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Re: Change of management? From: Joanne Bulley, MD (islesannie@yahoo.com) Thu May 8 20:57:39 2003 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Joanne Bulley, MD: "Re: Marking surgical site for c/s and BTL" Previous message: LCLEMOS@aol.com: "Re: Friday: Cell phone etiquette" In reply to: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.: "Re: Change of management?" This reflects the reasons I can't go with the current recommendations to stop doing Paps after a certain age - or after hysterectomy. Those who were 20 in 1960 at the start of the "sexual revolution" (that is multiple partners over a lifetime) are now 63. Nearly every woman has at least one (if not more) of the risdk factors: first heterosexual intercourse before age 18, more than one partner in her lifetime, her partner having had any other partner in his or her lifetime and smoking. I have had as a patient a widowed (for 10 years) 70-something woman who said she never had sex before 18 and only had sex with her one and only husband and never smoked - whose cervical neoplasia reflected her dwindling immune system and occurred a few years before her death from severe repiratory compromise. Even in our "small towns" the folks are still products of teh current sexual revolution and at risk. The molestation and incest rates need to be considered as well. Joanne At Thu, 1 May 2003, Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C. wrote: > > I think managing her conservatively is perfectly acceptable, make sure >she understands that she must be followed forever, the literature is >beginning >to show that women with cervical cancers in there 50's and 60' often >have high >risk Hpv subtypes most of these women acquired the hpv more than 10 >years ago >and for whatever reason chemo, AIDS etc thier immune response became >compromise >ed and the HPV reactivated with a vengeance. > >Factors associated with an increased risk of prevalent and incident >grade III cervical intraepithelial neoplasia and invasive cervical >cancer among women with Papanicolaou tests classified as grades I or II >cervical intraepithelial neoplasia. >Petry KU - Am J Obstet Gynecol - 01-Jan-2002; 186(1): 28-34 >>From NIH/NLM MEDLINE > -- Joanne Bulley, MD Keene, NH, USA ----- Work to create peace everywhere you go and with everything you do. ----- Let us accept truth, even when it surprises us and alters our views. -George Sand ----- The hottest places in hell are reserved for those who, in times of great moral crisis, maintain their neutrality. Dante Next message: Joanne Bulley, MD: "Re: Marking surgical site for c/s and BTL" Previous message: LCLEMOS@aol.com: "Re: Friday: Cell phone etiquette" In reply to: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.: "Re: Change of management?"

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