The Mammogram and Pap Smear Controversy
/An interview with Dr. Bobby Katz M.D., FOCOG
Dr. Katz received his undergraduate degree from UCSD, and his medical degree from The Chicago School of Medicine. He interned and completed his residency in Obstetrics and Gynecology from Cedars Sinai Medical Center.
Dr. Katz is an attending physician at Cedars Sinai Medical Center and an associate clinical faculty member of UCLA.
L.W.: There is a lot of buzz about the great controversy surrounding the new recommendation against yearly mammograms.
Can you shed some light?
B.K.: The American Cancer Society guidelines for early detection of breast cancer recommend annual screening with mammograms at age 40 in addition to breast exams. By adhering to these guidelines there was a 29% decrease in the number of breast cancer deaths.
The American College of OB/GYN agrees with annual mammography after the age of 40. The concerns for annual screening include exposure to low levels of radiation and false positives results. However, the arguments in favor, outweigh these concerns.
I agree with the above recommendations, and in addition, the need for testing should be strongly determined by family history and age factors.
L.W.: Is there a high degree of radiation exposure from a mammogram?
B.K: The exposure is minimal. The risk of missing a potential tumor is a greater risk factor than the radiation.
As an adjunct to the mammogram, for women who have a 1st degree family member with breast cancer or if a woman has fibrous breast tissue, a breast ultrasound or MRI are high recommended.
L.W.: What is the BRCA test and who should have it?
B.K.: The BRCA test is the genetic test for breast and ovarian cancer. The person affected with the cancer is the one who should be tested.
L.W.: Since the U.S. Department of Health recommends PAP Smears every 3 years, are you finding that women are waiting 3 years to have gynecological check ups as well?
B.K.: Yes, and that is the problem. A woman still needs to have her ovaries, uterus and breast exam every year. Unfortunately, when a woman hears that she is not an at risk candidate, then there is no need to go for regular check ups, when in fact, she still needs to have them.
L.W.: What is HPV and how is it related to Cervical Cancer?
B.K.: HPV or Human Papillomavirus is a virus that is tested for via the PAP Smear. If a woman tests positive for the virus, it indicates that she was once exposed to it. It can lead to venereal warts, abnormal cells on the cervix, and cervical cancer. If a woman tests positive for HPV, she should continue to have yearly PAP Smears.
L.W.: Now that they have developed a vaccine for HPV, which our children have been receiving, will this wipe out the existence of the virus and reduce the need for PAP Smears in the future?
B.K.: Unfortunately, the vaccine only protects against 4 strains of the virus, which happen to the most virulent ones. there are, however, over 30-40 strains of the virus that affect the female parts.
L.W.: So just to recap, is it correct to say that if one chooses not to have a yearly mammogram and PAP Smear in the pre and post menopausal years, then one should still have yearly gynecological exams, so that the ovaries, uterus and breasts continue to be examined.
B.K.: That is what I would recommend, yes.
