Get HPV Test After LEEP or Cone

Residual precancerous changes of the cervix dysplasia and residual HPV disease after a woman has had  LEEP, a conization, a cryoconization, a laser therapy or even a hysterectomy for precancer or early cancer of the cervix, is common. But what is even more common is persistent HPV disease. Especially if the abnormal pap was caused by HPV 16 or HPV 18. Once you get a surgery such as a LEEP or a Cone (also called conization),  the first discussion is whether the margins of the specimen were clear or not. If your margin on the surgical specimen was said to be free of disease, then this has been the "gold standard" of determination of clearing. But the HPV virus can persist and cause repeat abnormal pap smears. A relatively recent study has shown that recurrence is possible in up to 30% of women with actually clear margins. On the flip side about 60% of patients with the positive margins will actually not have recurrences. So physicians have been long telling women they need to get follow up pap smears for many years after a prior abnormal.\. A group of Korean researchers reporting in the July 2009 issue of ACOG have done a hysterectomy study looking at whether women with positive and negative margins when they had prior dysplasia (abnormal pre-cervical cancer tissue) were really cleared as well as they were thought to be based on actual tissue examined at their hysterectomy. They found, based on their study, that large groups (up to 25-50% of women were either under treated or over treated. So better tests of resolution of HPV disease have been needed. Now that we have more and more specific HPV tests available, such as the type specific testing, they propose that persistent HPV disease is a better predictor than the prior gold standard. This is probably a better test, than just a pap alone, but even this test was not completely accurate either. Some women will have HPV disease without residual disease and visa versa. There is not complete agreement as to when to perform HPV testing after LEEPs, Cones, or even after Hysterectomes, but one group feels you should have this performed about 6 months after the initial treatment. And like with other diseases, healthy diets, including fruits and vegetables, may help improve your immune system. In the picture is cilantro, quite spicy with a fresh locally grown tomato!


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