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Re: Squamous metaplasia vs. ASC-H From: Atkinson, Samuel M (ATKINSONS@ECU.EDU) Thu Sep 7 19:48:06 2006 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: R. Daniel Braun: "Re: One layer uterine closure" Previous message: Efrain Ramirez: "Re: One layer uterine closure" Maybe in reply to: 4ahamlin@comcast.net: "Squamous metaplasia vs. ASC-H" Next in thread: Larry Glazerman: "Re: Squamous metaplasia vs. ASC-H" unfortunately the same trap applies. significant numbers of sexually active young women have pos tests for HPV, Thus, you do a pap and get a positive HPV read--if it is a 16 or 18 you feel compelled to start the train to colpo, Bx or LEEP. the overwhelming majority clear within two years. but we then feel compelled to work them up because they are a 16 or 18 HPV. The numbers of under 25 , sexually active women pos for HPV approach 50%. 40.999% clear spontaneously without leep, colpo or biopsy. We need to worry about the women over age 21 who do not clear the HPV within two years. Of course all this will be moot when the pediatricians start giving the HPV vaccine. Then the days of necessary or unnecessary paps will be clearer. Some of our providers of female health care may have to find some other way to earn a living...like preventing cardiovascular disease and obesity that really does kill women. While one out of 9 may die of breast cancer, guess what most of the rest die of...it ain't cervical or ovarian or colon..it is CV disease. Less than 500 women die per year in NC from cervical....more than that die each week die from heart attack and stroke in NC. And if they are under age 21 they die from pregnancy problems, not cervical disease. The recommended practice is no pap until at least 3 years of sexual exposure or age 21. Even if they are pregnant. We cut out LEEPS and biopsying pregnant cervices in young women women a long time ago also. And no PAP for 4 months after delivery. Healing and repair look just like dysplasia on a PAP so let the cervix heal up first. Then the smear will be normal. We have been preying over women too long. Of course we could start doing an HPV test (not PAP) and if they are negative (a prerequisite for the HPV vaccine) then give the vaccine. Maybe then we would accomplish our real goal. sAm ________________________________ From: ob-gyn-l@obgyn.net on behalf of 4ahamlin@comcast.net -- ________________________________ Sent: Tue 9/5/2006 7:58 PM To: Multiple recipients of list OB-GYN-L Subject: Squamous metaplasia vs. ASC-H 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 th! e 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 r! arity o f 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 ha d never had a pelvic examination. > > Should I have done a pap? > > Garry > > -- > Garry E. Siegel, M.D. > Private Practice > Roswell, GA Next message: R. Daniel Braun: "Re: One layer uterine closure" Previous message: Efrain Ramirez: "Re: One layer uterine closure" Maybe in reply to: 4ahamlin@comcast.net: "Squamous metaplasia vs. ASC-H" Next in thread: Larry Glazerman: "Re: Squamous metaplasia vs. ASC-H"

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