DEAR DR. DONOHUE: Why isn’t the cervical cancer vaccine given to women in their 30s and 40s?

Also, please discuss Pap smears and the new and better Pap smear. Why is it better? – Anon.

ANSWER: Gardasil, the new vaccine for prevention of papillomavirus infection – the cause of cervical cancer – is not as likely to be effective in preventing cervical cancer in women already infected with the papillomavirus. It works best before exposure to the virus. Therefore, the principal target is younger women, between the ages of 9 and 26, with girls of 11 and 12 being the ones chosen to be the concentrated focus of immunization.

More studies are needed to ascertain the vaccine’s effectiveness in older women and in men.

Doctor George Papanicolaou deserves the credit for saving the lives of an uncountable number of women through his work in devising the Pap smear for detection of cervical cancer. The standard Pap smear is still an excellent way to detect what was once a very common cancer. All women who have been sexually active for three years or who have turned 21 – whichever comes first – are strongly urged to begin having Pap smears.

The “new” Pap smear is a new technique in processing cells taken from the cervix. (The cervix is the necklike projection of the uterus; it juts into the vagina.) The technique is called liquid-based cytology, “cytology” being the microscopic study of cells. The sample cervical cells are suspended in liquid and then spun in a centrifuge. The cells collect at the bottom of the centrifuge tube and are more plentiful than cells put directly on a slide after obtaining them from the cervix. The sensitivity of this test – its ability to detect abnormal cervical cells – is increased over the standard test. That’s not to say that the standard test is not good or reliable.

The booklet on cervical cancer and Pap smears provides details on both subjects. Readers can obtain a copy by writing: Dr. Donohue – No. 1102, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: My question is brief. Has anyone ever had a heart attack or dropped dead while taking a stress test on a treadmill? – R.W.

ANSWER: Somewhere around 1 in 2,500 have had a heart attack while undergoing a stress test. Deaths have been reported to be 1 in 10,000.

Those numbers make it sound like stress tests are dangerous. They aren’t. The heart-attack problem is actually not as great a problem as it sounds. The people who experienced a heart attack would have had one shortly and, most likely, in circumstances that might not have been favorable for treatment and recovery. A heart attack during a stress test occurs in a place where emergency treatment is readily available.

The deaths are tragic and inexplicable.

DEAR DR. DONOHUE: This 75-year-old just had a shunt inserted in a heart artery because of a blockage that led to a heart attack.

My five grown children were stunned, since I have always done everything by the book. I got off cigarettes 15 years ago by using nicotine gum. I misread the directions on how to use it, but I got off cigarettes in 10 days – and I was a heavy smoker. When my daughter informed me that I had not followed the directions on how to use the gum, I was amazed. Did my misreading of the instructions come full circle to haunt me now? – M.J.

ANSWER: The instructions that come with some brands of nicotine gum tell you to take one piece of gum every two hours for the first six weeks; one piece every two to four hours for weeks seven through nine; and then one piece every four to eight hours in weeks 10 to 12.

Your getting off cigarettes in 10 days was just fine and did you no harm – then or now. It did you a world of good, even though you eventually had a heart attack. More likely than not you would have had it sooner had you kept smoking.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com

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