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Advisor Forum

PAP SMEARS FOR VIRGINS?

Since most cervical cancer is due to human papillomavirus, which is sexually transmitted, why do we tell women who have never had sex to start regular Pap tests at age 21?—Teresa Beck, MD, Atlanta Such organizations as the American Cancer Society recommend starting annual cervical cytologic screening three years after the initial act of coitus…
Advisor Forum

Standards for Pap and HPV testing

Does the current standard of care call for stopping Pap smears after age 65 in women with negative Pap histories? Should human papillomavirus (HPV) testing be routine with Pap smears?—Jack Zoldan, MD, Chicago If a woman older than aged 65 years has had three normal Pap smears in the past five years, Pap smear screening…
Advisor Forum

Managing a high-risk HPV patient

What is the best way to follow a thin-prep Pap smear when the results indicate no intraepithelial lesion or malignancy, but the patient is at high risk for human papillomavirus (HPV)? Should I do nothing, counsel the patient, repeat the Pap smear, or perform colposcopy?—Judy Werner, DO, Dallas The American Cancer Society recommends that women…
Advisor Forum

AGE-LIMITED HPV TESTING

We began combining human papillomavirus (HPV) testing with Pap smears a couple of years ago. Recently, Medicare refused to pay for the HPV screening. I assume that Medicare made the judgment that older women were less likely to get HPV and therefore won’t pay for testing. I have adopted the strategy that if a woman…
The Waiting Room

Counseling patients about annual Pap smears

Counseling patients on the difference between a Pap smear and a pelvic exam will help them realize the importance of following up with a gynecologist for an annual visit.
Consultations

Pap and high-risk HPV

Should a Pap smear be repeated if the first report reads “no endocervical cells found”? Also, what should I do if the Pap smear is normal, but high-risk human papillomavirus (HPV) is detected? What is the likelihood the HPV will resolve on its own over time?—Smita Kapoor, MD, Phoenix There is no medical reason to…
Legal Advisor

Timing was everything in this case

Plaintiff lawyers argue to extend the state statute of limitations, based on alleged concealment of abnormal test results.
Advisor Forum

WHEN TO BEGIN PAP SMEARS

The latest guidelines recommend beginning Pap smear screening within three years after the onset of sexual activity or at age 21. I have encountered two teenagers, aged 18 and 15, who have developed low-grade squamous intraepithelial lesions (LSILs) within one year of first intercourse. Both patients have required colposcopy, and one has yet to return…
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