Pap smears have done an awesome service to women. The procedure is credited with reducing cervical cancer from the leading cancer killer of women to the seventh-rated cancer killer. Unfortunately, many medical professionals have told women past menopause they don't need the Pap smear anymore. As you'll see, this is a big mistake.

The Pap test is one of the very few screening exams in which I place significant value. It's especially effective because it detects cellular changes early, before the cells have become a form of invasive cancer. If the changes are found this early, doctors can completely remove the cells, often by non-invasive therapies.

Still, this year, 12,900 American women will develop the disease and 4,400 will die of it. About 60 percent of cases of cervical cancer in the U.S. occur in women who have never had a Pap smear performed, or who have had them infrequently. And more than 25 percent of cases occur in women who have stopped getting Paps, usually after menopause.

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A few years ago, the American Cancer Society changed its recommendation for the timing of this test for women who have had three normal yearly exams in a row. They are leaving the frequency of tests in this population of women to the discretion of their physician, who may choose to test as seldom as every three years.

However, Paps fail to detect abnormal cells 10-25 percent of the time. If your Pap falls in that false negative category and you go for more than three years without an exam, you may be placing your health at significant risk. Over half of cervical cancer in America occurs in women who have not had a Pap in the past three years.

Except for a few special circumstances I'll discuss in a moment, I feel that testing every three years is risky at best and may be downright dangerous. My preference is to perform yearly tests, since the HPV virus, which accounts for 45 percent of cancers, may remain dormant for years or, sadly, there are often cases of infidelity, which spread the virus.

However, if the woman has been monogamous for at least 10 years, and has had three negative yearly Paps in a row, I will repeat exams every two to three years, not yearly. Testing too often may lead to unnecessary procedures and emotional trauma for women. And there are a high number of false-positive screens, leading to unnecessary biopsies and other procedures.

In most cases, where the reading involves only atypical cells (not major changes), I've seen complete correction with vaginal packs of vitamin A and folic acid, along with oral doses (100,000 units of vitamin A and five mg of folic acid daily). Also, the Brassica vegetable supplement Indole-3-Carbinol, which is available at most health food stores, was reported two years ago to actually resolve early invasive cervical cancer! (Take 400 mg daily.)

Regardless, high-grade changes require referral to a gynecologist for close examination and follow up. If cervical-cell changes are caught early enough, the packs and oral vitamins have worked very well in my experience. Do not gamble with your health, even if you think you're at low risk. Invasive cervical cancer is a disease that does not have to happen. This test is a must, even if you're past menopause!

Ref: Morbidity and Mortality Weekly Report, 2000;49:1001-1003.

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