As a family nurse practitioner with 30 years experience in women’s health in eastern North Carolina, I truly believe that there is a particularly virulent strain of human papillomavirus in this part of the nation. Just two examples include advanced cervical cancer in a 15-year-old and a 19-year-old without a history of multiple partners or sexual assault.

I am concerned that we are putting young women at risk for long-term problems. The 15-year-old was managed at a teaching center with multiple loop electrosurgical excision procedures, followed by a successful pregnancy later. The 19-year-old had such advanced cancer that the only option was radiation. A valiant attempt to spare her ovaries prior to radiation by surgically moving them up in the pelvis was not successful. Thankfully, she has been cancer-free for 5 years.

Women are confused by the current recommendations/guidelines. They are just that—not an absolute edict. Each person should be evaluated, as you noted [“Cervical cancer screening: why less is best“], based on history and exposure risk. I ask the patients not only how many partners they have had, but how many partners their current and former partners have had. Too many patients are deferring pelvic exams also, as the perception is that the only indication for a pelvic exam is to obtain a Pap smear.

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I have this discussion with younger physicians in our office regularly. It is fortunate, as a mid-level provider, I am able to continue to be aggressively conservative with those entrusted to my care.

—SARA BROWN, FNP, Leland, N.C. (207-1)

These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have a clinical pearl, submit it here.