Re: Adolescent pap guidelines
From: Barbara Nicol (blnicol@ix.netcom.com)
Wed Oct 25 16:53:35 2006
(Perhaps I should then add that I then put away the pap materials and scheduled a pap visit and an IUD visit - because it was only 2 weeks postpartum. But - here's how conditioned I am - I was reflexively getting them out. Now of course I have time to consider whether she really really needs the pap visit.)
- BN
-----Original Message-----
>From: Barbara Nicol <blnicol@ix.netcom.com>
>Sent: Oct 25, 2006 2:38 PM
>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>Subject: RE: Adolescent pap guidelines
>
>Married, monogamous, both partners claim no other partners - actually I think she is quite low risk, although I see that the basis for that opinion wasn't in my original presentation. I grant you that we get lied to daily by most of our patients, and we therefore have to treat them all that way - yet I'm inclined to trust this situation.
>
>Even if it weren't so, the ACOG opinion recommended against early pap screening not because HPV isn't common - it is - but because severe disease is so rare and overtreatment of HPV that will spontaneously clear is quite common.
>
>My immediate reaction was of course to get out the pap materials; I have the same training you do, but I'm trying to think this through a bit more. Is there an actual benefit here?
>
>- Barb Nicol, M.D.
>
>-----Original Message-----
>>From: Lynn Montgomery <apgar10@qwest.net>
>>Sent: Oct 25, 2006 2:21 PM
>>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>>Subject: RE: Adolescent pap guidelines
>>
>>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
>>
>>-----Original Message-----
>>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Barbara
>>Nicol MD
>>Sent: Wednesday, October 25, 2006 3:11 PM
>>To: Multiple recipients of list OB-GYN-L
>>Subject: Adolescent pap guidelines
>>
>>ACOG and ACS says not to do a pap smear until age 21 or 3 years after
>>1st intercourse (ref Oct 2004 ACOG committee opinion on cervical cancer
>>screening in adolescents). They give pretty good reasons for this, too,
>>so I try to adhere to it, while doing lots of STD tests in this
>>population.
>>
>>So I have a patient, age 20, less than 3 years since starting sexual
>>intercourse, presenting for her 2 week postpartum visit. She has never
>>had a pap smear, because we are following the guidelines. She desires
>>an IUD for contraception and is a good IUD candidate in every other
>>respect, quite low risk for STDs, normal uterus, etc.
>>
>>Do I do a pap smear just because she wants an IUD, and normal paps are
>>considered a prerequisite for IUD use?
>>
>>Or do I say that she doesn't need a pap yet, and is quite low risk for
>>HPV given her social situation, and can have the IUD anyway? "Abnormal
>>pap" is a contraindication for IUD use, but I haven't experienced
>>"doesn't need a pap yet" and "wants an IUD" at the same time. Until
>>now.
>>
>>What to do? Is the pap smear in this context only wasting money to ward
>>off lawyers, or is there actual patient benefit?
>>
>>--
>>Barbara Nicol MD
>>St. Luke's Health Care Center
>>San Francisco CA USA
>>
>
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