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Re: When to do a firstFrom: Atkinson, Samuel M (ATKINSONS@ECU.EDU)Tue Sep 5 09:34:15 2006
NO! You should not have done a Pap. It adds unnecessary cost to the bill, regardless of who is paying. It also has an enormous false positive rate as there is no mature squamocolumnar junction. The pap in these young girls will thus be read as squamous metaplasia/cannot r/o severe dysplasia. The large, dense chromatin of metaplastic cells cannot be distinguished from premalignant(or worse) cells. Thus large numbers of these girls are then forced to undergo colposcopy/biopsy or worse yet, LEEP. Then we will wonder why they have an incompetent cervix. The average cost of this is usually over $1000.oo. Then when no significant disease is found they are told it is nothing to worry about but to come back for a pap every 6 months. By the time they are 21, they won't come in for a pap ever again. Shortly, insurance companies are going to read the guide lines and begin refusing to pay for them. Are we going to do them for free? Or pay Lab Corp's price ourselves. A Medicare patient of mine refused a hemocult because Medicare didn't pay for it. I really cannot understand why, at the age of 21 women now need paps even if they have never been exposed to HPV - in other words , have never had sex. There are still some women who believe the Republican birth control of abstinence is acceptable. And we know they don't lie! sAm -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Garry E. Siegel, M.D. Sent: Wednesday, August 30, 2006 6:58 PM To: Multiple recipients of list OB-GYN-L Subject: Ob: When to do a first New guidelines regarding the timing of the first pap are pasted below: Based on the natural history data and the rarity of cervical cancer in the population of women younger than 21 years, the ACS recommendations for initial Pap testing changed, and the new criteria have been endorsed by the American College of Obstetricians and Gynecologists (ACOG) (2). Adolescents should undergo their first Pap test approximately 3 years after the onset of vaginal intercourse or no later than age 21 years. The decision about the initiation of cervical cytology screening in an adolescent patient should be based on the clinician's assessment of risks, including 1) age of first sexual activity, 2) behaviors that may place the adolescent patient at greater risk for HPV infection, and 3) risk of noncompliance with follow-up visits. Obtaining a complete and accurate sexual history, therefore, is critical I saw a newly pregnant 17 year old today, who had not been sexually active for 3 years, and had never had a pelvic examination. Should I have done a pap? Garry
-- Garry E. Siegel, M.D. Private Practice Roswell, GA
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