MEDICATIONS: SEXUALLY ACTIVE POSTMENOPAUSAL WOMEN MAY BENEFIT FROM CONTINUED PAP SCREENINGS

July 27, 2006 — Unmarried sexually active postmenopausal women may benefit from continuing to have cervical cancer screening even if they have previously had normal cervical cytology results, according to research published in the August issue of Obstetrics & Gynecology. The new research found that while estrogen plus progestin hormone therapy (HT) increased the incidence of abnormal cervical cytology results, it had no impact on the incidence of actual cervical cancer.

Researchers analyzed a subset of data from the larger Women's Health Initiative (WHI) study to estimate the effect of oral HT on the incidence of cervical cytology abnormalities and cervical cancer among postmenopausal women. The researchers looked at cervical cytology data of 15,733 women ages 50 to 79, all of whom had their uterus. None of the women in this analysis had a history of invasive cervical cancer. Roughly half of the women were taking estrogen plus progestin HT, and the other half were taking placebo.

Women's marital status and sexual activity were also reviewed. Women were divided into three groups: married/living as married; not married/living as married and not sexually active; or not married/living as married but sexually active.

Researchers found that the overall annual incidence rate of high-grade squamous intraepithelial lesion or cervical cancer was significantly higher among sexually active unmarried postmenopausal women than among either unmarried postmenopausal women who were not sexually active or married postmenopausal women. They also found that oral HT did not increase the risk or incidence of cervical cancer, but it did significantly increase the incidence of abnormal Pap test results.

Although there is an age-related decrease in the incidence of abnormal cytological results, the researchers say that it isn't enough of a decrease to ignore the risk of cervical cancer in all women older than 70. They conclude that cervical cytology screening every three years is appropriate for low-risk postmenopausal women (married or not sexually active) with normal cytology screenings, but that sexually active unmarried elderly women may benefit from continuing to get Pap screenings, even if they have previously had normal cervical cytology.

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