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Annual Exams are important

As published in 5ive For Women Spring 2011

Recently there has been a lot of confusion surrounding the yearly ritual of annual exams for women. The misunderstanding began in 2009 when the American College of Obstetricians and Gynecologist (ACOG) released their recommendations regarding the frequency of pap smears. They suggested that pap smears not begin before the age of 21, be done every 2 years from 21-29, and every 3 years for women over 30 with a history of 3 consecutive normal paps. Unfortunately, many women interpreted ACOG’s recommendations to mean they no longer needed to have a yearly physical exam. I would suggest that YOU ARE MORE THAN YOUR CERVIX, and that the rest of your body/mind/soul deserves a yearly check-up. I would also suggest that some women need to continue to have yearly pap smears either as a personal preference or for medical reasons. That conversation and decision lies with you and your provider.

The advent of the pap smear in the 1940’s as a screening test for cervical cancer dramatically reduced the number of deaths caused by this disease. This simple test has allowed providers to detect cervical changes that lead to cancer much earlier. With early detection and treatment the death rate associated with cervical cancer plummeted. That being said, we still lose over 4000 women per year to this cancer. Unfortunately, 50% of the women who die from cervical cancer did not have a pap smear in the 5 years preceding their diagnosis. In addition, we now understand that cervical cancer is caused by a sexually transmitted virus, HPV. There are over 100 different types of HPV; each given a number 1-100. The types are further broken down into low-risk types, that cause genital warts but no cancers, and high-risk types, that are responsible for causing cancers of the cervix, vagina, anus, and certain neck and throat cancers. By age 50, 80% of women have contracted some type of HPV infection. Fortunately, within 2 years of infection 90% of those women will clear the virus through their immune system. It’s the 10% of women who don’t clear the virus that are at higher risk of developing cervical cancer. We now have 2 cervical cancer vaccines, Gardasil* and Cervarix*, available for girls and women between the ages of 9 and 26. Both vaccines protect women from acquiring two of the high-risk types of HPV responsible for about 70% of cervical cancers; types 16 and 18. With adequate screening and vaccine administration there is hope we will continue to see a steady drop in the deaths associated with this cancer.

Aside from a pap smear, there are many equally important components to a yearly physical exam. Your exam should include listening to your heart and lungs, checking the size and structure of your thyroid, feeling for lymph nodes in your neck, a thorough breast exam, palpating your abdomen, and a comprehensive pelvic exam including a yearly Chlamydia test for women under 27. Women over 26 who have had a new partner within the last year should also have STD screenings done. Additionally, each exam should include a blood pressure reading, height, weight, BMI, urine analysis, medication/immunization review, review of family and personal medical history, and when indicated blood tests for cholesterol, thyroid function, and anemia. The annual exam is also the time to schedule mammograms, bone density scans, and colonoscopies as indicated by age or history. Each of these assessments ensures that the rest of your body is healthy. In my own practice, I would say that all of the above components of the yearly exam are equally important. However, I also believe that taking the time to address issues of stress, lack of life balance, parenting issues, employment issues, financial stressors, relationship issues, and life transitions rank just as high as the actual physical part of an exam. Women lead complicated and stressful lives and sometimes need the time and space to focus just on themselves for this visit. I believe we have all come to appreciate the connection that the mind and body have in concert with health. It’s a delicate dance and one we need to honor.

So even if your provider has recommended that you no longer need annual pap smears-please don’t forget that “ YOU ARE MORE THAN YOUR CERVIX! “

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