Re: ASCUS/ Positive HPV in elderly
From: FRANCES WREN (fwren@shaw.ca)
Fri Mar 28 10:11:12 2008
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good info re the vaginal estrogen and improvement of the paps ..I wouldn't have thought of giving estrogen creme ....
I love this list for these kind of tips.
frances wren MD FRCS
>----- Original Message -----
From: islesannie@gmail.com (Joanne Bulley, MD)
Date: Thursday, March 27, 2008 7:14 pm
Subject: Re: ASCUS/ Positive HPV in elderly
To: Multiple recipients of list OB-GYN-L <ob-gyn-l@mail.obgyn.net>
> I would colpo. This is what it is all about. the
> estimates from the
> research over the last 30 years suggests that by age 50, 80% of adults
> have been infected and 90% or so clear the virus. The
> others carry it
> for life and those are the folks who are at risk for cervical cancer
> late in life.
>
> With some of my 80-something patients that I have managed (Some with
> oncology consult) - the change to ASCUS and / or LSIL was concurrent
> with their other medical issues heading downhill - and their
> other end
> organ issues usually took them before the cervical changes (one
> was end
> stage pulmonary disease and the other was cardiac).
>
> With my GynOnc's involvement - we keep the vagina estrogenized
> (cream or
> Vagifem or Estring) and monitor to see that the cervical epithelium
> stays at LSIl or CIN 1 or less. Interestingly, whenever
> they stop the
> estrogen, their pap is worse.
>
> In my 70 & 80 yo women with CIN and HRHPV - some appear to all
> questionsto have been in a lifelong mutually monogamous
> relationship. Others
> were widowed or divorced - celibate for years and then met with
> and had
> a new partner (with or without marriage) and likely got their
> HRHPV from
> the new partner.
>
> Joanne
>
> At Thu, 27 Mar 2008, Kathleen Griffin, M.D. wrote:
> >
> >I have an 80 year old patient who had hematuria and her PMD did
> a Pap
> >smear, which came back ASCUS, endocervical cells absent,
> positive for
> >high risk HPV by Digene Hybrid Capture II testing. A
> repeat test was
> >also positive.
> >Her entire lifetime her Pap smears were always normal, and her last
> >sexual activity was 10 years ago.
> >She is taking "natural" compounded HRT.
> >Could this be false positive? Is it indicated to do colposcopy?
> >
> >--
> >Kathleen Griffin, M.D.
> >
>
> --
> Joanne Bulley, MD
> solo gyn
> Keene, NH
>
> "enjoying" the results of epidural depomedrol for a bulging L4-5 disc.
> Ruins the end of the ski season and start of hiking. Bah Humbug
>
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<DIV>good info re the vaginal estrogen and improvement of the paps ..I wouldn't have thought of giving estrogen creme ....</DIV>
<DIV>I love this list for these kind of tips.</DIV>
><DIV>frances wren MD FRCS<BR><BR>----- Original Message -----<BR>From: islesannie@gmail.com (Joanne Bulley, MD)<BR>Date: Thursday, March 27, 2008 7:14 pm<BR>Subject: Re: ASCUS/ Positive HPV in elderly<BR>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@mail.obgyn.net><BR><BR>> I would colpo. This is what it is all about. the <BR>> estimates from the<BR>> research over the last 30 years suggests that by age 50, 80% of adults<BR>> have been infected and 90% or so clear the virus. The <BR>> others carry it<BR>> for life and those are the folks who are at risk for cervical cancer<BR>> late in life.<BR>> <BR>> With some of my 80-something patients that I have managed (Some with<BR>> oncology consult) - the change to ASCUS and / or LSIL was concurrent<BR>> with their other medical issues heading downhill - and their <BR>> other end<BR>> organ issues usually took them before the cervical changes (one <BR>> was end<BR>> stage pulmonary disease and the other was cardiac).<BR>> <BR>> With my GynOnc's involvement - we keep the vagina estrogenized <BR>> (cream or<BR>> Vagifem or Estring) and monitor to see that the cervical epithelium<BR>> stays at LSIl or CIN 1 or less. Interestingly, whenever <BR>> they stop
the<BR>> estrogen, their pap is worse.<BR>> <BR>> In my 70 & 80 yo women with CIN and HRHPV - some appear to all <BR>> questionsto have been in a lifelong mutually monogamous <BR>> relationship. Others<BR>> were widowed or divorced - celibate for years and then met with <BR>> and had<BR>> a new partner (with or without marriage) and likely got their <BR>> HRHPV from<BR>> the new partner.<BR>> <BR>> Joanne<BR>> <BR>> At Thu, 27 Mar 2008, Kathleen Griffin, M.D. wrote:<BR>> ><BR>> >I have an 80 year old patient who had hematuria and her PMD did <BR>> a Pap<BR>> >smear, which came back ASCUS, endocervical cells absent, <BR>> positive for<BR>> >high risk HPV by Digene Hybrid Capture II testing. A <BR>> repeat test was<BR>> >also positive.<BR>> >Her entire lifetime her Pap smears were always normal, and her last<BR>> >sexual activity was 10 years ago.<BR>> >She is taking "natural" compounded HRT.<BR>> >Could this be false positive? Is it indicated to do colposcopy?<BR>> ><BR>> >--<BR>> >Kathleen
Griffin, M.D.<BR>> ><BR>> <BR>> --<BR>> Joanne Bulley, MD<BR>> solo gyn<BR>> Keene, NH<BR>> <BR>> "enjoying" the results of epidural depomedrol for a bulging L4-5 disc.<BR>> Ruins the end of the ski season and start of hiking. Bah Humbug<BR>> </DIV>
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