Dear Dr. Roach: I am a 64-year-old woman who goes every year for an annual gynecologist visit, and I have always had a yearly Pap smear. When I turned 60, I was told by my doctor that since my Pap smears were always normal, I need a Pap smear only every three years. At my most recent visit, I was told that a Pap smear for women over 50 is recommended only after five years, if consistently normal in the past, and that after 65, it is not necessary to have a Pap smear.
What are your thoughts on this? I am feeling very uneasy. This sounds like a cost-cutting issue rather than being proactive to prevent a possible issue.
S.S.
Dr. Georgios Papanikolaou found that cancer cells can be seen on a slide prepared from a vaginal swab. As a result, the number of cervical cancer cases in the developed world has dropped precipitously. More recently, it has become clear that cervical cancer develops after exposure to certain types of human papilloma virus (HPV). This virus can be screened for at the same time that cells are taken for the Pap smear. Cervical cancer grows slowly, so occasional screening is very successful.
As women get older, they tend to become less exposed to HPV, and so are at lower risk of developing cervical cancer. Thus, the new guidelines for less-frequent screening make sense. However, I would not recommend screening only every five years unless the woman had numerous normal tests and the testing includes a negative result for the high-risk forms of HPV.
Finally, it is imperative that longer duration of screening be reserved only for women who are either sexually active with one long-term partner or no longer sexually active. Women over 65 with multiple partners should continue screening.
Yes, it is cost-saving, but the guidelines reflect the biology of the disease. The critical women to test are young women at high risk of acquiring the strains of HPV that will eventually cause cervical cancer.
Dear Dr. Roach: Only recently, I noticed two small indentations on the top of my head, a little past the forehead area on either side. They feel about half a centimetre wide and one centimetre long. They don’t hurt, and there hasn’t been an injury that might have caused them. Also, I have no headaches, but it is puzzling that I wasn’t aware of them before.
L.L.
It sounds like you may be feeling the coronal suture, where the frontal bone has fused with the parietal bone. As infants, the bones are unfused, allowing for growth of the bones and the brain. In childhood, they fuse together. In adulthood, the fusion is complete and completely ossified (turned to bone). I suspect you are feeling a slight defect where the joint was. It is nothing to worry about.
I often have patients see me about normal anatomic structures that they have been unaware of for their whole lives, only to become intensely curious about it once it’s brought to their attention, often by trauma or a skin issue.
Dear Dr. Roach: My wife, 64 years old, had been active and strong. Now, because of rheumatoid arthritis, she has lost strength, stamina and interest in things she used to do. As a child, she suffered from rheumatic fever and took penicillin daily for more than 50 years. Two years ago, our family doctor took her off penicillin abruptly. Six months later, she developed rheumatoid arthritis. I asked the doctor if the abrupt stopping of penicillin caused her rheumatoid arthritis. He said no. He referred her to a rheumatologist, who put her on different medicines. Do you think, as I do, that penicillin would work better for her?
E.K.
I understand your consternation. Your wife was fine when she took penicillin. Six months after stopping it, she’s not so fine. She took the penicillin to prevent a second attack of rheumatic fever. At this point in her life, she no longer needs that kind of protection. I have no way of being absolutely certain, but I don’t believe that stopping penicillin, even stopping it abruptly, was instrumental in her developing rheumatoid arthritis.
Your point of view has some justification. If you and your wife want to experiment, she could go back on penicillin for a short time to satisfy your curiosity. Her doctor would have to agree. I’m not sure this is the right thing to do. Needless taking of antibiotics leads to the emergence of supergerms.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
