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By Air and by Land DHART Celebrates Its 10Th Birthday Sary Pap Tests

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By Air and by Land DHART Celebrates Its 10Th Birthday Sary Pap Tests vitalsigns FACTS & FIGURES By air and by land DHART celebrates its 10th birthday sary Pap tests. If a hysterectomy DMS researcher CO was done because of cancer, RUM PHOTOGRAPHY documents incidence Sirovich adds, having a regular of needless Paps Pap is still a good idea. But most hysterectomies are not cancer re- Ten million women who have lated. For these women, testing had hysterectomies are tested cells from the vagina, in lieu of each year, needlessly, for cervical the absent cervix, tells nothing. cancer. In most hysterectomies, Vaginal cancer is very rare, and the cervix as well as the uterus is the Pap smear was not designed surgically removed. “It doesn’t to find it. make sense to screen a woman Practice: “The interesting ques- for cancer in an organ that she tion to ask,” Sirovich says, “is It used to be called the Dartmouth-Hitchcock Air Response doesn’t have,” explains Dr. Bren- how did this practice evolve? I Team. It’s still northern New England’s only medical flight da Sirovich, an assistant profes- don’t know. In medical school, service, but now DHART stands for Dartmouth-Hitchcock sor of medicine at DMS. we were taught to do vaginal Advanced Response Team and two high-tech ground vehicles The test for cervical cancer is smears on women who had had augment the service’s two helicopters. Here’s a numerical look the Pap smear, in which a few hysterectomies. It didn’t make at DHART’s impact (“calls” are requests for service; weather or cells from the cervix are scraped sense to me, but when you’re in simultaneous calls can keep them from being completed): off and examined under a micro- training a lot of things don’t scope. Since the test was invent- make sense.” ed in the 1940s, the incidence of 7/1/1994 Sirovich and Welch, who are cervical cancer has greatly de- Date that DHART service began part of the Outcomes Group at clined. Yet for a woman without the White River Junction, Vt., a cervix, the Pap has no value, as 7 VA Medical Center, published guidelines issued in 1996 by the their findings in the Journal of the Minutes after the service started that the first call came in U.S. Preventive Services Task American Medical Association. Force pointed out. 473 / 320 Afterwards, Sirovich was inter- Logic: Yet despite their intu- viewed by more than 20 news itive logic, those guidelines have Number of flight calls / completed missions in 1994-95 outlets, including the New York been ignored. Sirovich and Dr. Times and the Associated Press. H. Gilbert Welch, a professor of 1,709 / 851 She also appeared on NBC’s To- medicine at DMS, analyzed data day Show, National Public Ra- Number of flight calls / completed missions in 2003-04 on 187,670 women who’d had dio, and CNN. hysterectomies. Their source was News: “We can be a little opti- the Behavioral Risk Factor Sur- 820 / 679 mistic,” she says, “that the pub- veillance System, an annual tele- Number of ground calls / completed missions in 2003-04 licity will make a difference, that phone survey conducted by the the awareness of both doctors Centers for Disease Control and 20 and women was raised.” The Prevention. “We looked at Pap Number of DHART staff members in 1994 feedback she’s received suggests smear screening before and after that “both parties think the oth- the 1996 guidelines came out,” 42 er one is not willing to give up Sirovich says. “The rate didn’t this practice that has become so change. It was absolutely flat.” Number of DHART staff members in 2004 universally accepted.” Doctors, She and Welch estimate that she explains, feel “it’s hard to do nearly half of the 21 million U.S. 12,885 / 8,087 less. Once people have come to women who have had hysterec- Total calls / completed missions since 1994 accept an intervention, it’s hard tomies continue to get unneces- to take it away. And screening Fall 2004 Dartmouth Medicine 3 signsvital JON GILBER New students bring vestigating the effects of Ginkgo earned a bachelor’s degree from biloba in preventing or delaying Columbia University. T FOX wealth of experiences the onset of dementia in elderly Four of the ’08s are enrolled as they begin at DMS participants.” in the M.D.-Ph.D. program— Others wrote humorously of two in microbiology and two in With interests encompassing al- their roundabout journeys to pharmacology-toxicology. pine skiing, hiking, rock-climb- DMS. Irvin Sanchez was born in Other programs: The doctoral ing, swimming, logging, and kay- rural Puerto Rico, and, “after a programs in the biomedical sci- According to DMS’s Brenda Sirovich, aking, Dartmouth’s 84 first-year three-year stop at Fort Buchanan ences welcomed 45 other new some 10 million women a year who M.D. students would surely do in San Juan, where I learned to candidates—35 in microbiology, don’t need a Pap test get one anyway. well in an episode of Survivor. speak English, I moved with my six in pharmacology and toxicol- What they’ve survived, how- mother and brother to Dallas, ogy, and four in physiology. for cancer is apple pie. It has this ever, is a rigorous medical school where I ran into the first cowboy And 61 new students entered intrinsic value. Doctors aren’t application process. The new store I could find—yee-haw!” the programs of DMS’s Center willing to risk losing a patient’s students, who were selected from Sanchez later moved to the At- for the Evaluative Clinical Sci- trust by stopping it.” about 5,000 applicants, have a lanta suburb of Peachtree City, ences—18 M.S. students, 40 Another factor, says Sirovich, mean undergraduate grade point “land of golf carts and Delta pi- M.P.H. students, and three Ph.D. may be “report cards” by health- average of 3.7 in nonscience lots,” and earned a degree in mi- candidates. maintenance organizations. The courses and 3.6 in the sciences. crobiology from the University Yet regardless of which pro- Pap is one measure of high-qual- They represent 60 undergradu- of Georgia. “My personal interest gram they are entering, the new ity care for women. “To the ate institutions and 31 states, for learning about new cultures, students, like Jessica Walls, seem HMO,” says Sirovich, “the best and 13 were born outside the people, and ways of life,” he said, to be enthusiastic about being at doctors are the ones with the U.S.; 58% are women, 42% are “is matched only by my love for DMS. “My combined experi- highest number of Pap tests.” But men, and over 25% are of color all things baked, especially bread ences,” she wrote, “leave me in- report card databases often don’t or international students. —Atkins Schmatkins.” spired and excited for the won- note hysterectomies. But the numbers tell only Rigors: For some students, the derful years that lie ahead.” Finally, doctors worry that part of the story. The brief auto- path to medical school involved Matthew C. Wiencke without the pull of a yearly Pap, biographies the ’08s wrote to in- rigors far beyond those of the ap- women may not come in for a troduce themselves to each oth- plication process. Deogratias Ni- Below, team-building exercises like this checkup. “It’s something to keep er reveal a wide range of experi- yizonkiza, who grew up in Bu- are part of the orientation-week activi- in mind,” Sirovich concedes, ences. The class includes a rural rundi and started medical school ties for the first-year M.D. students. “but if it’s worthwhile to see your engineer who worked in the Hi- there, wrote, “I was doing a clin- T doctor every year, it’s not worth- malayas, an oceanography in- ical clerkship in a hospital with while to spend all your time get- structor, a military police officer 750 beds, where 70% of the RA HEBER ting an unnecessary Pap smear who served in Bosnia and Croa- patients were infected with MEDO and discussing it. There are a lot tia, a registered Maine guide, and HIV/AIDS, TB, and other op- of patient-driven issues that 11 EMTs. One student was a portunistic infections.” But Niyi- could benefit from having more Peace Corps volunteer in Nepal zonkiza had to flee Burundi dur- time addressed to them. and another was the in-country ing a period of political genocide Time: “We are not advocating coordinator of NASA’s Large and made his way to the U.S., stopping Pap smear screening for Scale Biosphere-Atmosphere “homeless, speaking not a word women who have a cervix,” she Experiment in Amazonia. of English,” but still hoping to emphasizes. “We just want to Many, like Laura Shiveley, complete medical school. After make the practice more rational. have research experience, too. volunteering at a hospice and a As doctors, we want to use our She majored in biology at the nursing home, learning English, resources better—and our main University of California at Davis and working to support the rest resource is time.” and after her graduation was “a of his family while they were still Nancy Marie Brown postgraduate researcher . in- in refugee camps, he eventually 4 Dartmouth Medicine Fall 2004 vitalsigns Study of innovative first of its kind, the study now of the electromagnetic spectrum, gives the investigators essential these modalities detect differ- breast-imaging methods data on tissue characteristics in ences in a tissue’s electrical prop- gathers benchmarks non-cancerous breasts of varying erties—its permittivity (its ca- JOSEPH MEHLING age and composition, thereby pacity to store an electrical Three out of four women who providing baseline information charge) and conductivity—and undergo a breast biopsy turn out for future studies of these tech- in its light-scattering and -ab- not to have breast cancer.
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