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Re: Inflammatory PapFrom: Ronald Helm (drshelm@sprynet.com)Fri Oct 31 16:47:12 1997
>At 03:00 PM 10/31/97 -0600, you wrote: >>Case for your collective wisdom: >> >>28 year-old medical student, completely asymptomatic throughout the events >>below, married and monogamous now (though I didn't ask about previous # of >>partners). Assume her to be reliable for whatever follow-up you recommend. >> >>5/95: Routine Pap, normal. >> >>4/96: Pap with reading "atypical benign (020); Bethesda system--benign >>pathology", with comment "Inflammation." No treatment instituted. Advised >>follow-up >>in 6 months to repeat. >> >>12/96: Pap with precisely the same reading as before. >> >>QUESTION #1: Would you recommend, at this point: >> >>A) Colposcopy >>B) Empiric treatment of some sort >>C) Repeat Pap in 1 year >>D) Repeat Pap sooner (e.g., 4-6 months) >> >>? >> >>I chose D. Which gets us to: >> >>4/97: Normal Pap. >> >>QUESTION #2: >> >>Would you now continue more frequent Paps, revert to annual schedule, or >>do something else? >> >>(Disclaimer: My medical director is disagreeing with my recommendation >>after the second "inflammation" pap--thinks colposcopy should have been >>done then. I obviously disagree, but I doubt that either of us can point >>to any hard data to support our positions.) >> >J.G.M. Robertson MD, 109-9181 Main St. Chilliwack, B.C., Canada, V2P 4M9 >(604) 793-9988, Fax 793-9987 >e-mail jgmr@unixg.ubc.ca If we have to do anything about a Pap smear that only states "benign inflammatory changes", then we are all in trouble. Has anyone ever done a cervical biopsy that did not report "cervicitis"? Leukocytes are present on all Pap smears done in the luteal phase of the cycle. I would conservatively estimate that our cyto-pathologists report inflammation or benighn inflammatory changes on over 50% of all Paps. If this woman is a non-smoker, no history of HPV, monogamous presently, and otherwise low risk, I would only do annual Pap smears. BTW, I thought our Canadian brethren only did Paps every three years. Ron
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