When to discontinue pap smears?

DEAR DR. DONOHUE: I am 63 and have had a Pap smear every year for as long as I can remember. How long do I have to continue? I am embarrassed to admit it, but I don’t really know why this test is done. I do know that it has something to do with cancer, but that’s the extent of it. — K.S.

ANSWER: Pap smears — named after the pathologist Dr. George Papanicolaou — are taken to detect early cervical cancer. The cervix is the funnel-shaped, lowermost portion of the uterus. It projects into the vagina. At one time, cervical cancer was the leading cause of female cancer deaths. Since the introduction of Pap smear screening, its death rate has been cut in half. This year, about 11,000 new cases of cervical cancer will occur in the United States and a number comparable to its population in Canada.

Papillomaviruses cause this cancer. The new vaccine Gardasil, developed to prevent papillomavirus infection, will further reduce the number of cervical cancer cases. The vaccine affords protection against the viruses responsible for 70 percent of cervical cancers.

The age at which it’s safe for women to stop having Pap smears varies according to different expert panels. Women who have never been screened should be, regardless of their age. At age 70, if a woman has had three consecutive normal tests in the previous 10 years, many experts say she no longer needs to undergo testing. The United States Preventive Services Task Force, another group of experts, states that a woman can stop testing at age 65 if she fulfills the same requirements.

Women who have had a hysterectomy and have had their cervix removed do not need to continue to have Pap smears.

The pamphlet on cervical cancer and Pap smears provides more information on these topics. Readers can order 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 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: Please explain a varicocele. My 48-year-old son was just diagnosed with one. — L.H.

ANSWER: A varicocele (VAIR-uh-koe-SEAL) is a tangle of dilated veins in the scrotum. It’s very much like varicose leg veins.

A varicocele might cause achy pain. There is a question about its role in contributing to infertility. If neither of these applies, then the varicocele can be ignored.

Varicoceles that are painful or suspected of influencing fertility can be removed surgically. The operation is not an involved one, and recuperation in quick.

DEAR DR. DONOHUE: My mother is 80 and usually in good health, but she often feels tired and complains of generally not feeling well. When she goes to the doctor, she often states that she feels her doctor is in a hurry and doesn’t listen to all she has to say.

I have recommended that she consider changing to a geriatric specialist, who, I have been told, allows more time for office visits. I assume that such a specialist is more versed on matters pertaining to the treatment of seniors.

Would you share your thoughts on what might be the advantages of someone my mother’s age having a geriatric specialist as her primary physician? — R.C.

ANSWER: Children have a different physiology and a different set of illnesses than adults. That’s why the specialty of pediatrics developed. Older people also have a unique physiology and a unique set of illnesses. That’s the reason for the field of geriatrics.

I know your mother needs a change of doctors. She needs a doctor who will listen to her. A geriatric doctor would be a good choice for someone her age.

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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