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New cervical cancer guidelines start making Pap smears obsolete



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New cervical cancer screening recommendations out Tuesday have started to make old-fashioned Pap smears a thing of the past for women over 30.

Most women may opt for the human papillomavirus test, the U.S. Preventive Services Task Force says in its latest recommendations.

And women over 30 can safely wait five years in between tests if they feel comfortable doing that, the task force says in the recommendations, published in the Journal of the American Medical Association.

For women under 30, the Pap smear is still the best option, but testing every three years is all right. The recommendations are based on a now-solid body of evidence showing that almost all cases of cervical cancer are caused by the human papillomavirus and that the HPV test is the best way to find evidence that the virus is causing the damage that can lead to cancer.

The guidelines, in short:

  • Women ages 21-29 should get a Pap smear every three years
  • Women ages 30-65 can get an HPV test every five years, or a Pap test every three years, or a combination every five years
  • Women over 65 who have had recent clear tests probably don’t need testing any more
  • Women under 21 probably do not need testing.

While the new guidelines may seem confusing, they are simpler than the last batch, said Dr. Kathleen Schmeler, a cervical cancer specialist at the University of Texas MD Anderson Cancer Center.

“It’s actually nice that they provide a lot of options,” Schmeler told NBC News.

She said the guidelines may make it easier for women in areas with fewer doctors or clinics to get tested.

“The new guidelines are not at all confusing to us physicians, since they are very similar to our usual practice from 2012,” said Dr. Ranit Mishori, a professor of family medicine at Georgetown University.

“I do not find that the longer interval is confusing to women — many, in fact, are relieved that they don’t have to undergo this procedure every year and are thankful to find out that they can wait three or five years before they need to get the next one.”

But, he added, women need regular doctor visits to make sure other problems have not popped up.


What is important, experts said, is that women get tested.

“We found that regular screening with any method will lead to lower cervical cancer rates,” said Joy Melnikow, director of the Center for Healthcare Policy and Research at the University of California, Davis, who led a study showing that the HPV test is effective.

“In the U.S., where most women are not part of an organized screening program, our biggest challenge is reaching women who have not been screened.”

In the past, cervical cancer was one of the most common cancer killers of American women.

It is still diagnosed in 13,000 American women a year and will kill more than 4,000 of them, according to the American Cancer Society.

Incomplete screening is the most common reason. “Most cases of cervical cancer occur among women who have not been adequately screened,” the Preventive Services Task Force says in its recommendations.

“In the U.S., it’s pretty rare that I see someone with advanced cervical cancer who never had a Pap,” Schmeler said.

“They almost always tell the story that ‘10, 15 years ago I had abnormal Pap but I didn’t go back because I lost my insurance.’ I hear that a lot,” Schmeler said.

Or women have trouble finding a clinic where they can get the follow-up test, called a colposcopy, which is used to examine the cervix to see if cancer is beginning to grow.

If the body, for whatever reason, does not clear the HPV infection, that is worrisome.

A Pap smear will find precancerous changes in the cervix without frightening women who simply have a fresh HPV infection that won’t necessarily cause trouble.

But by the time a woman is 30, the virus has had time to potentially take hold in the tissue and start causing the damage that can lead to cancer. The HPV test will find the virus if it is still lingering, or if it has resurfaced for some reason.

“It is not like you get HPV and then you get cancer,” Schmeler said. It only happens in a few people, and the process usually takes years.

For now, a woman’s experience at the clinic will be the same whether she has a Pap or an HPV test. It still requires getting into the stirrups.

But Schmeler is hopeful that at-home HPV tests will hit the market in the coming years. They would resemble a tampon.

“I can envision a day where we could go to the pharmacy and it would be like a pregnancy test,” she said.

That could help women who don’t have good access to medical care.

And all the tests may become a thing of the past if HPV vaccines become universal for boys and girls.

“We have an amazing preventive vaccine,” Schmeler said. “We really need to vaccinate kids before they become sexually active, so that we can prevent all of this.”

Most insurance companies, as well as Medicare and Medicaid, cover procedures based on recommendations made by the task force.

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Is It Really That Bad to Eat Non-Organic Produce?




Yes, they are bad, but it’s way more important to include a wide variety of fruits and vegetables in your diet than to avoid them because of pesticide concerns. Here’s a tip: If you thoroughly wash your produce with cold water and throw away the outer leaves of leafy vegetables (like romaine), you will remove most of the pesticide residue.

If you’re still worried about ingesting chemicals, buy organic varieties of the produce on the Environmental Working Group’s “Dirty Dozen” list, which highlights the conventionally grown foods that tend to have the most pesticide contamination, like strawberries, spinach, apples, and tomatoes. Load up on more foods from their “Clean Fifteen” list too, like avocados (yes!), broccoli, kiwis, and mangoes. You can find both lists on their website. As a general rule, fruits that you eat after removing the outer covering—like bananas—are less prone to pesticide contamination. And whatever you do, focus more on getting as many fruits and veggies into your diet as possible: Organic or not, these types of foods are associated with countless important health benefits, like a decreased risk of cancer, heart disease, and overall mortality.


Health’s medical editor, Roshini Rajapaksa, MD, is an associate professor of medicine at the NYU School of Medicine and a cofounder of TULA Skincare.

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6 Things This Nutritionist Wishes She Knew About Food Years Ago




I’ve been a practicing dietitian for more than two decades, which is a l-o-n-g time. Over the years, I’ve had the opportunity to work with so many wonderful clients with nutrition-related concerns, including pregnant women, children, amateur and professional athletes, overweight and obese adults, and the elderly.

I’ve learned so much during the years, and while new guidelines and recommendations will come and go, there are six core principles I wish I had realized years ago–and they apply to everyone.

Healthy food isn't all-you-can-eat food

Studies show that people will subconsciously eat more food if they believe it’s healthy. More often than not, clients I see struggling with their weight have high-quality diets. Their food journals reveal they’re eating lots of fruits and veggies, lean protein, healthy fats, and quality carbs.

So what gives? They eat too much–period. With today’s oversized portions, it’s easy to overeat without realizing it. And even the healthiest foods can contribute to weight gain if you're taking in too many calories daily. If you can relate, perfect your portions by paying more attention to how much you’re eating compared to what’s recommended.

RELATED: 9 Foods This Nutritionist Always Has in Her Pantry

Think progress, not perfection

Healthy eating is a lifelong journey, so it’s important to have a plan to navigate the bumps and detours that you will eventually encounter in the road. As a dietitian, I can attest that everyone slips up on their diet and fitness routines at some point. If you overdo it on pizza or ice cream every now and again, don’t freak. It’s going to be okay; life happens!

Those who eat well and maintain a healthy weight for life are most likely to get back on track after they’ve had a setback. They don’t give in or give up, they move on. Heart disease or type 2 diabetes won’t develop from what you ate on a specific day, week, or month; these and other conditions progress from the cumulative effects of behaviors like unhealthy eating, lack of exercise, tobacco use, and more. Take a big-picture look at eating, with the ultimate goal of living the longest and healthiest life that you can.

RELATED: Is Eating a Ton of Ice Cream in One Sitting Worse for You Than Eating a Little Every Night?

Use mental tricks to keep you on track

Did you know you make more than 200 food-related decisions every day? If you leave those choices up to chance, you’ll deplete your daily willpower—and you’ll be more likely to overeat. But if you have a plan for what and when you’re going to eat, you will limit the number of times you tap into your willpower reserve.

New weight-loss research is focusing on removing many food-related decisions or making healthier options the easiest choice, so your willpower stays strong all day long. To do this, researchers recommend the following: Get adequate sleep (without enough Zz’s, your willpower is weakened, and you’ll be more likely to make less nutritious decisions), and keep your kitchen tidy (store the healthiest foods front-and-center so you’re reminded how convenient they are to eat).

RELATED: The Number One Thing You Need to Do to Lose Weight Forever, According to Experts

Eat lower on the food chain

Eating low on the food chain means eating more plant-based foods. According to the Centers for Disease Control and Prevention (CDC), around 90% of Americans don’t meet the daily recommended servings for fruits and veggies, which is 1.5 to 2 cups of fruit and 2 to 3 cups of veggies a day. A plant-forward menu will naturally have plenty of filling fiber and a range of vitamins and nutrients, plus it keeps calories, sugar, and saturated fat in check. No matter what type of eating plan you follow, strive to fill half your plate with produce for all (or most) of your meals.

A well-stocked pantry, with plenty of canned produce like tomatoes and beans, can help ensure that you hit those targets. Canned produce has similar—and sometimes even more!—nutritional value than fresh varieties.

RELATED: 8 Kitchen Gadgets That Make Healthy Cooking Super-Easy, According to Nutritionists

Supplements aren't cure-alls

It’s estimated that more than half of all Americans take at least one dietary supplement to improve their health. However, according to the National Institutes of Health Office of Dietary Supplements, there’s not always sufficient evidence that supplements improve health–and in some cases, supplements may increase risk for disease.

Throughout my career, I’ve seen a lot of "must-have" supplements that claim to increase energy, burn off belly fat, keep your brain sharp, or fend off (or even cure) any number of chronic conditions. Since manufacturers don’t have to prove that dietary supplements work before they are sold, there’s no guarantee they’ll be effective.

If you fit one of these specific cases, you may benefit from a certain supplement. Otherwise, focus on eating a plant-rich, balanced diet based on the foundation of wholesome, real foods that provide a complex matrix of nutrients.

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Eat quality carbs, not low-carb

If you eat according to what’s trending on your social feeds, you might be avoiding carbs at all cost. However, what I’ve learned through the years is that low-carb diets are hard to follow long-term, and eating quality carbs is better than cutting them out. (The body needs a minimum daily amount of carbohydrates to fuel your muscles and brain, after all.)

However, the types of carbs in, say, soda or cookies are metabolically different than the carbs in beans or brown rice. Enjoy wholesome carbohydrates present in real foods like fruits, veggies, whole grains, and legumes to help you maintain a healthy weight and live longer.

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Two bitten by rabid raccoon that was living in Kennebunkport home




A Kennebunkport woman and a game warden were bitten last week by an injured rabid raccoon that the resident had illegally taken into her house.

Game warden Eric Blanchard was bitten as he tried to remove the wild animal from a house in town. The woman had taken in the injured animal illegally and could face charges, according to officials.

It was the first confirmed case of rabies in Kennebunkport this year, police said. Blanchard and the woman are both undergoing treatment for rabies.

“This is kind of a worst-case scenario,” said Cpl. John MacDonald of the Maine Warden Service. “It’s a real reminder that this is the reason why it’s not a safe thing to do.”

MacDonald said it is not uncommon for people to take in wild animals, but said they should not do so because it is both illegal and dangerous.

“People have an instinct to want to take care of animals. Most people understand the risk involved with taking a wild animal into their home,” he said. “They think they’re doing the animal a favor, but wild animals can be very dangerous and unpredictable, especially one prone to rabies.”

Blanchard, the 2017 game warden of the year, was wearing a thick, rabies glove similar to ones used to handle raptors with talons when the raccoon tried to bite through the thumb. Blanchard did not believe the raccoon had broken through his skin, but was advised to go through treatment for rabies exposure as a precaution, MacDonald said.

MacDonald said the Warden Service would not make Blanchard available to speak to a reporter about the incident.

In Maine, it is illegal to keep wildlife in captivity without a proper permit, MacDonald said. Permits and licenses are issued to people who regularly come into contact with wild animals, including wildlife rehabilitators and people who relocate nuisance animals. Possessing wildlife without a permit is a Class E crime punishable with a minimum fine of $50 per day the animal was in a person’s possession.

MacDonald said he is not yet releasing the name of the woman because it is likely she will face charges.

Police said in a Facebook post that wild animals should be left alone outside. Local police or the Maine Warden Service should be contacted when wild animals appear injured or have become a nuisance.

“In no circumstances do we tell people to take (wild animals) into their homes or even touch them,” MacDonald said.

The attack in Kennebunkport follows a number of high-profile rabies incidents this year in Brunswick, where seven people have been bitten by rabid animals.

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