In this issue of HEALTHbeat:
  • Another reason to trim your waistline
  • How long should I keep getting Pap tests?


blank
Harvard Health Publications -- Harvard Medical School blank HEALTHbeat
April 28, 2009

Dear HEALTHbeat subscriber,

Do you worry about your waistline? Lots of us do. And most of us who do also want to tame bulges and look better—maybe with a passing consideration of the health effects of belly fat. This issue of HEALTHbeat gives a new reason to be vigilant about our shape. The abdominal fat we put on in middle age may contribute to dementia when we’re elderly. Also in this issue, Dr. Celeste Robb-Nicholson, editor in chief of the Harvard Women’s Health Watch, discusses at what age women can safely stop having Pap smears.

Wishing you good health,


Nancy Ferrari
Managing Editor
Harvard Health Publications
HEALTHbeat@hms.harvard.edu

In This Issue
1 Another reason to trim your waistline
[READ]
2 Notable from Harvard Medical School:
* Healthy Solutions to Lose    Weight and Keep it Off
* Harvard Women’s Health    Watch
[READ]
3 How long should I keep getting Pap tests?
[READ]

From Harvard Medical School
Healthy Solutions to Lose Weight and Keep it Off
Healthy Solutions to Lose Weight and Keep it Off is a Special Health Report from Harvard Medical School. This special report will help you determine the cause of your excess weight and tailor a plan to your particular needs. It also provides details on popular weight-loss diets, organized self-help programs, weight-loss supplement ingredients, weight-loss surgery, and steps for keeping the weight off.
[READ MORE]
 
 
     
 
 

1\ Another reason to trim your waistline

Over the past several years, researchers have slowly accumulated evidence linking excess weight to dementia. But it may not be overall weight that matters most, but rather where it sits on the body. A study published in 2008 indicated that it’s fat tissue in the abdominal cavity — the stuff that expands our waistlines — that’s most strongly associated with dementia. 

Lose it, or lose it!

If getting fat translates into a higher risk of developing dementia, that might add some fresh motivation to weight-control efforts. “People aren’t as scared of cardiovascular disease as they are of losing their minds,” points out Rachel A. Whitmer, an epidemiologist for Kaiser Permanente who has conducted several of the important studies on weight and dementia. Whitmer says it’s time we started paying attention to belly size as a bona fide health indicator, like cholesterol levels and blood pressure readings, not just a source of aesthetic anguish or wardrobe malfunction.

The fat-brain connection

There are several theories about how abdominal fat might cause dementia. Most start with the observation that abdominal fat is busy tissue that secretes hormones, growth factors, and a witches’ brew of other biologically active molecules. Some of these secretions may affect brain tissue directly. Some researchers have proposed that fat tissue affects the brain by weakening the blood-brain barrier, which may let harmful molecules cross it. But much of the evidence of direct effects is circumstantial.

Fat tissue may also affect the brain by causing subtle damage to arteries that supply the brain and by making blood “stickier,” so blood clots are more likely. We tend to equate dementia with Alzheimer’s disease, but often the cause is vascular (that is, it involves blood vessels) or a mix of vascular and Alzheimer’s disease.

Is fat the innocent bystander?

It could be, though, that much-maligned abdominal fat is more an innocent bystander than the real troublemaker. Instead, obesity and dementia may have common roots in the brain. A brain abnormality that leads to overeating or a dysfunctional metabolism in midlife may lead to dementia once we get old. At this point, this theory is mainly conjecture, although there are some connections between structures in the brain that control appetite and metabolism and those that are active in memory and cognition.

What’s next?

Cardiovascular disease (including heart attacks and strokes) is the No. 1 cause of death in the United States, but there’s a lot we can do about it — lower our cholesterol levels and our blood pressure readings, drink alcohol in modest amounts, exercise. And if you do have a heart attack, all the high-tech prowess of modern medicine can be brought to bear. But so far, we’ve been pretty defenseless when it comes to dementia. So if there’s good news to be gleaned from the emergence of a weight-fat-dementia connection, it’s that it gives us something to do. Unfortunately, that something is the ever-difficult task of weight control.

Future midsection testing

Once researchers get a better handle on the relationship between abdominal fat and dementia, other avenues for dealing with obesity might open up. Drugs that block the effect of hormones and other chemicals produced by fat tissue may be developed. The day may come when we’ll be tested for fat-related biomarkers, or have imaging studies of our midsections to measure the fat content, and then be treated medically depending on the results. The fad diet will seem archaic by comparison.

For now, all we know is that weight and dementia may be related, and that achieving and maintaining a healthy weight is good for body and mind.

For more information about achieving and maintaining a healthy weight, order our Special Health Report, Healthy Solutions to Lose Weight and Keep it Off, at www.health.harvard.edu/WL.

 
FOR FURTHER READING
For more information about achieving and maintaining a healthy weight, order our Special Health Report, Healthy Solutions to Lose Weight and Keep it Off.
[READ MORE or BUY]
    [Back to top]

2\ Notable from Harvard Medical School
** Healthy Solutions to Lose Weight and Keep it Off
Healthy Solutions to Lose Weight and Keep it Off is a Special Health Report from Harvard Medical School. This special report will help you determine the cause of your excess weight and tailor a plan to your particular needs. It also provides details on popular weight-loss diets, organized self-help programs, weight-loss supplement ingredients, weight-loss surgery, and steps for keeping the weight off.
 
[CLICK TO READ MORE or BUY]
** Harvard Women’s Health Watch
Harvard Women’s Health Watch puts you in closer touch with everything that’s happening right now in the new age of women’s health and medicine — new prevention strategies, new diagnostic techniques, new medications and treatments. From heart disease in women to breast cancer, from diet and nutrition to vitamins and supplements, from hormone therapy to exercise and strength training, Harvard Women’s Health Watch focuses on health from a woman’s perspective.
 
[CLICK TO READ MORE or SUBSCRIBE]
[Back to top]

3\ How long should I keep getting Pap tests?

Q: Is there an age when a woman no longer needs a Pap smear?

A. Most women are used to getting a Pap test every year or two as part of their routine health care. A Pap test, or Pap smear, examines cells from the cervix to screen for cervical cancer or abnormal cells that could progress to cancer if left untreated.

The success of cervical cancer screening is irrefutable. Once, cervical cancer was the No. 1 cause of cancer death for women in the United States. But today, it’s fallen to 10th place, largely because of Pap testing. Since 1950, the rate of new cases and the number of deaths from the disease have dropped by more than 50%. Still, an estimated 11,070 cases of invasive cervical cancer will occur in the United States this year, and some 3,870 women will die because of it.

One reason Pap testing has been so effective is that invasive cancer develops from well-known and well-described changes in cervical cells. These changes progress very slowly — over years to decades — from low-grade to high-grade. This long, predictable period of transformation permits detection of cancer before it becomes invasive, when it can be treated and cured. Cervical cancer is largely a disease of sexually active women. Experts believe that most, if not all, cases are caused by infection with specific high-risk strains of the sexually transmitted human papillomavirus (HPV). That’s why women aren’t targeted for cervical cancer screening until three years after they’ve become sexually active.

Cervical cancer screening guidelines in this country are issued by three major organizations: the U.S. Preventive Services Task Force (USPSTF), the American Cancer Society (ACS), and the American College of Obstetricians and Gynecologists (ACOG). All three groups agree that a woman should have her first Pap smear about three years after first having sexual relations or at age 21, whichever comes first. After that, the guidelines differ slightly in their recommendations for Pap test frequency. There’s also disagreement about the upper age limit for routine Pap tests.

The USPSTF recommends that Pap testing be discontinued at age 65. The ACS advocates stopping at age 70 if a woman has had three consecutive normal Pap tests over the previous 10 years. And ACOG recommends that women talk to their clinicians about when to stop Pap testing, since there’s so little evidence to guide this decision. All agree that women who’ve had a total hysterectomy (including removal of the cervix) for a non-cancerous condition may stop getting Pap tests.

There are no published studies about the effectiveness of routine Pap testing after age 65, but there are a few points that physicians take into consideration. An average woman’s risk of having precancerous changes on her Pap smear is greatest during her 20s and 30s and begins to decline about age 40. High-grade lesions — those most likely to progress to cancer — are rare among women over 65 who’ve had normal Pap tests. And although the death rate due to cervical cancer increases with age, experts think that’s largely due to cervical cancer in women who haven’t been routinely screened in their younger years.

The decision to stop screening is up to you and your clinician. If you’re at average or low risk (mostly a function of the number of sexual partners you’ve had) and have been getting routine Pap tests — and the last three have been normal — you can safely stop getting Pap smears after age 65 or 70. If you haven’t been routinely screened before 65, you need a Pap test. Older women who’ve never been screened have the highest incidence of, and mortality from, invasive cervical cancer. Smoking is another risk factor. If you have become sexually active with a new partner (which increases your exposure to HPV infection), it’s reasonable to continue Pap smears beyond age 65 and to have a discussion with your clinician about HPV testing. Some women find it hard to give up the routine of Pap testing, because it reassures them about their health. Talk to your clinician so you can agree on a screening schedule that makes you feel comfortable. Even if a Pap test is not done, many experts recommend a pelvic exam at regular intervals, although evidence about this is lacking.

— Celeste Robb-Nicholson, M.D.
Editor in Chief, Harvard Women’s Health Watch

This Question and Answer first appeared in the December 2008 Harvard Women’s Health Watch, available at www.health.harvard.edu/women.

 
FOR FURTHER READING
For more information on women’s health, subscribe to Harvard Women’s Health Watch.
[READ MORE or SUBSCRIBE]

 

 

    [Back to top]