Published January 26, 2006 in issue 0504 of the Hook

BY JOHN HONG, MD [email protected]

When I worked part-time in an Emergency Department in Richmond, there was a young clerk who knew every rap song out there. However, when I sang, "Happy Talk" (even with choreography), she had no clue where the song came from. Her blank stare is permanently burned in my memory.

So being the Ira Gershwin that I am, I changed the lyrics to "Pappy Talk" as in PAP smears. "Pappy, pappy pappy pappy talk, talk about the smear you like to do..." The clerk's blank stare was then accompanied by a dropped jaw. Shouldn't PAP smears be a happy topic?

Papanicolaou smears (PAP) have reduced deaths by cervical cancer by 75 percent. PAP smears are for women within three years of starting sex or over the age of 21. The US Preventive Services Task Force concludes that PAP smears are beneficial and needed at least every three years in sexually active women who have a cervix.

Thirteen thousand new cases of cervical cancer and 4,100 cervical cancer deaths occur in the US each year. But because of awareness and compliance, the incidence continues to drop. One of the main causes of cervical cancer is the Human Papillomaviruses (HPV). (Papilloma and Papanicolaou should marry each other and hyphenate their names. "Introducing Peter and Pauline Papilloma-Papanicolaou!" What a tongue twister!)

There are over 80 different HPV, two of which are most associated with cervical cancer. HPV is sexually transmitted, which is why safe sex is so important whether you have one or multiple partners. Do I sound like the church-lady on Saturday Night Live?

HPV testing is available, but there is no universal consensus on routine screening. Perhaps women over the age of 30 should be simultaneously tested for PAP and HPV.

The Task Force hasn't determined yet if new PAP smear technology is more effective in detecting the onset of cervical cancer. Overall, a PAP smear is about 50-70 percent successful in detecting cancer development. That isn't so great, but yearly PAP smears are more likely to catch something going wrong.

When is it time to hang up the speculum? The Task Force recommends discontinuing PAP smears after the age of 65 in women who have had three consecutive normal PAP smears in the past 10 years, and if there is no change in sex partner. So if you're Cher and go after different men, you probably still need to keep doing your PAP.

Also, women who have had a hysterectomy don't need PAP smears, unless the hysterectomy was because of pre-cancer or cancer.

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