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This project on pap smears started during dinner at Il Mulino, a well known Italian restaurant in Manhattan's West Village.
I was waiting for my appetizer when I overheard two women diners talking about pap smears. The one in her 40's said she hated pap smears. The one in her 30's enthusiastically agreed. And they both said they do whatever they can to postpone them.
Part of their conversation was masked by the loud conversation of other diners. From what I could gather, the problem was that the gynecologist's instrument is refrigerated. I thought I heard the words, "Really cold spatula!" But I later learned that the gynecologist's instrument is actually called a "speculum" (meaning I'd either misheard the word spatula… or simultaneously picked up part of a conversation taking place in Il Mulino's kitchen).
In any case, I shuddered at the thought of a cold instrument being used for such a medical screening and hardly noticed as the waiter shaved large chunks of parmesan cheese onto my side plate.
As the appetizer arrived (lightly fried calamari drizzled with a really great spicy marinara sauce), I was asking myself the question, "Should CBS Cares do a project on pap smears? Why had we not seen public service campaigns on the subject?"
By the time the main course arrived (breaded shrimp sautéed in a delicate wine sauce, accompanied by a surprisingly verdant escarole), my mind was made up – I would call Isaac Schiff on Monday to pursue the matter!
Isaac Schiff, M.D. is a legendary gynecologist at Harvard Medical School and the Massachusetts General Hospital with whom CBS Cares had worked on other women's health issues.
Dr. Schiff took my call. He listened as I excitedly relayed what I had overheard at Il Mulino. He told me that many women – especially as they get older – think it's okay to skip their pap smears… sometimes with fatal consequences. Dr. del Carmen on Dr. Schiff's staff – who is an expert on the subject of pap smears – joined. They urged us to proceed.
And who would have thought that – on the eve of this project's launch – The American College of Obstetricians and Gynecologists (ACOG) would announce new pap smear recommendations?? These guidelines state that annual pap smears may no longer be necessary for most women.
Based on this news, we debated whether this project was still important. We concluded – in consultation with Drs. Schiff and del Carmen - that it is actually more important and timely than ever… because an announcement that recommends less frequent pap smears could cause some women to mistakenly conclude that pap smears are not important.
In fact, while the experts may hotly debate ACOG's findings, they all agree on one thing – a pap smear remains one of the most important health screenings a woman can have. And skipping them costs lives. CBS Cares stands by the pap smear!
What follows is Dr. del Carmen's essay on pap smears, which addresses ACOG's new guidelines. Whether you're a woman, or a man who cares about the women in your life, we hope you will take a few minutes to read Dr. del Carmen's important essay and talk to your doctor. And, if you're overdue for a pap smear, please get one – the staff of Il Mulino would want you to!
Wishing you a healthy and happy holiday season.
Cervical cancer is the second most common cause of cancer-related disease and death among women worldwide. However, cervical cancer is an entirely preventable cancer with adequate screening. The best way to detect cervical cancer is by having a regular Pap smear. Pap smears save lives. Half of the women who are diagnosed with cervical cancer have never had a Pap smear.
Screening is recommended starting at age 21 or no later than three years after initiating vaginal intercourse. The newest recommendations from the American College of Obstetricians and Gynecologists (ACOG) state that women in their 20s should be screened every two years. In women over the age of 30 who have had three normal, consecutive Pap smears, a screening once every three years may be appropriate. The ACOG guidelines note that women can stop having Pap smears between the ages of 65 and 70 if they have had three or more negative tests in a row and no abnormal test results in the previous 10 years. The ACOG recommendations for less frequent screening do not apply to women who may have a compromised immune system, such as women with HIV infection or those who have had an organ transplantation.
The Pap smear is done during a pelvic exam, and consists of collecting cells from the cervix. After the cells are collected, they are placed into a solution, which is then sent to a lab for testing and analysis.
In the US, there are about 2-3 million abnormal test results found each year. An estimated 11,070 new cases of cervical cancer and 3,870 deaths from this malignancy were reported in the United States in 2008. Worldwide, there was an estimated yearly incidence of 500,000 cases and 250,000 deaths. We have seen a decline in US incidence and mortality rates from cervical cancer that can largely be attributed to the implementation of Pap smear screening programs; however, marked disparities in these rates continue to persist despite overall reductions.
Cervical cancer incidence and death rates vary considerably among racial and ethnic groups. The Hispanic-Latino and African American groups had the highest incidence and death rates when compared to the Caucasian group. The issues that affect this disparity in incidence and mortality are complex. It is of critical importance to fold these underserved populations into Pap smear screening programs and educate them on the role Pap smears play in preventing cervical cancer and subsequently saving lives.
Dr. Isaac Schiff, Chief of the Vincent Memorial Obstetrics and Gynecology Service at the Massachusetts General Hospital and I are strong supporters of Pap smear screening and advocates for the development of screening programs reaching out to underserved communities. Cervical cancer is a preventable disease with the use of Pap smear screenings. We implore you to be vigilant in protecting your health by calling your doctor and scheduling your Pap smear today!
Biosketch of Marcela G. del Carmen, MD, MPH
Dr. del Carmen is a graduate of the Johns Hopkins School of Medicine. She completed a residency in Gynecology and Obstetrics at the Johns Hopkins Hospital and a fellowship in Gynecologic Oncology at the Massachusetts General Hospital. Dr. del Carmen received her Masters in Public Health degree from the Harvard School of Public Heath. She is Associate Professor of Obstetrics, Gynecology and Reproductive Biology at Harvard Medical School in Boston, MA.
Dr. Schiff is a graduate of McGill Medical School and did his Residency in Obstetrics and Gynecology as well as a Fellowship in Reproductive Endocrinology at the Boston Hospital for Women (now Brigham and Women’s Hospital). He was Director of the Division of Reproductive Endocrinology at Brigham and Women’s Hospital before moving over to the Massachusetts General Hospital to become Chief of the Vincent Obstetrics and Gynecology Service. He was responsible for initiating the Obstetrics program, the IVF program, the Division of Urogynecology and recruiting the leadership for the Vincent Center for Reproductive Biology. He is the Joe Vincent Meigs Professor of Gynecology at Harvard Medical School. Dr. Schiff is one of the founding trustees of the North American Menopause Society and has served as Editor-in-Chief of its journal Menopause since its inception. Dr Schiff is also Chairman of the Medical Advisory Board of Pause, a consumer journal of the American College of Obstetricians and Gynecologists.
CBS Cares would like to warmly thank (alphabetically):
Chris Beetem, Marcela del Carmen, M.D., M.P.H., Tracey Goldblum, Karen Leon, Brian Liebman, Josh Pais, Isaac Schiff, M.D., …and the two women at Il Mulino whose dinner conversation sparked this project.