When Should Young Women Start Getting Pap Smears?

5461276006_df3a5a44b8_zCervical cancer was once the number one cancer killer, but with the introduction of the Pap smear almost 60 years ago, this cancer has become increasingly rare.  The guidelines for cervical cancer screening are always evolving, and the American Society for Colposcopy and Cervical Pathology (ASCCP) has been at the forefront of these changes.

The relationship between high-risk HPV (human papillomavirus) and the development of pre-cervical and cervical cancer has been well established.  Thankfully, most HPV infections are short-lived and not detected within 1-2 years.  Only a small percentage of infected women will go on to develop a high-grade cervical abnormality or cervical cancer.

More than 80% of all women will develop a genital HPV infection by the time they reach the age of 50.  HPV infections are the most common in young women, and again, these infections are cleared by most young women in less than two years.

We now have a good understanding of the natural history of HPV infections and the development of cervical cancer and the pre-cancers.  ASCCP’s guidelines advise that cervical cancer screening should begin at age 21 regardless of the age of sexual initiation.  Since most of the infections in the young will regress, starting a screening program at an earlier age may result in many unnecessary treatment interventions.

Remember to always discuss your particular concerns and develop your individual screening program with your healthcare professional.

-Dr. P






Polycystic Ovary Syndrome in Young Women – Signs You May Have It

…..P??????????????????olycystic ovary syndrome (PCOS) is a common endocrine problem in young women, and it often goes undiagnosed in the adolescent population.  The patients are frequently presented with menstrual irregularity and signs of androgen excess, which includes unwanted excess hair growth and acne.  These are the symptoms that usually lead the patients to visit their health care professional.  The weight of the young women can range from normal to elevated, and with obesity, the androgen affects can be more advanced.

…..To make the diagnosis of PCOS, certain criteria need to be met.  The most common guideline requires 2 of the following characteristics:

  • Signs of androgen excess
  • Irregular menses (probably secondary to problems with ovulation)
  • On a sonogram exam of the pelvis, the ovaries are found to have many small cysts (polycystic ovaries)

…..PCOS can have metabolic consequences with major effects on the glucose metabolism, affecting up to 25% of these young women.  There are different ways to screen for this abnormality, from obtaining fasting levels of glucose and insulin to a full glucose tolerance test.  Elevated weight levels, monitored by determining the BMI, increases the risk of developing these metabolic problems.

…..Next time we will review management for the young PCOS patients.

-Dr. P