With modern medical practices constantly evolving, physicians frequently find themselves adjusting to updates in their respective disciplines. And as they handle those changes, it is important they educate and familiarize their patients with new developments and changing practices.
Dr. Tessa Reisinger and Dr. Francis Finneran, who both practice at Canandaigua Medical Group and joined the Thompson Hospital staff in 2017, recently took time away from their busy schedules to discuss a couple of these new developments. Reisinger addressed new Pap smear guidelines, while Finneran spoke about a recent study on birth control and its possible relationship to breast cancer.
New rules for Pap smear
Guidelines for the Pap smear, a test that involves sampling cells from the cervix to check for abnormalities that may be indicative of cancer, have changed several times over the years. This repeated altering of guidelines can lead to confusion for patients, Reisinger says.
“For a long time, it was getting a Pap smear once a year,” Reisinger says. “That was simple and people were used to that. But now they are spaced out a bit. Now, for low-risk women, we recommend them once every three to five years, depending on age.”
The reason for the lengthening of time between screenings is that doctors have a better understanding of how long it takes for abnormal cells to become cancerous.
“We’ve found that it takes probably more than five years, in most cases,” Reisinger says. “In a lot of cases, more mild abnormalities will go back to normal on their own without us intervening.”
Another reason is the human papilloma virus, HPV, which is the cause of most cases of cervical cancer. Women who have, through testing, been confirmed to not have the HPV virus are far less at risk of developing cervical cancer.
“We know their chances of developing abnormal cells are very low, so we’re able to space out the testing farther,” Reisinger says.
The doctor notes the HPV vaccine helps protect against the most common, but not all, strains of the virus that lead to cervical cancers.
“So it’s still important to have regular Pap smears if you’ve had the vaccine,” she says.
For women ages 21 to 29, Pap smears are recommended every three years, Reisinger says. Women 30 years and older should be tested for abnormal cells and the HPV virus. If they do not have abnormal cells or the virus, they can go five years before their next smear, she adds. Women of any age whose tests show abnormalities should receive a Pap smear annually, she says.
Patients’ reactions to the updated guidelines have been mixed.
“It makes some happy,” Reisinger says. “A pap smear is not fun. But for some of the older patients, there’s a little anxiety about spacing it out more and the possibility we may miss something.”
If you have concerns, it is recommended you speak with a doctor.
Finneran, meanwhile, likes to keep close tabs on studies related to birth control. A recent Danish study that found a link between using hormonal forms of birth control and developing breast cancer later in life caught his attention. He emphasizes the study’s findings do not prove using birth control causes breast cancer.
According to the study, “there is an increased rate of breast cancer in women who have taken hormone-containing birth control,” Finneran says.
That topic has become popular in the exam room, he adds. The study has had the positive effect of leading to longer conversations between Finneran and his patients about risks, benefits and alternatives when prescribing birth control.
“I still think birth control is a very individual topic that needs to be discussed with your provider when a woman is deciding what she’d like to use for contraception,” he says.
Finneran’s patients range in age from teenagers to women in their 80s, and some have expressed their concerns about the link.
“Especially women with family histories of breast cancer,” he says.
Finneran admits he was surprised when he first read the article because such a link had never before been demonstrated.
When it comes to discussing birth control with patients, Finneran begins with their reasons. Some women take oral contraceptives to regulate their menstrual cycles; others prefer to avoid having to remember to take a pill every day.
“Again, it’s a very individualized conversation with each patient,” he says.
None of Finneran’s patients have thus far decided to stop taking oral contraceptives because of the study’s findings.
“More research needs to be done,” Finneran says. “It does allow for further conversation between providers and patients.”