Ask Dr. Roach: Pap smear returns with unsatisfactory results

DEAR DR. ROACH >> I am a 59-year-old female in good health, except for my rheumatoid arthritis, which is controlled with a prescription of methotrexate.

My question pertains to Pap smears. My OB-GYN says that guidelines indicate Pap smears are to be done every three years, unless there is a complication. My most recent one, last month, came back “unsatisfactory,” because the lab didn’t have enough cells to perform the test. A second Pap smear a couple weeks later yielded the same result. My doctor wasn’t concerned about it, saying that the likelihood of there being a complication decreases with age, and I can stop getting them altogether in my mid-60s. The nurse who gave me my results over the phone suggested I get another Pap smear next year, just to be sure. I have been with the same man for the past 18 years.

My OB-GYN said the problem with gathering cells is caused by menopause. I am not on any estrogen treatments. Do you agree that it’s OK to wait another year before trying again?

— T.P.

Dear T.P. >> The Papanicolaou smear is a screening test for cervical cancer. This type of test looks for changes in the cells of the cervix. If the physician didn’t get enough cells (and menopause is a reason for that), the test cannot be relied upon to refute the possibility of cervical cancer.

The risk of developing cervical cancer in a woman in her 60s is small. Virtually all cases of cervical cancer are caused by a high-risk type of the human papillomavirus, and if you have had three negative Pap results in the last 10 years, your risk is very small, especially if you are in a stable, monogamous relationship.

Waiting another year is a reasonable option. I would consider looking not only for abnormal cells by the Pap smear, but also looking for the HPV that can cause cervical cancer in the first place. A negative HPV result is strong evidence against cervical cancer. HPV testing should only be done every five years.

Women at low risk, who have had negative results in the previous 10 years, can stop screening at age 65. Some doctors continue to test until an older age: The risk of continuing to do so is small.

DEAR DR. ROACH >> My husband was diagnosed with mild COPD years ago. He hasn’t had any problems until now. This summer has been extremely hot and humid, and he is having

a hard time breathing. Also, when he tries to talk and eat, he coughs. He won’t talk to his doctor about it. Is there medicine that can help with this?

— C.W.

Dear C.W. >> There are at least three different types of medical treatments to alleviate symptoms. The first is an inhaled bronchodilator (called a beta agonist), the same used in people with asthma. They come in short-acting (like albuterol) and long-acting (likes almeterol) formulations. Short-acting formulations are best for acute symptoms, while long-acting helps prevent them.

The second are inhaled anticholinergic drugs, like ipratropium. There are several inhalers that combine beta agonists and anticholinergic drugs for ease of administration, since they work well together. The third first-line treatment are inhaled steroids, almost always given with a long-acting beta agonist. Your husband will have to see a doctor to get any of these prescribed.

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