Abnormal Pap and Cervical Dysplasia Follow Up Plans

Knowing what to do next after an abnormal pap can be both confusing, anxiety producing and a matter of the prevailing gynecologic thought. So if you thing your gyno has been changing her mind, you are lightly right, but you may also have choices. We are most concerned with women who have been diagnosed with the most severe pap smear changes that are not cervical cancers, but have to be carefully monitored.Moderate and severe dysplasia, also called CIN II and III is diagnosed in 500,000 American women each year. Aggressive diagnosis and treatment has lead to successful prevention of cancer and death. But then what is next for these women? Here is where guidelines for care have gotten a bit confusing. Choice and careful follow up is usually the best. For many of us who treat young women it’s important to be able to discuss what may be recommended by the next gyno, as many women will move and have several gynos over time and several follow up strategies offered. Your abnormal pap condition may have been treated, but remember, the virus or the condition that led to the acquisition of the virus is often still present, and the future gyno plan is debated among eperts, as explained in the November "Green Journal" Obstetrics and Gynecology, talks about women who have been completely treated, with clear margins on LEEP or conizations (operations to clear the CIN) can be followed by some combination of pelvic exams, HPV tests, type specific HPV plans, pap smears and colposcopies. And the guidelines do offer some flexibilities. No where do women have unlimited medical coverage for these follow up tests, so that cost effectiveness was the goal of the recent study undertaken by the newest group to look into this. The article clearly states that the precise order of tests, the timing of the tests, and the number of tests that an individual woman should have to maximize safety or to be reasonably safe has actually  not yet been determined. This article evaluated 12 (!) different strategies on the most moderate risk individuals, as women with extensive residual disease, and multifocal (lots of spots, like in the vagina as well as on the cervix, or in the rectum) disease are the most high risk. They don't talk about women who have complicating STDs like Herpes or CT at the time of follow up, those are also separate cases. Other strategies are possibly as effective or more effective, just so women can know that they need to understand some basics when evaluating what advice they are getting.So, to make this clear, you need to sit down with your gyno and come up with a personal plan, based on your own goals, and your own risks, and your own cost effectiveness thoughts.


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