Abnormal pap smear

Question 1

Secondary prevention of cervical CA

Answer 1

• Cervical CA screening: the NPV of a negative HPV test is extremely high (mean they have almost 0% of getting cervical CA)
• Management of abnormal results: colposcopy

Question 2

Who should be screened and why 1

Answer 2

• Up to 40% of women in their 20s have HPV, but this drops to 10% by age 30 (most of the women clear the infection)
• Combining pap test and HPV DNA testing increases sensitivity and allows for less frequent screening
• If pt is <21 yrs old they should not be screened for HPV (just STD testing and sex counseling)

Question 3

Who should be screened and why 2

Answer 3

• If pt is 21-29 they should have annual pelvic exam, and HPV screening via pap cytology every 3 yrs
• If pt is 30-65 they should have annual pelvic exam w/ pap cytology and HPV DNA testing every 5 yrs (or pap cytology alone every 3 yrs)
• > 65 discontinue screening, unless pt has a Hx of CIN2 or greater (then continue screening for 20 yrs since Dx)

Question 4

Methods of cervical CA screening

Answer 4

• Risk factors for CIN: multiple sex partners, family Hx is NOT a risk factor at this time
• Pap test: can detect viral cytopathic changes but is not a sensitive way to determine HPV infection
• Nucleic acid detection is current gold standard for HPV detection

Question 5

Management of abnormal results

Answer 5

• Most women (90%) w/ LSIL (CIN1) will regress in 2 yrs to nl
• About 10% of women w/ LSIL will either progress to HSIL or will develop HSIL separately (HSIL is CIN2 or 3)
• Regression of CIN2 is 40-60%
• Regression of CIN3 is <20%
• Management of any abnormal pap result (LSIL or greater) requires colposcopy (w/ biopsy)
• Management initiation requires tissue Dx from biopsy (not just pap results alone)