Re: Adolescent pap guidelines
From: Joe (forcep@intercom.net)
Sat Oct 28 08:31:05 2006
You can add to that the two 21 yo's I saw die from cervical cancer , one
of whom was pregnant. Joe C
rmodugno@aol.com wrote:
>
> -----Original Message-----
> From: agfolley@hotmail.com
> To: ob-gyn-l@dns.obgyn.net
> Sent: Wed, 25 Oct 2006 6:33 PM
> Subject: RE: Adolescent pap guidelines
>
> My take of ACOG is to "leave those kids alone" ie they all have HPV and
> most of it will resolve on its own as long as we arent putting our 16-22
> year olds through conizations and leeps. How many times have we seen
> "abnormal pap,to colpo, leads to leep or conization???" all before the
> age of 21?
>
> >From: "Lynn Montgomery" <apgar10@qwest.net>
> >Reply-To: ob-gyn-l@obgyn.net
> >To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
> >Subject: RE: Adolescent pap guidelines
> >Date: Wed, 25 Oct 2006 16:21:40 -0500
> >
> >First of all, she is not at "quite low risk for HPV", she is at high
> risk
> >given that she is sexually active - being recently postpartum. I have
> >always adhered to the practice of doing the first pap at age 18 or
> when >they
> >become sexually active. Given the extremely high number of abnormal
> paps I
> >see in 14 through 18, I would not want to wait until age 21, and I
> live in >a
> >"low risk" community. I don't think this has anything to do with
> lawyers,
> >it has to do with the fact that the prevalence of HPV is very high and
> it >is
> >our role to apply appropriate screening to assure that cervical lesions
> >don't go undetected.
> >Lynn
> >
>
> I agree with Andrew, Lynn. Since moving to NC, I have seen numerous
> adolescents/teens referred to me for colposcopy from the surrounding
> county health departments (NC is well known for their excellent county
> health departments).
>
> Yes, they are at risk for HPV, but not necessarily for high- risk
> strains?- what is the natural course of the disease - and how many of
> these young women are going to be subject to procedures that jeopardize
> the integrity of the cervix? Ofcourse you are aware of the recent
> studies questioning the role of LEEP as a cause of premature delivery.
>
> We need less destructive methods to treat CIN - where is the cervical
> equivalent of Aldara? The 3M rep can't tell me lest they lose their job.
>
> Robert Modugno MD MBA FACOG
> Sylva, NC
>
> (Recently saw a 40+ year old patient with stage IIIB cervical cancer-
> the usual stage of presentation where I trained in South Africa - was
> DES exposed - had not had a pap smear for years.)
>
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