Q. Thank you for your October 26 column on older women and Pap smears. The National Cancer Institute (NCI) is currently reaching out to women over 65 and their physicians about the importance of continued cervical cancer screening in older women, and your column will help increase awareness of this important health issue.
This age group accounts for nearly 25 percent of all cervical cancer cases and 41 percent of cervical cancer deaths in the United States. A recent survey, conducted in part by the NCI, showed that women ages 65 and older greatly underestimated their risk of cervical cancer, do not know how often to get a Pap test, and are least likely to be tested regularly.
A. The NCI, through its Office of Cancer Communications, endorses regular Pap tests beyond age 65, with no upper age limit. In my discussion, I mentioned that several medical organizations said it was okay to stop doing regular Pap smears after age 65 or 70, provided that you've had consistently normal tests previously. Other organizations, including the NCI, do not specify an upper limit. How do these recommendations fit with the fact that many cases of cervical cancer occur in women older than 65?
The answer lies in the fact that most of the cases of cervical cancer in older women involve those who have not had regular Pap smears. In fact, half of all women with newly diagnosed cancer of the cervix had never had a Pap test. And another 10 percent have not had a Pap smear in the past five years.
This problem especially affects minority women. The highest rate of cervical cancer in the United States occurs among Vietnamese women. Many of them are recent immigrants and have not had the benefit of cervical cancer screening. Among older women, the death rate from cervical cancer is more than two times higher in African American women than white women. And the rate among Hispanic women age 65 and older is also higher than among white women. In many cases, these higher rates of mortality are due to lower rates of screening.
But more important than how often you should have Pap smears, or whether they could be stopped after a certain age, is having regular Pap smears in the first place. If women had regular screening at earlier ages, then the problem of cervical cancer in the elderly would decrease dramatically. To help address the problem of cervical cancer in older women, Medicare currently covers Pap tests once every three years.
For more information, call NCI's Cancer Information Service at 1-800-422-6237, or visit the Web site http://www.nci.nih.gov and click on "Information for patients, public and the mass media." This service also provides referrals for free and low-cost cervical cancer screening through the Centers for Disease Control's Breast and Cervical Cancer Early Detection Program, which targets medically under-served, low-income women, particularly members of racial and ethnic minorities.
Complications of Prostate Surgery
Q. Because of an enlarged prostate, I had prostate surgery performed a few years ago. Since then, whenever I have intercourse, I don't pass any semen. I'd like to know what happens to the sperm, and whether this will lead to any problems.
A. Your condition is what doctors call retrograde ejaculation. That's when the semen is discharged into the bladder rather than out through the penis. This complication can stem from operations on the prostate or the bladder when the tubes leading from the testicles (the vas deferens) join the tube draining the bladder (the urethra). The semen is eventually passed in urine. This condition won't harm you in any way, although it does make you infertile.
Jay Siwek, chairman of the department of family medicine at Georgetown University Medical Center, practices at the Fort Lincoln Family Medicine Center and Providence Hospital in Northeast Washington.
Consultation is a health education column and is not a substitute for medical advice from your physician. Send questions to Consultation, Health Section, The Washington Post, 1150 15th St. NW, Washington, DC 20071. Questions cannot be answered personally.