being what they are. Does she need the test? Nope. The Am Canc Soc recommends Pap smears beginning at age 18 or at the onset of sexual activity. They don’t exclude virgins. But that’s just the real world (it’s not based on science but instead on society)
Of course, our 32 y.o virgin can still get breast cancer (and is at higher risk by virtue of delayed childbearing). The American Cancer Society recommends clinical breast exams every 3 years for women aged 20-39 and that sounds reasonable.
**
I’m sorry about your friend, and although stories like that sound compelling (like my friend who would have died if he’d been wearing his seatbelt when some bozo smashed in his driver side door), they don’t help to make informed personal health choices or public health policy. It is all about odds. Odds, odds odds!!! There, I feel better. Every time you go to the doctor, it’s about odds. Your argument regarding testing is based on a false assumption: that testing causes no harm (or at least that it causes little harm). In fact, how much harm you do with a given test is inversely proportional to the frequency of the disease in the population you are testing.
Jodi: “Every woman is at risk for these diseases. And therefore IMO every woman should be examined for them on a regular basis – be that every year, every two years, or every three years, depending on their circumstances (age, sexual activity, family history, etc.). IANAD, but I have never heard any doctor recommend a woman of any type go more than three years without a Pap and breast exam.”
Here is what the U.S. Preventive Services Task Force (USPSTF, a bunch of doctors and PhDs) has to say:
On cervical cancer: “Routine screening for cervical cancer with Papanicolaou (Pap) testing is recommended for all women who are or have been sexually active and who have a cervix. Pap smears should begin with the onset of sexual activity and should be repeated at least every 3 years (see Clinical Intervention). There is insufficient evidence to recommend for or against an upper age limit for Pap testing, but recommendations can be made on other grounds to discontinue regular testing after age 65 in women who have had regular previous screenings in which the smears have been consistently normal.”
and
“The U.S. Preventive Services Task Force recommends screening mammography, with or without clinical breast examination, every 1-2 years for women aged 40 and older.” “The U.S. Preventive Services Task Force concludes that the evidence is insufficient to recommend for or against routine clinical breast examination (CBE) alone to screen for breast cancer.”
So women <40 (in general) don’t need breast exams and women > 65 (in general) don’t need Pap smears.
What the USPSTF knows that you don’t is that these tests cost money, are sometimes uncomfortable, often fail to detect disease when it is present, AND HAVE FALSE POSITIVES. The biggest issue is false positives which lead to pain, expense, terror, etc. If the test were free, painless and perfect, we could have them daily. Since they aren’t they need to be used only for people for whom they are likely to do the most good and those are the people at highest risk of disease. They are the ones who, if they test positive, are reasonably likely to actually have the disease. People at low risk of disease who are screened with an imperfect test are more likely to have a false positive than a true positive.
Ariadne: “The second one was to test for venereal diseases, and I knew I didn’t need it, but they kept telling me that I never know what my boyfriend might be doing when I’m not home (he’s a geek, I know what he does when I’m not home: plays computer games and dances to anime music).”
Obviously, you’ve got the right to control you own body but I’ve gotta say I think the nurses were doing the right thing. For one thing, they’ve probably seen “virgins” who were 3 months pregnant, let alone women who “definitely didn’t need to be checked for STDs” who had the clap. And as for your faith in your boyfriend, he’s evidently not so much of a geek that he doesn’t have sex with someone.
Wonko, my dear - I come from a large family (among my aunts and uncles 6-12 offspring is not uncommon) and among all my blood relatives only two have ever had cancer, and only one has ever died of it (the other has been in remission for 45+ years). The women are all remarkably free of gynological problems and have cycles so regular they use us to calibrate calendars. Nonetheless I have an aunt who, despite such a genetic background, started her cycles late, was never regular, started menopause at 25 years old, experienced any number of problems, and would up with a hysterectomy before she was thirty. And she was supposedly virgin during all that. She got a bad roll of the dice.
Your risk may be low, but just like getting struck by lightning or winning the lottery, it can and does happen to a certain number of people every year. Your risk is low - but you are not immune.
If the Pill works for you that is fantastic and I wholeheartedly support your decision - but in my family, among the aunts and cousins, we had eight instances of blood clots and three strokes (fortunately, minor strokes, if you can ever call a stroke minor). And only two of those women were smokers and not one over 30 at the time of their “side effect”. Not to mention the high blood pressure problem. Kinda goes beyond such side effects as acne and bloating and weight gain. For some reason the Pill does not agree with the women in my family. Therefore, I decided not to ever take it. Since there are alternatives it just did not seem worth the risk. Yet, throughout my 20’s my concerns were pooh-poohed and I was told I was being “hysterical”. Excuse me? Yes, 'tis appalling some of what I went through.
Even so, it is very necessary to get regular checkups. I also get things like blood pressure and cholesterol checked, too - in fact, I’m more concerned about that since heart disease does run rampant in my family. I go to the dentist every six months. I get regular eye exams. It’s all part of the body maintenance you need to do if you want health and old age at the same time.
Alright, maybe you don’t want to answer this if it’s too graphic, but WHY did it take “three nurses”? What was the “awful”? Maybe I’m just fortunate, but while it’s not fun I’m not sure at all why some women experience pain during this. It seems completely unnecessary.
And I really HATE the bullshit scare tactics involving cancer stories. That kind of “hardsell” makes me REALLY distrust a doctor. Emotional manipulation/blackmail is unethical in my book, and I think you’re just as likely to scare someone away forever as induce them to come back.
I see why this makes sense on a percentage basis; it does not make sense to me as an individual. As a woman, I want vigilant screening of my reproductive health and testing if a possible problem raises its head – as my own personal choice – and I would not for a minute stand for a doctor who would not give my what I considered appropriate testing because such testing, spread over the population as whole, might be deemed to do more harm than good. I’m not making decisions for the population as a whole; I’m making them for me. But maybe that’s just me. Maybe you’re comfortable telling a young woman she can skip her annual for several years – hey, you’re the doctor. But I would not want to be the “statistically insignificant” one for whom the extremely unlikely becomes reality. So it may be about “odds odds odds” for the population as a whole, but being tested in routine, non-invasive ways causes me no damage, and I’m really the only one I care about.
And, yes, I suppose you don’t need some of these tests pre-puberty or post-menopause, but I had been assuming (and rightly so, I think) that most of the people reading this thread are not going to be either of those, but rather are going to be somewhere in between, and further are going to be sexually active. For those people – in other words, for most of us – annual testing is a good idea. Do you disagree?
Actually, I am. My unique genetic makup includes a specific chromosone, which renders me immune from all types of Uterine, Ovarian, and Breast ailments of any and all kinds whatsoever.
Wonko, I think everyone has had quite enough. I know I have.
To anyone who hasn’t picked up on it yet, Wonko is male. Please do not prolong his enjoyment of his little joke at our expense.
Proving that Wonko is, indeed, a huge idiot, because every year there are thousands of men who are diagnosed with breast cancer. This attempt at hijacking this thread is most disgraceful and detestable.
It sounds like what you want is the best health care possible. If a sensible preventative measure or screening exam were out there, you’d like to take advantage of it. I find that commendable. You imply that while community standards and personal standards for health maintenance may differ, for your own safety, you’d opt for more screening than less. I have no difficulty with this position either. What I wonder, though, is how you decide what constitutes a sensible preventative or screening measure versus what would constitute overkill? You say:
Putting things in the context of breast cancer again, how do you decide what constitutes appropriate testing? Do you follow the American Cancer Society’s recommendations (breast self-exams and clinical breast exams only until age 39, supplemented with annual mammography at age 40). Do you want mammography beginning at age 30? Would you opt for prophylactic mastectomy as a preventative measure? What if you had five first-degree relatives all of whom developed breast cancer between 25-40 yo? Surely, you’d opt for even more aggressive breast cancer surveillance, but how would you know what strategy to choose? How can you afford yourself the greatest chance of avoiding disease without subjecting yourself to the worry, pain, and harm of unnecessary medical and surgical interventions? I suggest to you that the only rational approach is to study the biology of the diseases that concern you and how various interventions for these diseases play out when applied to populations of women similar to yourself. Allowing “anecdotal” evidence, like your poor friend with ovarian cancer, to influence your choices unduly, in the absence of any biological or epidemiological rationale, in the end will result in poorer outcomes for you.
That being said, I’m all for rational health care choices. Like when Bozo the Sane was saying he/she was a 32 yo virgin and therefore didn’t require annual gyn exams. Biologically, and epidemiologically there’s nothing wrong with this sentiment. As I discussed in my earlier post, such an individual’s risks for breast, cervical, endometrial, and ovarian cancer are all very low. I’d push hardest for such a person to get a clinical breast exam. The question of cervical cancer surveillance is only an issue because as a physician you can’t always be sure that your patients are 100% forthright. If she truly has never had sex, though, and has no menstrual abnormalities and is otherwise healthy, there’s little to be gained from a pelvic exam.
This is the false assumption you make that I brought up in my previous post. Do you think that non-invasive testing is always harmless? Of course, a clinical breast exam or mammogram can’t hurt you, but a false positive test result can and will. This is why screening large populations for rare diseases is incredibly challenging.
**
I agree 100%. The medical literature is too cumbersome and rapidly changing for the average health care consumer to digest it all and make customized rational decisions. Additionally, often, all the information necessary to make a custom, informed decision is unavailable. Most people are like most people and in that sense, general practice guidelines are a great first approximation of the kinds of health care folks should receive. However, rational choices based on personal traits that deviate from the norm are OK, too.
Geez, you go away for a day or two and look what happens! I had a post back there before Wonko wonked out that got eaten by the server.
I was the first to answer the OP and instantly spouted that annual exams can early detect uterine, cervical and ovarian cancer. Yeah answered with some information that showed that routine screening for ovarian cancer is ineffective.
I found that enlightening, because I also thought that ovarian cancer couldn’t be detected with conventional exams/pap smears until a friend said her doctor said he could “feel” the ovaries during the exam and could, ostensibly, “feel” any cycsts or abnormalities. I thought at the time that sounded weird because the ovaries are pretty tiny. But a doctor said it, so it must be true. And smarty pants me passed on the misinformation here.
Not that that is a reason to *not *get an annual or biannual exam.
To me, the OP was a strange question because back when I was 16 or 17 I just automatically assumed I would go have my first gyno visit at 18 and go every year after that for the rest of my life. It didn’t even occur to me to question having to go. Now I guess I’m so used to it, it doesn’t bother me much at all. And I’ve had that dreaded call-back with an abnormal pap. Thank goodness I didn’t have to get frozen, but the biopsy was plenty bad enough to scare me into (eventually) quitting smoking!
That’s a price I’m willing to pay. Look, by the time the docs are talking about putting a needle in my breast it’s because they at that point think there is a chance I might have cancer. At that point I’m willing to undergo a painful and at that point apparently necessary procedure to determine if I have cancer or not. IOW, it only becomes a “pointless” medical procedure once we’ve determined it is a “false positive,” and not a “true positive,” and that we can’t know until after the fact.
I can see the rationale against over-testing. If 100 women are tested via needle biopsy, for example, and one 1 has cancer, then that’s 99 women who’ve had a procedure they didn’t need. But in light of the fact that you won’t know which is the unlucky one until after the procedures are done, I will continue to demand to be tested if less invasion procedures (such a a external breast exam) indicate further investigation and/or testing is in order for me. It may be “odds, odds, odds” for the population as a whole, but I am not playing the odds with my health. If I make the decision that I will take the pain of an invasive procedure to purchase peace of mind that I would not get simply from being reassured that there’s only a 1 in 100 chance of a malignancy, then that’s my choice to make. And I’m the only one I’m making decisions for.
I’m trying to understand how a “false negative” breast exam can hurt anyone. IS “worry” enough of a negative that it balances out the potential benefit of early detection? I don’t even really understand what a false negative would be in this context. Either the doc finds a lump or they don’t. If they do find a lump, then certain tests (including observation) are required to determine what type of lump it is.
**Of course, a clinical breast exam or mammogram can’t hurt you, but a false positive test result can and will. **
I find this an odd notion. I’m 26 and my NP found two lumps at my last clinical breast exam. Yes, I was worried, although I understood that most likely they were benign. I had to visit the Scary Cancer Wing ™ of my local hospital for some tests and encounter People With Actual Cancer™. but I fail to see how this was harmful to my psyche… The lumps were placed such that they can be easily felt. I mean, if I find the lump on my own, am I “harming myself”? What happened to “Early Detection, Early Cure?” I’d rather know than not know, that’s for sure!
This is all very interesting, and thanks for the input. I’ll consider going in regularly, but I still think that every single year is excessive.
I’ll feel like a bigger idiot if I don’t ask this: How are you defining “sexually active?” Somehow, I’m getting the impression that we’re talking about penis-vagina intercourse here.
On the breast cancer issue: this doesn’t really count as a false positive issue, but modern mammograms can find very small lumps–and it is impossible to tell if they are going to develop into dangerous cancers or if they’ll just stay small forever. The general medical practice is to remove them–and if there are enough of them, that involves a mastectomy. For any given woman, it may be that the surgery is unnecessary and the lumps would never have become a problem . . . or it may be that removing the lumps saved them from a cancer that would have killed them.
That’s one of those cost/benefit things that are very difficult to consider on a personal level, and still pretty damn tough to asses on a statistical level
That sounds like a wise course. Good luck on finding a better place!
I think that’s the typical definition (IANAD, obviously) . . . Anal intercourse would probably qualify as sex, too.
I’d say that you should be checked regularly if you’re doing anything that could possibly get you pregant or has a good chance of giving you STDs. Keep in mind that some behaviour that isn’t technically intercourse can still spread germs. Watch those bodily fluids . . .
Sexually active means having sex. Cold sores and mono spread by kissing could be considered STD’s since kissing is considered foreplay which is considered part of sex.
And oral-genital contact can spread some STD’s - meaning even your strictly lesbian girls need to get exams (in fact, a lesbian couple recommend my current gyne to me).
However, we must keep in mind that multiple partners is the biggest risk factor, regardless of gender. A het girl in a long-term truly monogamous relationship with just one man is at lower risk than a lesbian who screws a new partner every other week. That doesn’t mean multiple partners dooms you to STD’s and other horrors - you can’t get a disease from a partner who doesn’t have any so if you excercise caution and you’re choosey about where you go to scratch your itch you may enjoy an active sex life with more than one person and remain absolutely healthy - it’s just going to be harder than for the virgin or the monogamous gal (of any orientation).
The risk you’re at depends on your current general health, your genes, your lifestyle, who you screw, their health, their habits, and their honesty. That’s a lot of factors to consider. Which is why you need to find a gyne YOU are comfortable with to discuss your health, maintaining your health, and how often you need a checkup.
While you are in the danger zone for cervical cancer, make sure you get your yearly pap smear.
I was 23 when I was told I had the preliminary signs of cerivical cancer. Luckily, since I had been going in for a yearly pap (I was on birth control) it was something they caught. I got to experience the joy of cervical freezing, and all my paps so far have been clear. (yay!)
It’s better to risk an hour of embarassment/uncomfort than have to worry about something like cervical cancer, which can be caught and halted early.
I second (third, fourth, umpteenth) the opinion that you should get a doc you’re comfortable with. Mine delivered me, so I’m sorta biased.
"I also thought that ovarian cancer couldn’t be detected with conventional exams/pap smears until a friend said her doctor said he could “feel” the ovaries during the exam and could, ostensibly, “feel” any cycsts or abnormalities. "
Yes, a doctor (especially one with long, thin fingers) can usually feel the ovaries in women who are not obese. The problem is that all she can tell is if an ovary is enlarged or not, not whether or not there is cancer. Too often, by the time an ovary is noticeably enlarged, ovarian cancer has already spread. And not every abnormally large ovary is cancerous.
“I’m trying to understand how a “false negative” breast exam can hurt anyone. IS “worry” enough of a negative that it balances out the potential benefit of early detection?”
You’re confounding false negative and false positive. A false positive is a result that indicates disease in the absence of disease. And for some conditions the consequences of a false positive are significant. A false positive screening test for breast cancer can lead to unnecessary surgery which is expensive, painful, disfiguring, and potentially dangerous. And don’t dismiss “worry” until you’ve been told you have probably have cancer and need to get your affairs in order. That can ruin your whole day even if it turns out to be a “false positive.”
Choosybeggar, this surprised me. Please take a moment to fight some more ignorance. (though yes, I will check with my gyn -> who I treasure, she’s brilliant, funny and gentle.)
Are you saying that the only cause of cervical cancer is by the above sexually transmitted disease ? Is the above virus the same as herpes or genital warts ? If this is so, why would Pap smears be necessary for monogomous women, once their partner is checked for this virus ?
Thanks, I’d never heard the above before and it made me curious. I figured that cervical cancer was as likely as breast cancer, hence the regular testing, and not dependent on the virus.
