Insomnia is the most common sleep complaint in the U.S. population, affecting as many of 10% of adults at one time or another. Insomnia is defined as trouble falling or staying asleep, or feeling that one’s sleep is nonrestorative. Chronic insomnia can result in a number of problems–daytime fatigue, anxiety, feeling cranky or irritated, forgetfulness, or making mistakes, to name a few–and because of this, it can affect the relationships and work of those who experience it.

Insomnia has many causes, and determining what is causing one’s sleep problems is often the first step toward finding a solution. For example, certain medical conditions that cause pain or breathing difficulty can keep one awake. Having to get up to go to the bathroom frequently can interfere with sleep. Some medications may have side effects that make sleep difficult. And stress or anxiety–due to work issues, the death of a loved one, etc.–can make a good night’s sleep a chronically unattainable goal.

So how do we handle the inability to sleep well through the night? For starters, if you do have an uncontrolled physical symptom or medical issue causing your insomnia, talk to your doctor about it! The next step is to promote a restful sleep environment. This is referred to as “Sleep Hygiene”. First, make sure you have a set bedtime and wakeup time, and stick to them. Do not nap or doze during the day. Make sure your bedroom is dark and quiet, and kept at a comfortable temperature. Use an eye mask or earplugs, or a white noise machine, if needed. Exercise daily, but not right before bedtime. Do not have any alcohol, caffeine, or nicotine in the late afternoon or evening. And be sure to resolve any stressful issues from your day long before bedtime.

If you are still unable to sleep, then further steps may be taken. One option is to retrain your body to sleep through the night using the following method. If you cannot fall asleep after 15-20 minutes, get out of bed and do something relaxing, like reading. Do not engage in any activities that are goal-oriented or will make you more alert. When you start to feel tired, then return to your bed. If you are unable to fall asleep after another 15-20 minutes, repeat this cycle until you are able to fall asleep. Remember that even if you do not get a full night’s sleep at first, you should stick to your regular wakeup time. This may take a couple of weeks to result in a full night’s sleep, but eventually your body will adjust to the sleep cycle you are enforcing.

For those who do not respond to any of the above measures, other options–like cognitive or relaxation therapy–may be helpful. A formal sleep study, or even referral to a sleep medicine doctor, may be indicated. And as with any health concern, if your insomnia persists, you should follow up with your doctor to get to the bottom of it.

It’s an experience almost everyone has had: you wake up to find one eye seemingly glued shut. You carefully pry your lashes from the crust that has them stuck to your cheek revealing an eye that is red and watery – the dreaded pink eye.

Pink eye is the common name for conjunctivitis, inflammation of the thin membrane that covers the eyeball and inner surfaces of the eyelids. Acute conjunctivitis can be caused by an infection, allergies, or an unknown irritant. Infectious pink eye can be viral or bacterial and both are quite contagious.

Though many people think pink eye is always caused by a bacteria and needs an antibiotic eyedrop, the most common cause of infectious conjunctivitis in adults is the adenovirus, the same virus that can cause the common cold. Sometimes viral pink eye comes as part of a general cold syndrome with swollen lymph nodes (glands), fever, sore throat, and a runny nose. The eye can have a burning, sandy, or gritty feeling, is often crusted shut in the morning, and will have a watery or mucus discharge throughout the day. The other eye usually becomes infected in the next day or two. Just like a cold, viral pink eye symptoms often get worse for the first three to five days then gradually improve over one to two weeks. There is no cure for viral conjunctivitis and antibiotic eye drops will not reduce the duration or intensity of symptoms. Over the counter antihistamine eye drops or artificial tears can help with the eye discomfort. A warm or cool wet washcloth (whichever feels better) can also be soothing.

Bacterial conjunctivitis can involve one or both eyes. Whereas the discharge with viral conjunctivitis is watery with perhaps some mucus, bacterial conjunctivitis causes a thick white, yellow, or green discharge. The affected eye will continuously ooze throughout the day, with more pus-like discharge accumulating just a few minutes after the eye is wiped. An antibiotic drop or ointment can improve symptoms and reduce the likelihood of spreading the infection to others.

Both viral and bacterial conjunctivitis are spread by contact, usually with objects which have come into contact with the infected person’s eye secretions. For an example, an infected person touches her eye then touches her phone or a door handle. Some organisms can live for many hours on a surface so it is easy to see how it can spread. Infected individuals should consider themselves contagious as long as they have eye discharge and should not share tissues, towels, cosmetics, or bed linens. They need to discard any cosmetics that may have become contaminated. They should avoid touching the infected eye and wash their hands frequently to help reduce spread to others. Antibiotic eye drops can reduce the spread of bacterial conjunctivitis but do nothing to reduce the spread of viral conjunctivitis. Viral conjunctivitis is like a cold and the decision to return to work or go to a social gathering should be similar to how one would behave with the common cold.

Contact lens wearers need to wear glasses until their eye is no longer red. Their lens case should be discarded and the contact lenses disinfected overnight or replaced if disposable.

If you are not sure if you have viral or bacterial pink eye or you think you need an antibiotic please make an appointment to be seen in the office. Calling first thing in the morning (as soon as you unstick your eye, of course) can help us be sure to see you that day.

A red eye that is associated with moderate to severe pain, loss of vision, or intense sensitivity to light (cannot keep the eye open for more than a few seconds) indicates a more serious condition that could potentially lead to blindness if left untreated. Contact lens wearers are at higher risk of more serious infections, particularly with extended-wear lenses. Evaluation should be sought immediately at an Opthalmologic ER such as Wills Eye or Scheie Eye Institute.

Fall is just around the corner–back to school/work, and back to reality, for most of us. An important part of getting back into the swing of things is making sure your routine health screenings are in order. Many of the screening guidelines we have all grown up with have been changing as we learn more about the natural histories of many chronic diseases, so it’s important to make sure you are where you need to be in terms of prevention. The most obvious screening exam, and the gatekeeper for most others, is the “Physical”, or Periodic Health Maintenance Examination. As the name implies, the purpose of this exam is to ensure you are “maintaining” your optimal health by keeping up to date on preventive screenings and incorporating health-promoting/protecting habits into your lifestyle. It is different from the “problem-focused” visits most people schedule–rather than talking about headaches or skin rashes or other specific medical concerns, the physical focuses on preventive tests, behaviors, and immunizations. What are these?

For starters, vaccinations do not end when you graduate college; there are a number of shots that are specific to adult populations. All adults should receive a Tdap (Tetanus, Diptheria, and Pertussis) vaccination every 10 years. Even if you have had a recent Tetanus-only vaccination, you still need the Tdap shot. Pertussis has again become prevalent; it can be deadly for infants or immunocompromised people, and can be very debilitating even for healthy adults. Pneumococcal (pneumonia) vaccination is advised for all adults aged 65 and older (and for some younger patients with chronic health issues). The Shingles (Zoster) vaccine is recommended for adults 60 and older, as this age group is disproportionately affected by this condition. And annual influenza vaccination is recomended for virtually everyone now. Finally, for the adult population 26 and younger who have not yet received the HPV (Gardasil) immunization series, this may be indicated.

Aside from shots, different people require certain blood screenings. Recommendations from expert groups vary on some points, but baseline cholesterol screening at a minimum is important. Adults in the “baby boomer” generation should have a one-time Hepatitis C screening. Individuals with certain family histories, risk factors, or symptoms may need additional screening for diabetes, anemia, or thyroid conditions, among other screenings. These are decisions that can be made at your physical based on the conversation you have with your doctor.

Cancer screening remains of the utmost importance; here again, however, screening recommendations vary, so it’s important to discuss your specific risks and the appropriate screening interval for you with your doctor. Currently, cervical cancer screening (the “pap test”) is recommended for most women ages 21-65 at an interval of 3-5 years. Mammograms are recommended from 1-2 years from ages 40-75 by varying expert group; some advise screening to later ages, as well. Clinical breast examinations by a doctor are typically recomended every 1-3 years for women aged 21-39, and annually for women aged 40 and above. Colon cancer screening begins at age 50 and is recommended until age 75 or older, depending on the screening guidelines you are following and a patient’s specific risk factors.

There are additional screening tests that again, may vary among individuals. Bone density testing with a DEXA scan is typically begun in women at age 65, but sooner for women with certain risk factors. Dental exams are recommended for all adults every 6 months, or as directed by your dentist. Eye examinations are recommended every other year for older adults.

This is just a sampling of the preventive health measures that every woman should be aware of, but it is by no means exhaustive or one-size-fits-all, as you can see. The best thing to do is to schedule an appointment for a Health Maintenance Examination (Physical) with your doctor to evaluate your health status and get on a schedule for the preventive measures that are appropriate for you.

Summer has arrived and for many of us that means getting out and about on vacations and weekend getaways! RWWC wants to remind all of our patients looking to traverse the globe that we are here to provide you with the preventative care and information that you need to ensure a trip focused on destination and not illness!

This summer (and all year-round) you can make an appointment with us to review your itinerary and medical history, provide necessary vaccinations and prescriptions as well as get advice on staying healthy throughout your trip. We have also recently subscribed to a data source to make sure our patients also get the most up-to-date news on not only health risks but also any domestic problems in the country of their destinations. What better way to care for our patients than to try and ensure their health AND safety?

Since many insurance companies do not cover travel medicine, the cost of the visit is $75 plus the cost of any vaccinations that you may require. Many vaccines (Hepatitis A and B as well as the Tetanus vaccine) are covered by most insurances, but some are not and some insurance plans have limited coverage. We recommend you schedule your appointment six weeks before your departure so that you have ample time to get all of your vaccines as well as allowing you time to call your insurance after the appointment if you have any questions about coverage for vaccines that your physician recommends.

Special Vaccinations

When calling us to make an appointment, please make sure to tell the receptionist your itinerary so that the doctor can prepare for your appointment. Certain vaccinations, including those against rabies, Japanese encephalitis and Yellow Fever are only available at specialized travel clinics. We’ll help you determine whether you need any of these vaccines and direct you to the appropriate clinic. Travelers to equatorial Africa and parts of South America will require proof of vaccination against yellow fever, so be sure to follow through with any referrals your doctor recommends.

We hope that you are planning some wonderful adventures this year, but please make sure you come and see us first!

After lung cancer, breast cancer is the second deadliest cancer in all women, and periodical screenings are the best way to control it. Several medical studies have shown that being screened for breast cancer effectively lowers the mortality rate for women affected by this disease.

While different medical groups offer a wide range of recommendations, it is generally accepted that women between the ages of 50 and 70 should be screened.  Screening should continue if the patient is in good health, until the patient’s life expectancy is less than 5 to 7 years.  While it is agreed that routine screening mammography can be stopped at age 75, the age at which to start screening varies anywhere between 40 and 50.  At that time, the decision should be shared between the patient and the medical professional, and should take into consideration all potential benefits and complications.  This includes the individual’s level of breast cancer risk, established by medical history and by use of a risk prediction model. The most commonly used one is the Breast Cancer Risk Assessment Tool (Gail model), available online at www.cancer.gov/brisktool/ .

Studies show that breast cancer in women between 40 and 49 is usually more aggressive than breast cancer diagnosed in someone 50 or older.  Therefore, if it is agreed by the patient and their doctor that breast screening be started at age 40, it should be performed yearly until age 49.  Starting at age 50, the screening can take place every 1 or 2 years, depending on the risk of disease.

While there are obvious benefits to being screened, there are also two uncommon, but significant drawbacks:

• False positive results – when a mammogram suggests that a woman may have cancer and she does not.  This may lead to more unnecessary testing and increased anxiety.  This is more likely to happen in women under 50 years of age.
• Radiation exposure – because the mainstay of testing is mammography, this procedure exposes patients to radiation.  However, studies show that the number of lives saved by catching then onset of cancer early greatly outweighs the small risks that come from radiation exposure.

There are several specific symptoms to keep in mind when being vigilant about breast cancer:

• Breast pain or tenderness – while breast pain and tenderness are commonly associated with hormonal and dietary changes, as well as with stress, breast pain that is continuous and does not change with your cycle is a little more concerning.
• Nipple discharge – if you are having a discharge from one or both of your nipples, you should see your doctor.  It is common that healthy women can squeeze out a small amount of yellow, green or brown fluid from their nipple.  Clear or bloody discharge is more worrisome and should be followed up with a visit to your doctor.
• Inverted nipples – while it is normal for women to have inverted nipples when breasts develop or after breast feeding, if the change occurs without having breastfed, you should also see your doctor.  This may be the first sign of breast cancer.
• Breast skin changes – changes in breast skin can be signs of a rare but very serious form of breast cancer called inflammatory breast cancer.

Worrisome  symptoms include:

Skin that feels warm or hot
Color changes—skin looks pink, red or purple.
Thicker skin
Dimples or pits on the skin (like the rind of an orange)
A flat nipple
A nipple that turns red
A crust or blister on the nipple.
A nipple that points in (if it pointed out before)
Painful, swollen breast

There are a few lifestyle factors that can be introduced or modified to reduce your risk of breast cancer:

• Increased physical activity – exercise seems to protect against the disease in both premenopausal and postmenopausal breast cancer.  Weight gain and obesity are mostly associated with an increased risk of postmenopausal breast cancer.
• Alcohol consumption – as few as 3 drinks per week of any type of alcohol increases your risk of breast cancer.
• Smoking – both passive and active tobacco exposure has been associated with an increased risk of breast cancer, especially among premenopausal women.
• Diet – there appears to be evidence that a diet high in fruits and vegetables is associated with a lower risk of breast cancer.  Conversely, eating more than five servings of red meat per week may cause an increased risk of hormone-positive premenopausal breast cancer.  Diets low in calcium and Vitamin D have been associated with higher risks of breast cancer in premenopausal women.

While there are many non-modifiable risk factors that contribute to breast cancer, the most significant  is the BRCA1 and BRCA2 mutation.  Luckily, only 20 percent of women affected have a history of breast cancer involving a first-degree relative.  If anyone in your family has had breast cancer, it is well worth looking into being tested for this genetic risk.  This can be done with your medical professional.

Now that the weather has (finally!) started to improve, many of us are focused on getting outside for some fresh air and fitness. But what’s the best way to do this safely, with the maximum benefits to our health? Variety and moderation are the keys.

Exercise is any physical activity designed to improve/maintain some aspect of physical fitness. The benefits of exercise are numerous–risks for diabetes, high blood pressure, osteoporosis, cardiovascular disease, and stroke are all reduced in those who exercise regularly. Mood is improved, and life expectancy is increased. Although every individual’s exercise program should be tailored to her own preferences, abilities, and lifestyle, the health goals are basically the same for all. There are 4 main types of physical activity that help to achieve these goals:

1. Aerobic exercise: increases the blood flow to your heart and conditions the heart muscle. This type of exercise includes running, walking, swimming, etc. You should aim to get 30 minutes of moderate aerobic activity 5 days a week (this may be broken up into 10-minute intervals throughout the day) for maximal benefit.
2. Weight training: strengthens muscles and supports bone strength. This is the type of exercise that prevents osteoporosis and bone fractures. At least one set of twelve repetitions for each major muscle group is recommended, two or three times weekly.
3. Stretching: improves flexibility and balance and reduces the risk of injury. You should stretch each joint and hold for at least 10 seconds. Yoga is a great example of a stretching program.
4. Avoidance of inactivity: refers to a multitude of choices made throughout the day to be active instead of sedentary. A number of studies have shown that reducing the amount of time spent sitting–watching TV, etc,–has active health benefits above and beyond traditional forms of exercise. So get up and do the dishes, even if you have a dishwasher. Take the stairs instead of the elevator. Fidget!

Most people can begin an exercise program slowly and safely and work up to a level that is well-tolerated and sustainable. However, anyone with diabetes or cardiovascular risk factors should discuss the need for stress testing prior to initiating a new exercise program. Other health concerns can be discussed with your doctor on a case-by-case basis, to make sure that your regimen does not aggravate existing conditions. Of course, it is always important to stay well-hydrated when exercising, and make sure you are appropriately attired for the type of exercise and the conditions in which you will be exercising. Finally, it is important to be aware of warning signs that could be a sign of a serious problem while exercising–such as chest pains, difficulty catching your breath, dizziness, extreme fatigue, or joint pains–stop exercising if you have these symptoms, and seek medical attention. By being smart and sensible, and creating a well-rounded exercise program, you can improve your overall level of fitness and wellness.

Good luck!

Now that we are in the thick of winter, many of us have been getting sick with respiratory illnesses. A typical first reaction in this situation is “I’d better see my doctor right away for an antibiotic before this gets worse”. But in the vast majority of cases these infections are caused by viruses, and antibiotics (which only treat illnesses caused by bacteria) are unhelpful.

Take the common cold. Symptoms of a cold are sneezing, runny nose, sore throat, and nasal congestion. Colds are ALWAYS caused by viruses, and therefore, antibiotics will NEVER cure a cold. The goal of treatment is to manage your symptoms with medications and other therapeutic measures until the symptoms resolve, usually anywhere from 3-14 days for complete symptom resolution. Options for management of cold symptoms include over-the-counter decongestants such as pseudoephedrine, antihistamines such as diphenhydramine for runny nose and sneezing, and acetaminophen or ibuprofen for sore throat. Drinking plenty of fluids and getting adequate rest will also help you to feel better while you are sick, although these things will not shorten your illness.

Another common infection people develop this time of year is acute sinusitis, or inflammation of the nasal passages and sinuses. Symptoms can include nasal congestion, pain in the teeth or face, thick yellow or green nasal discharge, ear pressure or fullness, and occasionally, fever. The vast majority of sinus infections–more than 98%!–are also caused by viruses, so again, antibiotics will not help or shorten the duration of your symptoms. It can take 7-10 days before a typical sinus infection starts to resolve. Symptoms that suggest a bacterial sinus infection are fever over 102 degrees, sudden worsening of symptoms in the middle of your illness, or an illness that lasts 7-10 days without any improvement–in these cases, it is prudent to schedule an office appointment for an evaluation without delay. You may also schedule an appointment if over-the-counter medications are not controlling your symptoms adequately. Typically, however, the mainstay of management of acute sinusitis is to treat symptoms with nasal decongestants/sprays, nasal saline irrigation, and acetaminophen or ibuprofen for pain (limit the use of nasal sprays such as Afrin to 3 days, as longer use can actually worsen congestion).

The last type of infection we commonly see this time of year is Bronchitis, or inflammation of the large airways in the lungs. Bronchitis presents as coughing and congestion in the chest (commonly described as a “chest cold”), along with mucus which can be yellow or green in color. Again, most of these illnesses are caused by viruses, frequently in conjunction with common cold symptoms, and it can take up to 2-3 weeks before the cough completely resolves (although you should be improving over this time period). Over-the-counter cough medications may offer modest relief of cough symptoms; using a humidifier may also soothe cough and sore throat. Some studies suggest that a teaspoon of honey may be beneficial in soothing cough, as well. Symptoms that may signal a more serious lung infection–such as the flu or pneumonia, or the bacterial infection Bordetella pertussis (“whooping cough”)–include high fevers, fatigue and body aches, coughing up blood, shortness of breath, chest pains, or a barking cough. If you have any of these symptoms, antibiotics or other prescription medications may be indicated, and you should call the office right away to schedule an appointment.

The take-home point is that most of the respiratory infections you may develop this time of year are caused by viruses, and can be safely and effectively treated at home with over-the-counter medications, rest, and TIME. If you do develop a respiratory illness and you are not sure how serious your symptoms are, if any of the “flag” symptoms noted above are present, or if you have a chronic respiratory or other condition that may complicate your illness or treatment, you should always contact us to discuss how you’re feeling or schedule an appointment for an evaluation in the office.

Pertussis, also known as “whooping cough,” is a highly contagious, acute respiratory illness caused by Bordetella pertussis bacteria. The name comes from the Latin term meaning “intense cough.”

Over the last few years there has been an increase in the number of cases reported, with outbreaks reported in Pennsylvania.

The classic symptoms of pertussis include cough, an inspiratory whooping sound and vomiting after spells of coughing. However in adults, the symptoms are often much milder. It is thought that pertussis is responsible for 13-20% of cough illnesses lasting for more than one week in adolescents and adults. Most adults have much longer illnesses lasting from 3-6 weeks. Infants and young children typically contract the illness from adults. Each year pertussis causes approximately 300,000 deaths.

Individuals with pertussis are considered infectious until they have completed five days of appropriate antibiotic treatment.

An important misconception is that childhood pertussis vaccination confers lifelong immunity. Protective immunity wanes after 5 to 10 years and rarely lasts more than 12 years. Therefore, booster vaccination is recommended for adolescents and adults. In 2006 Tdap (Adacel) vaccine was introduced specifically for adults. It is recommended that all adults receive this vaccine one time.

The vaccine is generally well tolerated. It can cause injection site pain, headache, fatigue, GI upset and in rare cases flu like symptoms.

As we transition from fall allergy season to the winter cold and flu season many people are looking to alternative solutions for relief from mucus and nasal congestion. Nasal saline irrigation, often administered with a neti pot, has become a popular adjunct therapy. Reports of deaths from amebic brain infections linked to neti pot use were widely publicized in the media and raised some concern about this therapy. Before you take the plunge it is worth asking – are neti pots effective and are they safe?

A neti pot is a container with a spout that is designed to irrigate the nasal passages, usually with a salt water solution. The spout of the neti pot is placed in one nostril as the head is tilted and the solution flows into one nostril and out the other, flushing out mucus and particulate matter with it. They are used for head colds, sinus problems, allergies, and some people irrigate their nasal passages daily as part of their general health routine.

Though there are many enthusiastic neti pot users out there, the evidence for the true benefit of nasal saline irrigation is sparse and inconsistent. In one study of chronic rhinosinusitis (inflammation of the nasal and sinus passages persisting over 12 weeks) daily use of nasal saline irrigation showed a 64% reduction in overall symptom severity. However, there is some concern that ongoing daily use of nasal saline irrigation may make a person more susceptible to infection by washing away the protective layer of “good” mucus that acts as a first line of respiratory defense. For use with allergies, acute upper respiratory infections (colds), and nasal inflammation of pregnancy there is even less data on efficacy but, overall, safety and tolerability across the board looks good.

Fewer than 10% of people using nasal saline irrigation report adverse effects. The most common include a sensation of ear fullness, stinging of the nasal passages, and in rare occasions nosebleeds. The most serious concerns related to neti pot use have to do with the solution that is used in the neti pot, not the technique itself. You can make your own solution at home with purchased salt packets or by adding ¼ tsp salt per cup of water. The water you use to prepare the solution is very important and the CDC recommends it be bottled water that has been distilled or sterilized. Tap water can be used but only if it has been boiled for 5-7 minutes then allowed to cool.

There are organisms in bottled and tap water that are okay for drinking but can be harmful if introduced deeply into the nasal or sinus passages. In the deadly cases of amebic brain infections linked to neti pot use evidence of the causative ameba was found in the home plumbing. Other organisms cultured from hot water heaters have also been implicated in cases of chronic sinus infections in regular neti pot users who did not prepare their water correctly. You should make up fresh solution each time you use your neti pot. Care must also be taken to clean and completely dry the neti pot after each use.

Since it is generally well tolerated and safe when the proper solution is used, nasal saline irrigation, including the use of neti pots, can generally be recommended. Though hard evidence is lacking it is unlikely to hurt you and it just might help so go ahead and give it a try.

Cervical cancer, while one of the most prevalent diseases affecting women around the world, has seen markedly reduced incidence in the US over the past few decades due to a number of developments in prevention and screening. Risk factors for cervical cancer include early age at first intercourse, multiple sexual partners, multiple births, smoking, and immunodeficiency. It has further been established that the vast majority of cervical cancers are caused by “high risk” strains of the HPV, or Human Papilloma Virus, which affects cervical cells. Efforts at preventing cervical cancer in this country have focused on modifying certain lifestyle choices that put one at increased risk, as well as the development of vaccines against the HPV virus, and of course, screening with the pap smear test.

The many HPV virus subtypes are transmissable through sexual activity, including oral-genital and skin-skin contact. HPV infection is extremely common in sexually active women. In women under 30, the infection often clears in a couple of years, but in older women it can linger. Condoms do have some efficacy in preventing the spread of HPV, so it is important to use them consistently. In addition, the Gardasil vaccine, which is available here at RIM, was FDA-approved in 2006 for girls/women ages 9-26 (and more recently, for boys/men in the same age group, as well). This three-shot vaccination series protects against 2 types of high-risk HPV which are responsible for about 70% of all the cervical cancer cases in the US, as well as two types of HPV which cause genital warts. At this point, it is unknown how long the protection afforded by the vaccine lasts, and it does not yet change the pap smear screening interals for vaccinated individuals, but it does offer another level of protection against cervical cancer.

Current guidelines for cervical cancer screening in immunocompetent women vary slightly among different expert groups, but there is general consensus now that women do not need to be screened for cervical cancer until age 21, regardless of prior sexual activity. For women ages 21-30, screening with the liquid-based pap test is now recommended every 3 years, as long as the testing comes back normal. HPV screening in this age group is only done if the pap test has certain abnormal findings. For women ages 30-65, most screening groups recommend screening with the pap test and HPV testing every 5 years, assuming normal results. After age 65, most women can stop screening if they have had 3 consecutive normal pap results OR 2 consecutive normal pap/HPV tests within the past 10 years, with the last test being within the past 5 years. These guidelines do not hold in women who are immunocompromised, who have had previous high-grade abnormal screening results, or who have had a hysterectomy with removal of the cervix; these patients should discuss their individual screening recommendations with their physicians.

Prevention and treatment of cervical cancer in this country continues to move forward; the best way to protect yourself is to make careful choices about sexual activity, including the use of condoms, to consider getting the HPV vaccine if you are in the appropriate age group, to get regular pap smears, and to continue to stay informed about developments in this important area of women’s health.