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Dx Cervical PAP Smear Abnormalities Treatments:


The Consensus of the American College of Obstetricians and Gynecologists today is that
*Screening starts at age 21 for the woman
*Continues at 3 year intervals until age 30
*At age 30, cotesting for HPV viruses extends the screening to every 5 years if normal
*Screening endpoints are
   removal of the cervix (with no history of cervical intraepithealia neoplasia (CIN2)
   age 65

Consensus on the use of Gardisil is still not absolute. The U.S. government sites a reduction in the incidence of disease in young women; "the Canadian Mannitoba study showed a 23% reducing in women greater than 18 with no history of abnormal (pap smear) cytology but no protection for others" and others still warn of the long-term side-effects of a new vaccine.

Cervical HPV Infections and the PAP SMEAR

The Merck Manual Home Edition states that:

"Two important screening tests for women are cervical cell (cytology) testing, such as the Papanicolaou (Pap) test, to check for cancer of the cervix (the lower part of the uterus) and mammography to check for breast cancer (see see Mammography). Women at risk of sexually transmitted diseases should be screened for these diseases. Other screening tests are done in pregnant women (see see Medical Care During Pregnancy).

Screening for Cervical Cancer
Cervical cytology testing (such as the Pap test) involves collecting a sample of cells from the cervix and examining them under a microscope. There are two types of cervical cytology tests: the conventional test and the liquid-based test. Doctors collect the sample by inserting a speculum into the vagina to spread the walls of the vagina apart and using a plastic spatula (similar to a tongue depressor) to remove some cells from the surface and opening of the cervix. Then, a small bristle brush is inserted into the passageway through the cervix (cervical canal) to obtain cells from the wall of the canal. The samples are sent to a laboratory, where they are examined under a microscope for abnormal cells, which may indicate precancerous changes or, rarely, cervical cancer. Usually, the Pap test feels scratchy or crampy, but it is not painful and takes only a few seconds.

Pap tests identify 80 to 85% of cervical cancers, even very early-stage cancer. They can also detect changes in cervical cells that can lead to cancer (precancerous changes). These changes, called cervical intraepithelial neoplasia (CIN), can be treated, thus helping prevent cancer.

Pap tests are most accurate if the woman is not having her period and does not douche or use vaginal creams for at least 24 hours before the test. Experts now recommend that the first Pap test be done after a women reaches the age of 21 years. How often the test is needed depends mainly on the woman's age and the results of previous Pap tests:
From age 21 to 30: Testing is usually done every 3 years."

*[Editor] The official position of the American College of Obstetricians and Gynecologists had been that PAP smear screening during the high risk sexually active years should be yearly; maintaining well woman visits a yearly event.
A large Korean study warns of the folly of infrequent screening and the development of advanced cervical cancers.

*[Editor] Should America follow studies from Europe in offering women the ability to do PAP Smears at home? It has been effective in Europe, Africa and the Far East. "In developed countries offering self-sampling has shown to be superior to a recall invitation for cytology in re-attracting original non-attendees into the screening program. Additionally, self-testing has shown to facilitate access to cervical screening for women in low resource areas. This updated review of the literature suggests that HPV self-sampling could be an additional strategy that can improve screening performance compared to current cytology-based call-recall programs."

Medications Used in Treatment
1. Vaccination: Gardisil®
2. Cryosurgery (office procedure)

Suggested Links:
*N.H.S. Choice
*50% Effectiveness of the Gardasil® vaccine in doubt

*[Editor] In a Canadian study of 691,994 vaccination cases, approximately 25% had a 'rash'; 25% had non-severe effects and 7.5% had serious reported side-effects. Gardasil offers protection against CIN 2+ lesions caused by HPV 16/18 and against genital warts caused by HPV 6/11 for at least 5 years.

*[Editor] Cervical cancer is a sexually transmitted disease related to the HPV (human papilloma virus. Specific types are considered more virulent (16, 18) and cause 75% of all cervical cancers and 50% of vulvar cancers. PAP smears with HPV typing can identify those women at risk. [Case Report] My professor taught me 40 years ago to treat women after delivery with a 3-minute cryosurgical freezing of the cervix to destroy the superficial infection in the torn cervix. In 40 years of private practice, I had the good fortune to have discovered only 2 cases of micro-invasive cervical cancers requiring hysterectomy in almost 2500 deliveries and more than 100,000 women patient visits.

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