For Cervical Cancer Screening, Women Over 30 Can Now Choose HPV Test Only
Words Matter When Talking About Pain With Your Doctor
Smartphones, Vinegar and the Future of Cervical Cancer Screening
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The influential group, the U.S. Preventive Services Task Force, has expanded its recommendations for this potentially lifesaving exam.\u003c/p>\n\u003cp>The new recommendations \u003ca href=\"http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.10897\" target=\"_blank\" rel=\"noopener\">are published\u003c/a> in the latest issue of \u003cem>JAMA.\u003c/em>\u003c/p>\n\u003cp>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0022605/\" target=\"_blank\" rel=\"noopener\">Pap smears\u003c/a> have saved many lives since they became available decades ago. Inspecting samples of cervical tissue for precancerous changes is effective at catching possible cancer and is still the go-to test for women ages 21 to 29, according to the USPSTF guidelines.\u003c/p>\n\u003cp>But there's another option. \"Most cervical cancer is caused by what's called the human papillomavirus, or HPV,\" says \u003ca href=\"https://profiles.stanford.edu/douglas-owens\" target=\"_blank\" rel=\"noopener\">Dr. Douglas Owens\u003c/a>, a professor of medicine at Stanford University and vice chair of the USPSTF. \"And we now have tests for HPV and that's an important step forward.\"\u003c/p>\n\u003cp>These tests are available alone or in combination with the Pap test. And the USPSTF now says \u003ca href=\"https://www.npr.org/sections/health-shots/2018/07/03/625696664/for-women-over-30-there-may-be-a-better-choice-than-the-pap-smear\" target=\"_blank\" rel=\"noopener\">the evidence\u003c/a> is strong enough that HPV tests can be used by themselves, for women over 30. That third choice expands on the task force's previous recommendation, which was for the Pap test or the combination test.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>And while Pap tests should be repeated every three years, women can wait five years between HPV tests.\u003c/p>\n\u003cp>\"Five years is a good balance between the benefits and harms,\" Owens says. \"It's still highly effective at detecting cancer, and screening more frequently than that may increase some of the potential harms, so we think that's a good interval.\"\u003c/p>\n\u003cp>Potential harms of too frequent screening include unnecessary follow-ups such as biopsies. In a draft recommendation released last year, the task force had considered suggesting just two options, either the Pap smear or the HPV test, but its final recommendation included the hybrid test too.\u003c/p>\n\u003cp>\"The HPV test alone is not available everywhere,\" Owens explains. \"And so we want to be sure that women no matter where they're receiving care have options for cervical cancer screening.\"\u003c/p>\n\u003cp>He says the combination test is widely available, as is the Pap test, \"so all of those are good options and a woman can discuss with her physician what's available at the place where she's receiving care.\"\u003c/p>\n\u003cp>Women may not notice the difference between tests because tissue samples are all collected the same way. But \u003ca href=\"http://pressroom.cancer.org/debbiesaslow\" target=\"_blank\" rel=\"noopener\">Debbie Saslow\u003c/a>, senior director for HPV-related and women's cancers at the American Cancer Society, says if women have a choice, she would recommend the HPV test for women over 30.\u003c/p>\n\u003cp>\"I truly believe that including the HPV test, either along with the Pap or instead of the Pap, is superior than the Pap alone,\" she says. There's some evidence the HPV test is better than the Pap test at detecting a less common form of cervical cancer, adenocarcinoma, she says. \"So wouldn't you rather find the two most common cancers instead of just the one most common type?\"\u003c/p>\n\u003cp>The task force emphasizes that all three tests are highly effective. The overarching recommendation is simply that women should get screened, and to do so regularly until the age of 65. If screening has been adequate up to that point, the task force says women do not need further cervical cancer screening.\u003c/p>\n\u003cp>Health officials also recommend the HPV vaccine, which is given to girls and young women, up to age 26. (Boys and young men are encouraged to get the HPV vaccine as well.) But Owens says a vaccine alone doesn't replace cervical cancer screening.\u003c/p>\n\u003cp>\"Our recommendation applies to everyone whether you've been vaccinated or not,\" he says. \"It's very important that women do not forgo screening because they've been vaccinated.\"\u003c/p>\n\u003cp>An effective vaccine could ultimately render cervical cancer screening unnecessary, but that change will require careful study and could be years away.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>You can reach Richard Harris at \u003c/em>\u003ca href=\"mailto:rharris@npr.org\" target=\"_blank\" rel=\"noopener\">rharris@npr.org\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=For+Cervical+Cancer+Screening%2C+Women+Over+30+Can+Now+Choose+The+HPV+Test+Only&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"HPV testing is now seen as equally effective as Pap tests for cervical cancer screening. An influential federal advisory group has changed guidelines for how women over 30 should get tested. ","status":"publish","parent":0,"modified":1534966663,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":19,"wordCount":665},"headData":{"title":"For Cervical Cancer Screening, Women Over 30 Can Now Choose HPV Test Only | KQED","description":"HPV testing is now seen as equally effective as Pap tests for cervical cancer screening. An influential federal advisory group has changed guidelines for how women over 30 should get tested. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"For Cervical Cancer Screening, Women Over 30 Can Now Choose HPV Test Only","datePublished":"2018-08-22T20:00:25.000Z","dateModified":"2018-08-22T19:37:43.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"444026 https://ww2.kqed.org/futureofyou/?p=444026","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/08/22/for-cervical-cancer-screening-women-over-30-can-now-choose-hpv-test-only/","disqusTitle":"For Cervical Cancer Screening, Women Over 30 Can Now Choose HPV Test Only","source":"Health","nprImageCredit":"Science Photo Library","nprByline":"Richard Harris, NPR","nprImageAgency":"Getty Images","nprStoryId":"640514865","nprApiLink":"http://api.npr.org/query?id=640514865&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"https://www.npr.org/sections/health-shots/2018/08/21/640514865/for-cervical-cancer-screening-women-over-30-can-now-choose-the-hpv-test-only?ft=nprml&f=640514865","nprRetrievedStory":"1","nprPubDate":"Tue, 21 Aug 2018 21:50:00 -0400","nprStoryDate":"Tue, 21 Aug 2018 11:03:00 -0400","nprLastModifiedDate":"Tue, 21 Aug 2018 17:17:42 -0400","nprAudio":"https://ondemand.npr.org/anon.npr-mp3/npr/atc/2018/08/20180821_atc_for_cervical_cancer_screening_women_over_30_can_now_choose_the_hpv_test_only.mp3?orgId=1&topicId=1128&d=234&p=2&story=640514865&ft=nprml&f=640514865","nprAudioM3u":"http://api.npr.org/m3u/1640630633-193947.m3u?orgId=1&topicId=1128&d=234&p=2&story=640514865&ft=nprml&f=640514865","audioTrackLength":235,"path":"/futureofyou/444026/for-cervical-cancer-screening-women-over-30-can-now-choose-hpv-test-only","audioUrl":"https://ondemand.npr.org/anon.npr-mp3/npr/atc/2018/08/20180821_atc_for_cervical_cancer_screening_women_over_30_can_now_choose_the_hpv_test_only.mp3?orgId=1&topicId=1128&d=234&p=2&story=640514865&ft=nprml&f=640514865","parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Federal health advisers say women can now consider three options when it's time for their cervical cancer screening tests. The influential group, the U.S. Preventive Services Task Force, has expanded its recommendations for this potentially lifesaving exam.\u003c/p>\n\u003cp>The new recommendations \u003ca href=\"http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.10897\" target=\"_blank\" rel=\"noopener\">are published\u003c/a> in the latest issue of \u003cem>JAMA.\u003c/em>\u003c/p>\n\u003cp>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0022605/\" target=\"_blank\" rel=\"noopener\">Pap smears\u003c/a> have saved many lives since they became available decades ago. Inspecting samples of cervical tissue for precancerous changes is effective at catching possible cancer and is still the go-to test for women ages 21 to 29, according to the USPSTF guidelines.\u003c/p>\n\u003cp>But there's another option. \"Most cervical cancer is caused by what's called the human papillomavirus, or HPV,\" says \u003ca href=\"https://profiles.stanford.edu/douglas-owens\" target=\"_blank\" rel=\"noopener\">Dr. Douglas Owens\u003c/a>, a professor of medicine at Stanford University and vice chair of the USPSTF. \"And we now have tests for HPV and that's an important step forward.\"\u003c/p>\n\u003cp>These tests are available alone or in combination with the Pap test. And the USPSTF now says \u003ca href=\"https://www.npr.org/sections/health-shots/2018/07/03/625696664/for-women-over-30-there-may-be-a-better-choice-than-the-pap-smear\" target=\"_blank\" rel=\"noopener\">the evidence\u003c/a> is strong enough that HPV tests can be used by themselves, for women over 30. That third choice expands on the task force's previous recommendation, which was for the Pap test or the combination test.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>And while Pap tests should be repeated every three years, women can wait five years between HPV tests.\u003c/p>\n\u003cp>\"Five years is a good balance between the benefits and harms,\" Owens says. \"It's still highly effective at detecting cancer, and screening more frequently than that may increase some of the potential harms, so we think that's a good interval.\"\u003c/p>\n\u003cp>Potential harms of too frequent screening include unnecessary follow-ups such as biopsies. In a draft recommendation released last year, the task force had considered suggesting just two options, either the Pap smear or the HPV test, but its final recommendation included the hybrid test too.\u003c/p>\n\u003cp>\"The HPV test alone is not available everywhere,\" Owens explains. \"And so we want to be sure that women no matter where they're receiving care have options for cervical cancer screening.\"\u003c/p>\n\u003cp>He says the combination test is widely available, as is the Pap test, \"so all of those are good options and a woman can discuss with her physician what's available at the place where she's receiving care.\"\u003c/p>\n\u003cp>Women may not notice the difference between tests because tissue samples are all collected the same way. But \u003ca href=\"http://pressroom.cancer.org/debbiesaslow\" target=\"_blank\" rel=\"noopener\">Debbie Saslow\u003c/a>, senior director for HPV-related and women's cancers at the American Cancer Society, says if women have a choice, she would recommend the HPV test for women over 30.\u003c/p>\n\u003cp>\"I truly believe that including the HPV test, either along with the Pap or instead of the Pap, is superior than the Pap alone,\" she says. There's some evidence the HPV test is better than the Pap test at detecting a less common form of cervical cancer, adenocarcinoma, she says. \"So wouldn't you rather find the two most common cancers instead of just the one most common type?\"\u003c/p>\n\u003cp>The task force emphasizes that all three tests are highly effective. The overarching recommendation is simply that women should get screened, and to do so regularly until the age of 65. If screening has been adequate up to that point, the task force says women do not need further cervical cancer screening.\u003c/p>\n\u003cp>Health officials also recommend the HPV vaccine, which is given to girls and young women, up to age 26. (Boys and young men are encouraged to get the HPV vaccine as well.) But Owens says a vaccine alone doesn't replace cervical cancer screening.\u003c/p>\n\u003cp>\"Our recommendation applies to everyone whether you've been vaccinated or not,\" he says. \"It's very important that women do not forgo screening because they've been vaccinated.\"\u003c/p>\n\u003cp>An effective vaccine could ultimately render cervical cancer screening unnecessary, but that change will require careful study and could be years away.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>You can reach Richard Harris at \u003c/em>\u003ca href=\"mailto:rharris@npr.org\" target=\"_blank\" rel=\"noopener\">rharris@npr.org\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=For+Cervical+Cancer+Screening%2C+Women+Over+30+Can+Now+Choose+The+HPV+Test+Only&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/444026/for-cervical-cancer-screening-women-over-30-can-now-choose-hpv-test-only","authors":["byline_futureofyou_444026"],"series":["futureofyou_219"],"categories":["futureofyou_1060","futureofyou_1","futureofyou_73"],"tags":["futureofyou_213","futureofyou_1597","futureofyou_218","futureofyou_275"],"collections":["futureofyou_1093"],"featImg":"futureofyou_444027","label":"source_futureofyou_444026"},"futureofyou_443544":{"type":"posts","id":"futureofyou_443544","meta":{"index":"posts_1591205157","site":"futureofyou","id":"443544","score":null,"sort":[1532458816000]},"guestAuthors":[],"slug":"words-matter-when-talking-about-pain-with-your-doctor","title":"Words Matter When Talking About Pain With Your Doctor","publishDate":1532458816,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>If you're in the hospital or a doctor's office with a painful problem, you'll likely be asked to rate your pain on a \u003ca href=\"https://paindoctor.com/pain-scales/\" target=\"_blank\" rel=\"noopener\">scale\u003c/a> of 0 to 10 – with 0 meaning no pain at all and 10 indicating the worst pain you can imagine. But many doctors and nurses say this rating system isn't working and they're trying a new approach.[contextly_sidebar id=\"PzT9DEOa22PlTyV4kUDRN8kM4A2CX5Tx\"]\u003c/p>\n\u003cp>The numeric pain scale may just be too simplistic, says \u003ca href=\"https://www.urmc.rochester.edu/people/21192807-john-d-markman\" target=\"_blank\" rel=\"noopener\">Dr. John Markman\u003c/a>, director of the Translational Pain Research Program at the University of Rochester School of Medicine and Dentistry. It can lead doctors to \"treat by numbers,\" he says and as a result, patients may not be getting the most effective treatment for their pain.\u003c/p>\n\u003cp>Take the case of 33-year-old Adam Rosette, who was recently hospitalized for \u003ca href=\"https://orthoinfo.aaos.org/en/diseases--conditions/fibrous-dysplasia/\" target=\"_blank\" rel=\"noopener\">fibrous dysplasia\u003c/a>, a bone disorder that made it nearly impossible for him to chew or even speak. After brain surgery to remove benign tumors related to the disorder, he was definitely in pain. But he was reluctant to label the pain too high.\u003c/p>\n\u003cp>\"I don't think I ever answered higher than a '7' because an '8' would be, in my mind, like I'm missing half of my body or a limb,\" he recalls.\u003c/p>\n\u003cp>On the pain scale a rating of 4 to 7 is considered moderate. Mild pain is rated 1 to 3. Over 7 is considered severe.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Today, Rosette has recovered and is pain-free, but he wonders if \"low balling\" his pain level while in the hospital, meant he wasn't given adequate pain medication.[contextly_sidebar id=\"gNyBEO7kaaOOQQPLiTFHH1VcWAsQe2Bq\"]\u003c/p>\n\u003cp>\"You realize you got less medicine and it's been eight hours and they're not allowed to give you more for a while,\" Rosette says.\u003c/p>\n\u003cp>If your doctor gets the wrong idea about your pain, it's not just going to affect your comfort — it can affect your treatment. Markman says that especially after an injury, there's therapeutic value to keeping the pain tamped down, so that you can keep up with physical therapy.\u003c/p>\n\u003cp>For chronic pain, being clear can help clinicians choose the right mix of therapies or medications to allow you to stay as active as possible. And staying active can help manage chronic pain, says \u003ca href=\"https://anesthesiology.duke.edu/?page_id=834374\" target=\"_blank\" rel=\"noopener\">Dr. William Maixner\u003c/a>, with Duke University School of Medicine and current president of the American Pain Society.\u003c/p>\n\u003cp>Exercise, he says, \"causes the release of a number of anti-inflammatory substances from the muscle that can help diminish pain and pain processing and make the individual more resilient.\"\u003c/p>\n\u003cp>To find out more about how the numerical pain scale was affecting treatment, Markman and colleagues at the University of Rochester did a study, which they will present at the World Congress on Pain in Boston in September. The research analyzed data from other studies, which asked chronic pain patients to rate their pain using both numbers and words.\u003c/p>\n\u003cp>Patients were asked to rate their pain on a scale of 0 to 10, and they were also asked the question, \"Is your pain tolerable?\"\u003c/p>\n\u003cp>Surprisingly, three quarters of the patients who rated their pain between 4 and 7 on the numerical scale, a range that typically calls for higher doses of medications, also described their pain as \"tolerable\" — a description that normally means no more pain treatment is needed.[contextly_sidebar id=\"ClUbqCuoEqdLIyjzgS1I1irhMb4fhntn\"]\u003c/p>\n\u003cp>This showed the danger of relying only on a number, Markman says. \"If you were just treating by the numbers you might say, 'Well, someone has a pain that is 6 [out of]10. I feel obligated to do something about that ... to fix that number just like you might fix their blood pressure or their blood glucose,' \" he says.\u003c/p>\n\u003cp>If clinicians just look at a number, Markman says, they may be more likely to over-treat or prescribe more medication, which can be worrisome during an era of concern about opioid abuse and addiction.\u003c/p>\n\u003cp>So if today's pain scale isn't working well for patients and doctors, what's the alternative?\u003c/p>\n\u003cp>Many health care providers are trying to come up with a system that involves words, not numbers.\u003c/p>\n\u003cp>\"I never look at just the pain scale,\" says \u003ca href=\"https://www.uclahealth.org/chrystina-jeter\" target=\"_blank\" rel=\"noopener\">Dr. Chrystina Jeter\u003c/a>, an anesthesiologist and pain management specialist with UCLA Health, who was Rosette's doctor.\u003c/p>\n\u003cp>Using words to describe pain brings greater specificity to the measurement of pain, says Maixner.[contextly_sidebar id=\"jBdk15Gcdb1FQXh8PlzSvMvHZmeTdBu9\"]\u003c/p>\n\u003cp>If patients can describe their pain precisely, he says, their appointment with a health care provider will be much more focused, allowing the physician to \"come to a decision about treatment in a much more rapid and logical way.\"\u003c/p>\n\u003cp>Here's advice for the next time you need to talk to your doctor about your pain.\u003c/p>\n\u003cp>\u003cstrong>Get Descriptive\u003c/strong>\u003c/p>\n\u003cp>You can help doctors understand just how debilitating your pain is by being more descriptive.\u003c/p>\n\u003cp>\"It's perfectly OK to be a little more flowery in the description of pain,\" says Jeter. \"My pain is aching, burning. What does it feel like to you? Where is it? Does it move?\"\u003c/p>\n\u003cp>Jeter typically asks patients to compare their current pain to the worst pain they ever had, such as childbirth or kidney stones. This helps put their pain in context, she says, and may help them realize their pain may not be that bad after all.\u003c/p>\n\u003cp>\u003cstrong>Describe Your Day\u003c/strong>\u003c/p>\n\u003cp>It can be helpful to talk about how your pain waxes and wanes throughout the day, says Jeter. For example, is it mostly when you eat, walk, or do certain activities?\u003c/p>\n\u003cp>\"I look for trends over time and I look at their function,\" she says.\u003c/p>\n\u003cp>\u003cstrong>Talk About Function, Not Feeling\u003c/strong>\u003c/p>\n\u003cp>Be clear about how your pain interferes with daily activities, such as getting out of bed early, getting dressed, feeling fatigued, or no longer enjoying getting out with friends, suggests Maixner.\u003c/p>\n\u003cp>Thinking about function is key, agrees Markman. He says the most accurate measurement of pain may be what it prevents patients from doing. For example, if a patient cannot chew or talk, walk, or exercise that might be more disturbing to them than the pain. Sometimes it's more useful to seek ways to \"work around the pain\" rather than \"making it go away,\" Markman says.\u003c/p>\n\u003cp>\u003cstrong>Share Treatment History\u003c/strong>\u003c/p>\n\u003cp>Describe the history of the pain, the location, how long it's been hurting and what factors seem to aggravate it, or help it get better, suggests Maixner.\u003c/p>\n\u003cp>Share other treatments you've sought, such as acupuncture, massage and certain medications, he says. \"Let the doctor know what you've done and whether it was effective.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Family history is also important, he says, especially when you consider much of an individual's pain sensitivity is inherited. If your parents were highly sensitive to pain, chances are you will be, too, he says.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Words+Matter+When+Talking+About+Pain+With+Your+Doctor&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"When you go to the doctor in pain, you'll probably be asked to rate your discomfort on a scale of 0 to 10. But doctors say there may be a better way to assess pain.","status":"publish","parent":0,"modified":1532390120,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":37,"wordCount":1147},"headData":{"title":"Words Matter When Talking About Pain With Your Doctor | KQED","description":"When you go to the doctor in pain, you'll probably be asked to rate your discomfort on a scale of 0 to 10. But doctors say there may be a better way to assess pain.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Words Matter When Talking About Pain With Your Doctor","datePublished":"2018-07-24T19:00:16.000Z","dateModified":"2018-07-23T23:55:20.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"443544 https://ww2.kqed.org/futureofyou/?p=443544","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/07/24/words-matter-when-talking-about-pain-with-your-doctor/","disqusTitle":"Words Matter When Talking About Pain With Your Doctor","source":"Health","nprByline":"Patti Neighmond, NPR","nprImageAgency":"Lynn Scurfield for NPR","nprStoryId":"626202281","nprApiLink":"http://api.npr.org/query?id=626202281&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"https://www.npr.org/sections/health-shots/2018/07/23/626202281/words-matter-when-talking-about-pain-with-your-doctor?ft=nprml&f=626202281","nprRetrievedStory":"1","nprPubDate":"Mon, 23 Jul 2018 11:59:00 -0400","nprStoryDate":"Mon, 23 Jul 2018 05:01:00 -0400","nprLastModifiedDate":"Mon, 23 Jul 2018 11:59:51 -0400","nprAudio":"https://ondemand.npr.org/anon.npr-mp3/npr/me/2018/07/20180723_me_words_matter_when_talking_about_pain_with_your_doctor.mp3?orgId=1&topicId=1066&d=236&p=3&story=626202281&ft=nprml&f=626202281","nprAudioM3u":"http://api.npr.org/m3u/1631434748-973f75.m3u?orgId=1&topicId=1066&d=236&p=3&story=626202281&ft=nprml&f=626202281","path":"/futureofyou/443544/words-matter-when-talking-about-pain-with-your-doctor","audioUrl":"https://ondemand.npr.org/anon.npr-mp3/npr/me/2018/07/20180723_me_words_matter_when_talking_about_pain_with_your_doctor.mp3?orgId=1&topicId=1066&d=236&p=3&story=626202281&ft=nprml&f=626202281","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>If you're in the hospital or a doctor's office with a painful problem, you'll likely be asked to rate your pain on a \u003ca href=\"https://paindoctor.com/pain-scales/\" target=\"_blank\" rel=\"noopener\">scale\u003c/a> of 0 to 10 – with 0 meaning no pain at all and 10 indicating the worst pain you can imagine. But many doctors and nurses say this rating system isn't working and they're trying a new approach.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The numeric pain scale may just be too simplistic, says \u003ca href=\"https://www.urmc.rochester.edu/people/21192807-john-d-markman\" target=\"_blank\" rel=\"noopener\">Dr. John Markman\u003c/a>, director of the Translational Pain Research Program at the University of Rochester School of Medicine and Dentistry. It can lead doctors to \"treat by numbers,\" he says and as a result, patients may not be getting the most effective treatment for their pain.\u003c/p>\n\u003cp>Take the case of 33-year-old Adam Rosette, who was recently hospitalized for \u003ca href=\"https://orthoinfo.aaos.org/en/diseases--conditions/fibrous-dysplasia/\" target=\"_blank\" rel=\"noopener\">fibrous dysplasia\u003c/a>, a bone disorder that made it nearly impossible for him to chew or even speak. After brain surgery to remove benign tumors related to the disorder, he was definitely in pain. But he was reluctant to label the pain too high.\u003c/p>\n\u003cp>\"I don't think I ever answered higher than a '7' because an '8' would be, in my mind, like I'm missing half of my body or a limb,\" he recalls.\u003c/p>\n\u003cp>On the pain scale a rating of 4 to 7 is considered moderate. Mild pain is rated 1 to 3. Over 7 is considered severe.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Today, Rosette has recovered and is pain-free, but he wonders if \"low balling\" his pain level while in the hospital, meant he wasn't given adequate pain medication.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"You realize you got less medicine and it's been eight hours and they're not allowed to give you more for a while,\" Rosette says.\u003c/p>\n\u003cp>If your doctor gets the wrong idea about your pain, it's not just going to affect your comfort — it can affect your treatment. Markman says that especially after an injury, there's therapeutic value to keeping the pain tamped down, so that you can keep up with physical therapy.\u003c/p>\n\u003cp>For chronic pain, being clear can help clinicians choose the right mix of therapies or medications to allow you to stay as active as possible. And staying active can help manage chronic pain, says \u003ca href=\"https://anesthesiology.duke.edu/?page_id=834374\" target=\"_blank\" rel=\"noopener\">Dr. William Maixner\u003c/a>, with Duke University School of Medicine and current president of the American Pain Society.\u003c/p>\n\u003cp>Exercise, he says, \"causes the release of a number of anti-inflammatory substances from the muscle that can help diminish pain and pain processing and make the individual more resilient.\"\u003c/p>\n\u003cp>To find out more about how the numerical pain scale was affecting treatment, Markman and colleagues at the University of Rochester did a study, which they will present at the World Congress on Pain in Boston in September. The research analyzed data from other studies, which asked chronic pain patients to rate their pain using both numbers and words.\u003c/p>\n\u003cp>Patients were asked to rate their pain on a scale of 0 to 10, and they were also asked the question, \"Is your pain tolerable?\"\u003c/p>\n\u003cp>Surprisingly, three quarters of the patients who rated their pain between 4 and 7 on the numerical scale, a range that typically calls for higher doses of medications, also described their pain as \"tolerable\" — a description that normally means no more pain treatment is needed.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>This showed the danger of relying only on a number, Markman says. \"If you were just treating by the numbers you might say, 'Well, someone has a pain that is 6 [out of]10. I feel obligated to do something about that ... to fix that number just like you might fix their blood pressure or their blood glucose,' \" he says.\u003c/p>\n\u003cp>If clinicians just look at a number, Markman says, they may be more likely to over-treat or prescribe more medication, which can be worrisome during an era of concern about opioid abuse and addiction.\u003c/p>\n\u003cp>So if today's pain scale isn't working well for patients and doctors, what's the alternative?\u003c/p>\n\u003cp>Many health care providers are trying to come up with a system that involves words, not numbers.\u003c/p>\n\u003cp>\"I never look at just the pain scale,\" says \u003ca href=\"https://www.uclahealth.org/chrystina-jeter\" target=\"_blank\" rel=\"noopener\">Dr. Chrystina Jeter\u003c/a>, an anesthesiologist and pain management specialist with UCLA Health, who was Rosette's doctor.\u003c/p>\n\u003cp>Using words to describe pain brings greater specificity to the measurement of pain, says Maixner.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>If patients can describe their pain precisely, he says, their appointment with a health care provider will be much more focused, allowing the physician to \"come to a decision about treatment in a much more rapid and logical way.\"\u003c/p>\n\u003cp>Here's advice for the next time you need to talk to your doctor about your pain.\u003c/p>\n\u003cp>\u003cstrong>Get Descriptive\u003c/strong>\u003c/p>\n\u003cp>You can help doctors understand just how debilitating your pain is by being more descriptive.\u003c/p>\n\u003cp>\"It's perfectly OK to be a little more flowery in the description of pain,\" says Jeter. \"My pain is aching, burning. What does it feel like to you? Where is it? Does it move?\"\u003c/p>\n\u003cp>Jeter typically asks patients to compare their current pain to the worst pain they ever had, such as childbirth or kidney stones. This helps put their pain in context, she says, and may help them realize their pain may not be that bad after all.\u003c/p>\n\u003cp>\u003cstrong>Describe Your Day\u003c/strong>\u003c/p>\n\u003cp>It can be helpful to talk about how your pain waxes and wanes throughout the day, says Jeter. For example, is it mostly when you eat, walk, or do certain activities?\u003c/p>\n\u003cp>\"I look for trends over time and I look at their function,\" she says.\u003c/p>\n\u003cp>\u003cstrong>Talk About Function, Not Feeling\u003c/strong>\u003c/p>\n\u003cp>Be clear about how your pain interferes with daily activities, such as getting out of bed early, getting dressed, feeling fatigued, or no longer enjoying getting out with friends, suggests Maixner.\u003c/p>\n\u003cp>Thinking about function is key, agrees Markman. He says the most accurate measurement of pain may be what it prevents patients from doing. For example, if a patient cannot chew or talk, walk, or exercise that might be more disturbing to them than the pain. Sometimes it's more useful to seek ways to \"work around the pain\" rather than \"making it go away,\" Markman says.\u003c/p>\n\u003cp>\u003cstrong>Share Treatment History\u003c/strong>\u003c/p>\n\u003cp>Describe the history of the pain, the location, how long it's been hurting and what factors seem to aggravate it, or help it get better, suggests Maixner.\u003c/p>\n\u003cp>Share other treatments you've sought, such as acupuncture, massage and certain medications, he says. \"Let the doctor know what you've done and whether it was effective.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Family history is also important, he says, especially when you consider much of an individual's pain sensitivity is inherited. If your parents were highly sensitive to pain, chances are you will be, too, he says.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Words+Matter+When+Talking+About+Pain+With+Your+Doctor&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/443544/words-matter-when-talking-about-pain-with-your-doctor","authors":["byline_futureofyou_443544"],"categories":["futureofyou_1060","futureofyou_1","futureofyou_73"],"tags":["futureofyou_259","futureofyou_61","futureofyou_379","futureofyou_218"],"collections":["futureofyou_1093"],"featImg":"futureofyou_443546","label":"source_futureofyou_443544"},"futureofyou_1819":{"type":"posts","id":"futureofyou_1819","meta":{"index":"posts_1591205157","site":"futureofyou","id":"1819","score":null,"sort":[1430156452000]},"guestAuthors":[],"slug":"smartphones-vinegar-and-the-future-of-cervical-cancer-screening","title":"Smartphones, Vinegar and the Future of Cervical Cancer Screening","publishDate":1430156452,"format":"standard","headTitle":"Women’s Health | Future of You | KQED Future of You | KQED Science","labelTerm":{"term":54,"site":"futureofyou"},"content":"\u003cp>100 years ago, cervical cancer reigned as the leading cause of cancer death for women in the United States\u003c/p>\n\u003cp>Then,\u003ca href=\"http://weill.cornell.edu/archives/blog/2011/06/george-papanicolaou-development-of-the-pap-smear.html\">\u003cspan style=\"color: #1155cc\"> a doctor at Cornell University\u003c/span>\u003c/a> began conducting studies on the sex cycle of guinea pigs and in 1915 realized that a similar “smear” technique could be applied to the study of human vaginal cells. A few decades of disinterest and skepticism later, the Pap smear became the standard cancer screening test for women. Today, \u003ca href=\"http://report.nih.gov/nihfactsheets/viewfactsheet.aspx?csid=76\">\u003cspan style=\"color: #1155cc\">the cervical cancer death rate has plunged by more than 50 percent and ranks 14th in frequency in the United States.\u003c/span>\u003c/a>\u003c/p>\n\u003cp>This is far from the case in developing countries, where \u003ca href=\"http://www.womendeliver.org/assets/CervicalCancer_final.pdf\">\u003cspan style=\"color: #1155cc\">cervical cancer is the most common cancer\u003c/span>\u003c/a> and the leading cause of cancer deaths among women. \u003ca href=\"http://www.wcrf.org/int/cancer-facts-figures/data-specific-cancers/cervical-cancer-statistics\">\u003cspan style=\"color: #1155cc\">Over 85 percent of cervical cancer cases occur\u003c/span>\u003c/a> in the developing world and these staggering rates are largely due to the lack of screening. Pap smears are rare and less than five percent of women receive any cervical cancer screening at all.\u003c/p>\n\u003cp>However, new research and innovations in cervical cancer screening are helping to increase its breadth and frequency in many of the world’s poorest countries. Moreover, these new approaches are actually more accurate, convenient, and cost-effective than the traditional Pap smear, not to mention less unpleasant. They let doctors and their patients bypass the Pap smear altogether, while the Pap smear’s dominance in the U.S. remains strong.\u003c/p>\n\u003cp>\u003cstrong>No Place for the Pap\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Many women may be surprised to learn that the Pap smear only detects cancer about half of the time but repeating the test on a regular basis increases the chances of finding cancer since the disease is slow to develop.\u003c/p>\n\u003cp>Repeating the test regularly is often not an option in developing countries where a number of barriers -- time, money, distance, transportation, children, agricultural cycles, social stigmas -- prevent women from visiting health clinics. Paps also take a hefty amount of resources to administer and read.\u003c/p>\n\u003cp>“The Pap test is hard to implement in low resource settings because it requires expensive machines, labs, and trained technicians, as well as for women to make the trips to clinics,” said Dr. José Jerónimo, the senior adviser for women’s cancers in a reproductive health program called \u003ca href=\"http://www.path.org/our-work/reproductive-health.php\">PATH\u003c/a>.\u003c/p>\n\u003cp>\u003ca href=\"http://www.path.org/\">PATH\u003c/a> is an international nonprofit dedicated to accelerating health innovation in the developing world. The organization has a number of initiatives aimed at making cervical cancer screening and prevention more prevalent in under-resourced areas. A key part of its approach is a low-tech effort called “VIA”, which stands for visual inspection with acetic acid.\u003c/p>\n\u003cfigure id=\"attachment_2125\" class=\"wp-caption aligncenter\" style=\"max-width: 446px\">\u003cimg class=\" wp-image-2125\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/04/Unknown-4-800x450.jpeg\" alt=\"Many new technologies are deployed first in developing countries \" width=\"446\" height=\"251\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/04/Unknown-4-800x450.jpeg 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/04/Unknown-4-400x225.jpeg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/04/Unknown-4-1180x664.jpeg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2015/04/Unknown-4-768x432.jpeg 768w, https://ww2.kqed.org/app/uploads/sites/13/2015/04/Unknown-4-320x180.jpeg 320w, https://ww2.kqed.org/app/uploads/sites/13/2015/04/Unknown-4.jpeg 1920w\" sizes=\"(max-width: 446px) 100vw, 446px\">\u003cfigcaption class=\"wp-caption-text\">Many new technologies are deployed first in developing countries \u003ccite>(TeamLiveLonger )\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>This method involves swabbing the cervix with a 3 to 5 percent vinegar solution during a speculum exam, waiting for one minute, and then observing the cervix to see if white areas appear. In addition to being inexpensive and easy to administer, VIA also provides immediate results. It allows a patient to immediately receive guidance on next steps if the test is positive.\u003c/p>\n\u003cp>However, like the Pap, the vinegar technique only identifies 50 to 60 percent of precancerous cases, which is why PATH helped develop \u003ca href=\"http://www.path.org/news/press-room/147/\">a new molecular test called careHPV\u003c/a> that was developed and field tested for use in low-resource settings.\u003c/p>\n\u003cp>CareHPV can detect DNA from 14 cancer-causing types of HPV in 2.5 hours without extensive lab facilities, using an affordable machine the size of a toaster oven that runs on electricity or a battery. Women can collect their own samples using a small brush, without the need for a pelvic exam.\u003c/p>\n\u003cp>This approach is ideal for environments where health care resources are limited and testing is often administered by community health workers who visit people’s homes, as well as in places where stigmas against pelvic exams persist.\u003c/p>\n\u003cp>Dr. Jerónimo said that simply by allowing women to collect the sample themselves, coverage increases by 4 times.\u003c/p>\n\u003cfigure id=\"attachment_2124\" class=\"wp-caption aligncenter\" style=\"max-width: 443px\">\u003cimg class=\"wp-image-2124\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/04/Unknown-2-800x533.jpeg\" alt=\"A group of medical students learn how to send images \" width=\"443\" height=\"295\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/04/Unknown-2-800x533.jpeg 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/04/Unknown-2-400x266.jpeg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/04/Unknown-2-1180x786.jpeg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2015/04/Unknown-2-768x511.jpeg 768w, https://ww2.kqed.org/app/uploads/sites/13/2015/04/Unknown-2-320x213.jpeg 320w\" sizes=\"(max-width: 443px) 100vw, 443px\">\u003cfigcaption class=\"wp-caption-text\">A group of medical students learn how to send images \u003ccite>(TeamLiveLonger )\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Texting, Calling, and Cervical Cancer Screening\u003c/strong>\u003c/p>\n\u003cp>\u003ca href=\"https://www.mobileodt.com/\">MobileODT\u003c/a> is a startup that makes a mobile colposcope, a long-range, Internet-connected magnifying glass that plugs into smartphones. The device provides a high-resolution image of cervical tissue, which can then be securely transmitted for diagnostics.\u003c/p>\n\u003cp>[Skip to the bottom to a video of how a mobile colposcope works.]\u003c/p>\n\u003cp>“There are very few labs or specialists in developing countries who are able to correctly assess cervical cancer at its early stages,” said MobileODT chief executive and cofounder Ariel Beery.\u003c/p>\n\u003cp>“What we seek to do is enable those same health workers who are already in the field to use a tool they use everyday — a mobile phone — to better visualize the cervix and collaborate with experts to process those images with greater accuracy.”\u003c/p>\n\u003cp>The advanced prototype of the mobile colposcope is currently being piloted in Kenya, Haiti, Mexico, Botswana and the U.S.. The startup ultimately hopes to use the data it collects to develop algorithms that are able to assess the risk of cervical cancer at any stage of the viruses’ development.\u003c/p>\n\u003cp>\u003ca href=\"https://www.indiegogo.com/projects/teamlivelonger-battling-cervical-cancer-in-haiti\">TeamLiveLonger\u003c/a> is another startup leveraging smartphone technology to combat cervical cancer, although its goal is to increase the feasibility of Pap smears, rather than replace them.\u003c/p>\n\u003cp>Founder Lou Auguste is of Haitian descent and worked as a first responder after the 2010 earthquake. There, he learned that Haitian women have the highest rate of mortality from cervical cancer in the world, with 54 per 100,000 women dying from the disease each year.\u003c/p>\n\u003cp>“Most women in Haiti have never been tested for cervical cancer or they don’t catch it before it is too late,” Auguste said.\u003c/p>\n\u003cp>“Doctors know how to perform pap smears but we realized there were only 5 pathologists in the whole country, so we needed to figure out a system for sending slides for consultations abroad.”\u003c/p>\n\u003cp>TeamLiveLonger developed an adaptor that connects a smartphone to a microscope to acquire images of slides. Its mobile technology then stitches the images together to produce a whole slide and securely transfers the images via a service called BitTorrent Sync (which enables the app to transfer large files over bad Internet connections) to a pathologist in the U.S. for analysis and diagnosis. TeamLiveLonger also built an electronic health record for mobile devices that makes it easy for health workers to keep cases updated and know when people come back to the clinic to receive results or treatment.\u003c/p>\n\u003cp>The Pap smear may not be the best method of screening for cervical cancer but it does hold the dubious distinction of being the most prevalent one. Innovation after innovation has emerged in this space over the past 20 years but their adoption is much faster in the developing world without the entrenched legacy of the Pap smear to overcome.\u003c/p>\n\u003cp>While women in Haiti, India, Nicaragua and Uganda get screened for cervical cancer with a brush and a mobile phone, it looks like women in the U.S. will have to endure the speculum for the foreseeable future.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>[youtube http://www.youtube.com/watch?v=Mm5ogJT-M9k]\u003c/p>\n\n","blocks":[],"excerpt":"Already dreading your next Pap smear? New medical screening tools offer a more affordable, less invasive alternative and women in the developing world are among the first to try them.","status":"publish","parent":0,"modified":1430164393,"stats":{"hasAudio":false,"hasVideo":true,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":30,"wordCount":1207},"headData":{"title":"Smartphones, Vinegar and the Future of Cervical Cancer Screening | KQED","description":"Already dreading your next Pap smear? New medical screening tools offer a more affordable, less invasive alternative and women in the developing world are among the first to try them.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Smartphones, Vinegar and the Future of Cervical Cancer Screening","datePublished":"2015-04-27T17:40:52.000Z","dateModified":"2015-04-27T19:53:13.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"1819 http://ww2.kqed.org/futureofyou/?p=1819","disqusUrl":"https://ww2.kqed.org/futureofyou/2015/04/27/smartphones-vinegar-and-the-future-of-cervical-cancer-screening/","disqusTitle":"Smartphones, Vinegar and the Future of Cervical Cancer Screening","path":"/futureofyou/1819/smartphones-vinegar-and-the-future-of-cervical-cancer-screening","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>100 years ago, cervical cancer reigned as the leading cause of cancer death for women in the United States\u003c/p>\n\u003cp>Then,\u003ca href=\"http://weill.cornell.edu/archives/blog/2011/06/george-papanicolaou-development-of-the-pap-smear.html\">\u003cspan style=\"color: #1155cc\"> a doctor at Cornell University\u003c/span>\u003c/a> began conducting studies on the sex cycle of guinea pigs and in 1915 realized that a similar “smear” technique could be applied to the study of human vaginal cells. A few decades of disinterest and skepticism later, the Pap smear became the standard cancer screening test for women. Today, \u003ca href=\"http://report.nih.gov/nihfactsheets/viewfactsheet.aspx?csid=76\">\u003cspan style=\"color: #1155cc\">the cervical cancer death rate has plunged by more than 50 percent and ranks 14th in frequency in the United States.\u003c/span>\u003c/a>\u003c/p>\n\u003cp>This is far from the case in developing countries, where \u003ca href=\"http://www.womendeliver.org/assets/CervicalCancer_final.pdf\">\u003cspan style=\"color: #1155cc\">cervical cancer is the most common cancer\u003c/span>\u003c/a> and the leading cause of cancer deaths among women. \u003ca href=\"http://www.wcrf.org/int/cancer-facts-figures/data-specific-cancers/cervical-cancer-statistics\">\u003cspan style=\"color: #1155cc\">Over 85 percent of cervical cancer cases occur\u003c/span>\u003c/a> in the developing world and these staggering rates are largely due to the lack of screening. Pap smears are rare and less than five percent of women receive any cervical cancer screening at all.\u003c/p>\n\u003cp>However, new research and innovations in cervical cancer screening are helping to increase its breadth and frequency in many of the world’s poorest countries. Moreover, these new approaches are actually more accurate, convenient, and cost-effective than the traditional Pap smear, not to mention less unpleasant. They let doctors and their patients bypass the Pap smear altogether, while the Pap smear’s dominance in the U.S. remains strong.\u003c/p>\n\u003cp>\u003cstrong>No Place for the Pap\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Many women may be surprised to learn that the Pap smear only detects cancer about half of the time but repeating the test on a regular basis increases the chances of finding cancer since the disease is slow to develop.\u003c/p>\n\u003cp>Repeating the test regularly is often not an option in developing countries where a number of barriers -- time, money, distance, transportation, children, agricultural cycles, social stigmas -- prevent women from visiting health clinics. Paps also take a hefty amount of resources to administer and read.\u003c/p>\n\u003cp>“The Pap test is hard to implement in low resource settings because it requires expensive machines, labs, and trained technicians, as well as for women to make the trips to clinics,” said Dr. José Jerónimo, the senior adviser for women’s cancers in a reproductive health program called \u003ca href=\"http://www.path.org/our-work/reproductive-health.php\">PATH\u003c/a>.\u003c/p>\n\u003cp>\u003ca href=\"http://www.path.org/\">PATH\u003c/a> is an international nonprofit dedicated to accelerating health innovation in the developing world. The organization has a number of initiatives aimed at making cervical cancer screening and prevention more prevalent in under-resourced areas. A key part of its approach is a low-tech effort called “VIA”, which stands for visual inspection with acetic acid.\u003c/p>\n\u003cfigure id=\"attachment_2125\" class=\"wp-caption aligncenter\" style=\"max-width: 446px\">\u003cimg class=\" wp-image-2125\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/04/Unknown-4-800x450.jpeg\" alt=\"Many new technologies are deployed first in developing countries \" width=\"446\" height=\"251\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/04/Unknown-4-800x450.jpeg 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/04/Unknown-4-400x225.jpeg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/04/Unknown-4-1180x664.jpeg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2015/04/Unknown-4-768x432.jpeg 768w, https://ww2.kqed.org/app/uploads/sites/13/2015/04/Unknown-4-320x180.jpeg 320w, https://ww2.kqed.org/app/uploads/sites/13/2015/04/Unknown-4.jpeg 1920w\" sizes=\"(max-width: 446px) 100vw, 446px\">\u003cfigcaption class=\"wp-caption-text\">Many new technologies are deployed first in developing countries \u003ccite>(TeamLiveLonger )\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>This method involves swabbing the cervix with a 3 to 5 percent vinegar solution during a speculum exam, waiting for one minute, and then observing the cervix to see if white areas appear. In addition to being inexpensive and easy to administer, VIA also provides immediate results. It allows a patient to immediately receive guidance on next steps if the test is positive.\u003c/p>\n\u003cp>However, like the Pap, the vinegar technique only identifies 50 to 60 percent of precancerous cases, which is why PATH helped develop \u003ca href=\"http://www.path.org/news/press-room/147/\">a new molecular test called careHPV\u003c/a> that was developed and field tested for use in low-resource settings.\u003c/p>\n\u003cp>CareHPV can detect DNA from 14 cancer-causing types of HPV in 2.5 hours without extensive lab facilities, using an affordable machine the size of a toaster oven that runs on electricity or a battery. Women can collect their own samples using a small brush, without the need for a pelvic exam.\u003c/p>\n\u003cp>This approach is ideal for environments where health care resources are limited and testing is often administered by community health workers who visit people’s homes, as well as in places where stigmas against pelvic exams persist.\u003c/p>\n\u003cp>Dr. Jerónimo said that simply by allowing women to collect the sample themselves, coverage increases by 4 times.\u003c/p>\n\u003cfigure id=\"attachment_2124\" class=\"wp-caption aligncenter\" style=\"max-width: 443px\">\u003cimg class=\"wp-image-2124\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/04/Unknown-2-800x533.jpeg\" alt=\"A group of medical students learn how to send images \" width=\"443\" height=\"295\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/04/Unknown-2-800x533.jpeg 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/04/Unknown-2-400x266.jpeg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/04/Unknown-2-1180x786.jpeg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2015/04/Unknown-2-768x511.jpeg 768w, https://ww2.kqed.org/app/uploads/sites/13/2015/04/Unknown-2-320x213.jpeg 320w\" sizes=\"(max-width: 443px) 100vw, 443px\">\u003cfigcaption class=\"wp-caption-text\">A group of medical students learn how to send images \u003ccite>(TeamLiveLonger )\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Texting, Calling, and Cervical Cancer Screening\u003c/strong>\u003c/p>\n\u003cp>\u003ca href=\"https://www.mobileodt.com/\">MobileODT\u003c/a> is a startup that makes a mobile colposcope, a long-range, Internet-connected magnifying glass that plugs into smartphones. The device provides a high-resolution image of cervical tissue, which can then be securely transmitted for diagnostics.\u003c/p>\n\u003cp>[Skip to the bottom to a video of how a mobile colposcope works.]\u003c/p>\n\u003cp>“There are very few labs or specialists in developing countries who are able to correctly assess cervical cancer at its early stages,” said MobileODT chief executive and cofounder Ariel Beery.\u003c/p>\n\u003cp>“What we seek to do is enable those same health workers who are already in the field to use a tool they use everyday — a mobile phone — to better visualize the cervix and collaborate with experts to process those images with greater accuracy.”\u003c/p>\n\u003cp>The advanced prototype of the mobile colposcope is currently being piloted in Kenya, Haiti, Mexico, Botswana and the U.S.. The startup ultimately hopes to use the data it collects to develop algorithms that are able to assess the risk of cervical cancer at any stage of the viruses’ development.\u003c/p>\n\u003cp>\u003ca href=\"https://www.indiegogo.com/projects/teamlivelonger-battling-cervical-cancer-in-haiti\">TeamLiveLonger\u003c/a> is another startup leveraging smartphone technology to combat cervical cancer, although its goal is to increase the feasibility of Pap smears, rather than replace them.\u003c/p>\n\u003cp>Founder Lou Auguste is of Haitian descent and worked as a first responder after the 2010 earthquake. There, he learned that Haitian women have the highest rate of mortality from cervical cancer in the world, with 54 per 100,000 women dying from the disease each year.\u003c/p>\n\u003cp>“Most women in Haiti have never been tested for cervical cancer or they don’t catch it before it is too late,” Auguste said.\u003c/p>\n\u003cp>“Doctors know how to perform pap smears but we realized there were only 5 pathologists in the whole country, so we needed to figure out a system for sending slides for consultations abroad.”\u003c/p>\n\u003cp>TeamLiveLonger developed an adaptor that connects a smartphone to a microscope to acquire images of slides. Its mobile technology then stitches the images together to produce a whole slide and securely transfers the images via a service called BitTorrent Sync (which enables the app to transfer large files over bad Internet connections) to a pathologist in the U.S. for analysis and diagnosis. TeamLiveLonger also built an electronic health record for mobile devices that makes it easy for health workers to keep cases updated and know when people come back to the clinic to receive results or treatment.\u003c/p>\n\u003cp>The Pap smear may not be the best method of screening for cervical cancer but it does hold the dubious distinction of being the most prevalent one. Innovation after innovation has emerged in this space over the past 20 years but their adoption is much faster in the developing world without the entrenched legacy of the Pap smear to overcome.\u003c/p>\n\u003cp>While women in Haiti, India, Nicaragua and Uganda get screened for cervical cancer with a brush and a mobile phone, it looks like women in the U.S. will have to endure the speculum for the foreseeable future.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutube'>\n \u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutubeInside'>\n \u003ciframe\n loading='lazy'\n class='utils-parseShortcode-shortcodes-__youtubeShortcode__youtubePlayer'\n type='text/html'\n src='//www.youtube.com/embed/Mm5ogJT-M9k'\n title='//www.youtube.com/embed/Mm5ogJT-M9k'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/1819/smartphones-vinegar-and-the-future-of-cervical-cancer-screening","authors":["6620"],"programs":["futureofyou_54"],"series":["futureofyou_219"],"categories":["futureofyou_1","futureofyou_73"],"tags":["futureofyou_213","futureofyou_34","futureofyou_61","futureofyou_80","futureofyou_173","futureofyou_214","futureofyou_216","futureofyou_218","futureofyou_217","futureofyou_215"],"featImg":"futureofyou_2081","label":"futureofyou_54"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. 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