Squamous metaplasia vs. ASC-H
From: 4ahamlin@comcast.net
Tue Sep 5 18:53:21 2006
I wasn't aware that there was such a high false positive rate in this age group?
I'm suprised that ASC-H paps aren't more often reflexed with HPV typing and followed up with another pap, especially if no lesions can be seen. What is the recommended practice?
Anne Hamlin, CT
>-------------- Original message --------------
From: "Atkinson, Samuel M" <ATKINSONS@ECU.EDU>
...>> 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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