Week 2: Abnormal Pap

Question 1

HPV detection

Answer 1

• prevalence of HPV among women in mid 20s is as high as 40%. This drops to 10% after age 30.
• Negative predictive value of negative HPV test is extremely high
• combination Pap+ HPV test increases sensitivity

Question 2

Cervical cancer screening guidelines by ASCCP

Answer 2

• less than 21 yo: no routine speculum exam. STD testing and counseling
• 21-29: annual pelvic exam. Screening with cytology alone every 3 years
• 30-65 years: annual pelvic exam. Screen with cytology and HPV testing every 5 years. Or cytology alone every 3 years.
• Greater than 65: discontinue screening. Women with hx of CIN2 or more should continue screening for at least 20 years

Question 3

Risk factors for cervical epithelial abnormalities

Answer 3

• hx of multiple sex partners

- family hx not significant since HPV not transmitted vertically

Question 4

Abnormal pap-incidence. Of abnormal paps, what percentage demonstrate malignancy?

Answer 4

Estimated incidence of CIN in the United States is of approximately 2%
1.5% Low-grade squamous intraepithelial lesions
0.5% High-grade squamous intraepithelial lesions
Of those 0.25%-0.5% represent invasive cervical cancer

Question 5

follow up of pap smear showing epithelial abnormalities

Answer 5

Colposcopic evaluation (+/- biopsies) is indicated for women with:
ASC-US (HPV +), ASC-H, LSIL, HSIL, and cancer
-ASC=atypical squamous cells
-US=undetermined significance
-H=high grade changes not ruled out
Management requires tissue diagnosis, not just Pap result alone