New Pap Screening Guidelines

Wait...I don't need a pap every year anymore?

New Pap Screening Guidelines

Used to be, getting a pap was your yearly routine. But things have changed. Have you tried to book an appointment lately? You may have noticed some policy changes at your doctor’s office. And these changes are causing a fair bit of confusion.

On our YMC Facebook page recently, a member asked: Why do women now have to wait 3 years to get a pap done? Why is this service no longer available during an annual physical?

Are you wondering the same thing? Well, here’s the deal.

First of all, nobody is disputing the importance of pap smears. Paps can diagnose cervical cancer—and its precursors—at a very early stage, with plenty of time to treat and cure the disease. There is no doubt Paps save lives. But...in this case, there is such a thing as too much of a good thing.

After much international research, it seems that starting paps at a young age, and repeating them frequently, is unnecessary. And the danger of overdoing it with a screening technique means that you’re going to unearth many more borderline abnormal results than you otherwise would. Which means a lot of women have unnecessarily been subjected to colposcopy and interventions like cryotherapy and cervical biopsies that carry the potential for harms like bleeding, pain, and discharge. Worse, they may increase the risk of early loss of future pregnancies or premature labour. Not to mention all the anxiety caused by those false alarms.

Thing is, we’ve probably been overdoing this pap thing for a while now. Many other countries around the world (European countries, in particular) have been doing less frequent testing for quite some time and have achieved the same reductions in cervical cancer rates as we have in Canada.

The recent reduction in pap frequency in Canada is consistent with current research findings, and it’s also in line with what most developed countries are doing. For example:  

  • The UK has a recommended policy of not starting paps until over the age of 25, and only every 3 years.
  • The US recommendations? Every 3 years, over the age of 21.
  • Australia currently recommends doing screening paps every 2 years, but this is possibly set to change.

Screening guidelines in Canada are determined at the provincial level, but all of the provinces are heading in the same direction. Here’s a sampling:


Cancer Care Ontario now recommends (as of Aug 2012) that cervical cancer screening start at age 21 and continue every three years until age 70 for all women who are, or ever have been, sexually active.


Pap screening is advised to start at age 21, if sexually active, and continue every three years until age 70.

British Columbia

Women should start having pap tests at age 21 or 3 years after first sexual contact. Pap tests should be done every year for the first 3 years; then continue every 2 years if results are normal.

As I was looking at Alberta’s guidelines, I came across an info sheet for patients produced by Alberta Health Services that I thought offered a pretty clear explanation. So here it is, excerpted directly:

  • Most cervical cell changes are caused by infections with certain types of the human papillomavirus (HPV).
  • These types of HPV are spread by sexual contact.
  • HPV is common and spreads so easily that over 70% of people will get HPV in their lifetime.
  • Most people don’t even know when they have HPV because there are usually no symptoms.
  • The immune system will usually clear the HPV within 2 years.
  • When the virus does not clear, it can cause cell changes that may lead to cervical cancer. These changes happen slowly.
  • By getting Pap tests at least once every 3 years, cervical cell changes can be found early and if needed, treated so that cancer does not develop

As with many things, as we research more and understand more, and start to take into consideration the nuances of what we’re doing...we modify our approaches, and revise our recommendations.

If there’s one thing I’ve learned, you can be sure this will not be the last word on this subject. Things will change with these recommendations, as with everything that has to do with the incredibly complex human body and our even more complex disease processes.

It’s a sticky issue, however, because these guidelines are based on population-based research. Which means they’re looking at what’s best for the population, as a whole. There will always be individual cases that fall outside these averages. But how can you make guidelines for an entire population if you take into account every individual possibility? No easy answers there.

So, tell me: do you get regular paps done? What do you think of the new guidelines?


Keys To Happiness: Nurturing Friendships

Is a circle of friends more important than a network of relatives?

Keys To Happiness: Nurturing Friendships

I don’t know about you, but it always takes me several attempts, and multiple back-and-forth text messages, to finalize a date with girlfriends. It’s difficult, isn’t it? We’re all busy; we all have competing demands. But I always find, in the end, it was absolutely worth the effort.

And science backs this up. Many studies have shown the health benefits of strong social relationships. In particular, A recent study showed that people in their 40s with a wide circle of friends have a greater sense of well-being than those without close friendships.

They found the more frequently people meet up with their friends, the greater the benefit. And numbers appear to count, here: a wider circle of friends translated to better reported well-being in this study.

(As a side note, the researchers behind this study called these ages "mid-life" which I, for one, staunchly refuse to do. Having recently turned 40 myself I will probably never consider myself middle-aged. Never. I know, I can do the math. But I think I’ve decided that middle age will always remain the future, no matter how old I am.)

Now, I must say, I'm not hugely surprised at the finding that friendships are beneficial to health and happiness. It’s one of our key happiness behaviours (see why gratitude boosts happiness, and why kindness improves your health).

However, one interesting outcome of this study was that, for women, it wasn't as beneficial to have a wide network of family members as it was to have friends. For men, in contrast, it was a good thing to have plenty of close relatives around, in addition to friends.

One theory? In a family network, women traditionally play an obligatory caregiving and nurturing role. Which is, let's face it, not as restful as it could be. Being the caregiver can be satisfying, but it’s hard damn work. In contrast, friends tend to be more supportive of a woman's own choices. And won't depend on her, say, to make them a sandwich.

Still, there’s little doubt about the health benefits of friendships and social connections. For further proof, we can look to three of the communities with the longest-living people in the world: Sardinia, Italy; Okinawa, Japan; and Loma Linda, California. In 2005 National Geographic identified five things they each have in common. At the top of the list: “Put family first” and “Keep socially engaged.” (The other three, incidentally: don’t smoke, stay physically active, and eat a plant-based diet.)

Of course it's difficult, in our busy lives, to squeeze in time for friends. But the extra effort is always worth it. And now you’ve got validation that nurturing your friendships is an investment in your mental health.

For middle age.

Should you ever hit that.


Should You Google Your Health Symptoms?

The good, the bad, and the downright terrifying

Should You Google Your Health Symptoms?

Got a weird twinge in your neck? Kid just woke up with a strange rash? Something odd about the way your tongue feels? Hmm...what to do...ooh, I know. Jump on the old laptop and Google that freaky symptom!

Or, maybe not.

I typically assume most patients have already Googled themselves silly before turning up in my office. And that assumption usually turns out to be correct. But is it a good idea?

Well, yes and no.

Yes, because ignorance is a bad thing. I’m a fan of proactive patients, of people taking responsibility for their own (and their kids') health. It’s your body, and your family, after all. You should absolutely know what’s going on. We’re in the information age, and there is no shortage of information out there on every health issue imaginable. It gives us all a wonderful opportunity to take the very best care of ourselves and be an active partner in our own health decisions.

On the other hand, you can scare the bejeezus out of yourself looking up medical information online.

So, there are good ways to go about this and bad ways. Performing a random Google search is probably a bad way. You’re going to get all kinds of wacky opinions and terrifying images coming at you. Keep in mind: only the most bizarre cases and extreme examples end up online, particularly in full-colour glory. Also, just as there’s a ton of information out there, there is a whole lot of misinformation too. The trouble is, you’re not necessarily going to know if it’s good or bad information you're looking at.

Here’s the good way: stick to reputable sites. Go directly to a trustworthy portal, and enter your query there. Here are the ones I routinely recommend:

By sticking to high-quality, reliable sites, you’ll be armed with solid information. Not walking around all jittery with false fears and worries. (I mean, do you really need a whole new source of stress?) But even within this approach, there is, of course, a danger that you can develop a layperson’s case of “medical student’s disease”: the phenomenon that once you start reading about various medical conditions, you become increasingly convinced that you are actually have said medical conditions.  

So read, but try to limit your time spent poring over all the gruesome details of every rare condition you can lay your hands on.

One last note: some things should never be Googled, no matter what the circumstances. For example, never, ever Google for images of peri-anal genital warts. Trust me. Some things just can’t be scrubbed from your brain.

So tell me: Do you Google your health symptoms before booking a doctor’s appointment? Do you find it helps—or freaks you out?