Dr. Joel Kizner
OBSTETRICS AND GYNECOLOGY
Phone: 562-431-3606
HPV, Hormone Replacement
The FDA has approved a new way to screen for cervical cancer in women over 30. The conventional method has been an annual pap smear. The problem with paps has been a high rate of false positives (finding a problem when nothing is there) and false negatives (failing to detect a problem when there is one). The new test combines a liquid-based pap (LBP) with a test for human papillomavirus (HPV). HPV is the family of viruses that causes cervical abnormalities, including dysplasia (also known as cervical intraepithelial neoplasia or CIN, which are the type of cellular changes that have potential to become cancer, usually over a period of many years) and cancer. Compared to the old-fashioned pap, the new test greatly reduces the likelihood of a false result. The test is reliable enough that, if normal, the risk of getting a significant cervical abnormality for at least three years after the test is virtually zero. Typically, the test is only done every three years, rather than every year. For more information, check out the following link: http://www.thehpvtest.com. In my practice, the only paps I do are so-called liquid-based paps(I use the type known as thinprep), which are more reliable then the old-fashioned slide method (commonly called conventional pap.) I also routinely do HPV testing for women over 30 and in women who have an inconclusive pap smear. For more information and a brief history of the pap smear, check out the following link: http://www.cytyc.com/women/women_cervical_cancer.shtml
There has been a lot of publicity lately regarding the risks and benefits of hormone replacement therapy. Until recently, the prevailing wisdom was that the benefits of hormone therapy (estrogens and progestins) for menopausal women outweighed the risks. For years, it was widely thought that HRT helped to prevent heart disease. HRT is known to help prevent osteoporosis and menopausal symptoms (hot flashes, vaginal dryness). The recent publication of the Women's Health Initiative (WHI) study has forced us, the medical establishment, to re-evaluate the risks and benefits of HRT. In the WHI study, women who were on Prempro (a combination of equine estrogens and medroxyprogesterone acetate, a progestin or progesterone-like hormone) had slightly more heart attacks, breast cancers, and venous thromboses (blood clots) than women who were taking placebo (a pill with no active ingredients). The risk for heart attack or breast cancer was about 3 per thousand off HRT, and about 3.8 per thousand with HRT. As a result of these findings, I believe that HRT remains useful for prevention of menopausal symptoms, which can sometimes be quite severe. The duration of treatment should probably be 5 years or less. If the goal of therapy is to prevent osteoporosis (weakening of the bones), other treatments should be used. The following is a link to the American College of Obstetrics and Gynecology's discussion of hormone replacement therapy in light of the WHI findings: http://acog.com/from_home/publications/press_releases/nr10-01-04.cfm
Joel Kizner MD
