Angry Doctor

Saturday, November 04, 2006

There are no stupid questions...

This letter to Today gives angry doc the topic for this weekend's musing.

How often should pap smear be done?

Letter from Haslinda Shamsudin

I am pleased to read that the Obstetrical and Gynaecological Society of Singapore is launching a cervical awareness campaign ("Pap smears = prevention", Nov 2).

Many women are hesitant to go for pap smear screenings for fear of the pain. I was one of them. Having had pap smear screenings for many years now, I would say it merely involves a short period of discomfort during the procedure.

I would like to raise a point about conflicting advice given to women. Polytechnic [sic] doctors who perform pap smear screenings would advise their patients that it is sufficient to have it done once in three years.

Gynaecologists in private practice and at government hospitals would however, advise that such screenings be done annually. Perhaps the Obstetrical and Gynaecological Society of Singapore could clear the air.

Many patients have the misconception that in medicine, there is always (or at least often) a 'right answer'.

But most of the time, there isn't.

Instead, there are (usually) several 'right answers'.

And of course, there are probably many 'wrong answers' too, and a 'right answer' today may become the 'wrong answer' of tomorrow with the publication of a 'landmark study'.

Depending on which study or studies they base their protocol on, different centres will have different recommendations for frequency of Pap smear screening.

But angry doc suspects that Mdm Haslinda isn't really asking about the 'right' frequency for Pap smear screening though.

Or maybe he's seeing un-asked questions where there are none?



  • Here's another "what is the RIGHT answer" question for you angrydoc!

    After patients have completed primary immunization for Hepatitis B, are they recommended to have a booster after say 5 years? Or any booster at all?

    Some of the literature suggests that the value of a booster is not established. Note how they say it.

    While in some countries, the vaccination program recommends a booster every 5 years.

    So which is it?

    Patients are confused cos different doctors tell them different things.

    For myself I tell them the whole truth. If they want a booster it's fine (extra careful), and there is nothing to say that they SHOULD NOT or CANNOT have a booster dose. If they don't want to, it's fine also (no recommendation that they NEED a booster).

    Anyone out there has any comments?

    By Blogger Dr Oz bloke, At November 05, 2006 1:56 am  

  • To all GP's who are reading this :
    stick to 2 years. In between 1 and 3, so you can never be wrong. (I mention GP's because we do not have to follow protocol set by polyclinic administrators who are only good at covering their own ass)
    And I also tell my patients that this is what the O&G people taught me in Med school before they went into private practice.
    FYI - Cancer Society lists the duration as 3 yearly PAP smears in the tiny little adverts they put in the best medical journal in Singapore : The Straits Times. (Look out for them. Usually on top left hand corner of the even numbered ie left side page)

    By Anonymous Anonymous, At November 05, 2006 9:36 pm  

  • I have always followed the US recommendations.

    * Screening recommendations are as follows:

    o The American Cancer Society and US Preventive Services Task Force recommend that all women should begin screening for cervical cancer approximately 3 years after they begin to have vaginal intercourse, but no later than age 21.

    o Beginning at age 30, women who have had 3 normal consecutive Papanicolaou test results may get screening every 2-3 years. Women with high risk factors (DES exposure, HIV infection, or other immunodeficiencies) should continue yearly screening.

    o Another option for women aged 30 years and older is to get screened every 3 years with the conventional- or liquid-based Papanicolaou test plus HPV DNA test.

    o Women aged 70 years and older with 3 or more normal consecutive Papanicolaou test results and no abnormal Papanicolaou test results within the last 10 years may choose to stop having cervical cancer screening.

    o Women who have had a total hysterectomy may stop having cervical cancer screening. Exceptions are those who had a hysterectomy due to cervical carcinoma (or preinvasive changes) and women who had a hysterectomy without removal of the cervix.

    By Blogger Dr Oz bloke, At November 05, 2006 10:02 pm  

  • I have seen many patients in my GP practice who are returning to their Gynaecologists in private practice yearly post THBSO for PAP Smears. Have always wondered why they have been told to do so. But, being in such a closed fraternity, I have often had to stop myself from making comments to patients and just smile. At the same time, it sets me wondering. So far, the only logical explanation I have come up with is : these Gynaes know that they are crappy in their surgical skills and worry that they may have left behind some remnant cervical mucosa.

    It is not the high risk patients that we have a problem advising. Those are idiot-proof : YEARLY, if not 6 monthly. It is the non high risk ones that have generated so much controversy.

    By Anonymous Anonymous, At November 06, 2006 7:26 pm  

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