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Newlease posted 9/20/2013 16:18 PM

I have had 4 abnormal pap results in the last 2 years, getting checked every 6 months. I have had a colposcopy which came out ok a year ago.

I just keep going back to my gyn every 6 months as recommended, but how long should this go on before something else is done?

I'm 52 and went through menopause 2 years ago. Just looking for some kind of information or assurance that I'm doing the right thing.

I'm scheduled for another pap next week.

Thanks in advance!

NL

Laura28 posted 9/20/2013 16:30 PM

Hi honey

I'm not medical but maybe my experience will reassure you.

I am 57. I had an abnormal pap 30 years ago and had a colposcopy.

I had 6 monthly follow ups for a couple of years, then annual and then every 2 years like everyone else.

I have never had any problems since then.

If you haven't had abnormal results since the colposcopy I wouldn't be too worried. The fact that you had 4 abnormal results before they chose to do surgery (if I am understanding you correctly)would seem reasurring to me. It says to me that they didn't do the colposcopy after the first or second abnormal result because they really didn't think there was much to worry about.

The main thing I believe is to keep up the regular testing - not just for the sake of your health but also for your peace of mind.

HUGS

Laura

Newlease posted 9/20/2013 16:33 PM

The colposcopy was after the first 2 abnormal paps. I have had another abnormal pap after that which is why I'm going for another recheck next week.

NL

tushnurse posted 9/20/2013 16:44 PM

I would sit down and have a serious talk with the GYN.
I'm sure there are a set of standards of how frequent tests are done for irregular paps, the same as colonoscopies, and mamms. However it seems to me that you are in a category of folks that are a higher risk of problems/cancers, and would it be indicated to just go ahead and remove said parts. If you are only having this issue a vag hyst, where they leave ovaries is not that horrible of a surgery, and then to not have to worry about going through this every time you turn around would be done. It may seem a bit extreme as an option, but if you get all nervous, and worry for days on end each time, then I say it's worth a discussion

(this from a medical person who had a vag hyst for 32nd birthday, was thrilled with it, and never looked back).

HFSSC posted 9/20/2013 16:57 PM

Unless they have changed the terminology a tremendous lot since I last did GYN...

There are multiple levels of "abnormal".

The most common type of abnormal pap report is "Atypical Squamous Cells of Undetermined Significance" or ASCUS. This could be caused by something as minor as having had intercourse within the previous couple of days, inflammation or infection (bacterial or yeast) , or could be the beginning of something more serious. There is also "Atypical endocervical cells of undetermined significance". This is slightly more "serious" simply because the endocervical cells are less likely to be affected by inflammation or infection.

Atypical cells left untreated can progress to dysplasia ("precancerous"). There is mild, moderate and severe dysplasia. After dysplasia, then you get into "cervical cancer" which can be classified as carcinoma in situ (localized) or invasive carcinoma.

The colposcopy is done to magnify the cervix and allow the MD/NP to biopsy any suspicious areas. A biopsy is going to be more accurate than a pap.

The process is typically very slow, and it's pretty rare for someone who gets regular followup to develop cancer, because it's typically caught well before that point. There are many office procedures including cryosurgery (freezing the area), LEEP (using an electrical cautery unit with a wire loop to "scoop out" the affected tissue) or laser treatments.

Many cases of ASCUS or mild dysplasia correct themselves, which is why it's sometimes prudent to just do what your doc is doing and keep a close eye. If the atypia worsens to dysplasia, more aggressive management may be indicated.

I hope this helps and is not an overwhelming amount of information.

Newlease posted 9/20/2013 16:59 PM

Thanks. I'm not afraid of the testing, and I'm not afraid to have surgery.

I'm in the category of feeling like maybe I SHOULD be more concerned. And I don't want to come off as seeking surgery if it's not warranted. However, I have no use for these organs any longer and having them removed would not be a problem for me.

NL

SuperDuperWonderboy posted 9/20/2013 17:10 PM

I am not a doctor but I did stay at a holiday inn last night.

(Actually I am a med mal defense attorney and have dealt with this issue before)

What HFSSC said is right on. And I think your level of "not too concerned" is just fine.

HFSSC posted 9/20/2013 17:11 PM

I can't imagine any insurance company these days being willing to pay for a hysterectomy unless there is a definite carcinoma dx. In fact, when I worked GYN, we had difficulty getting approval for hyst unless it was invasive carcinoma. They all want to try the least invasive/aggressive treatments (least expensive) first.

Also, the risks of general anesthesia are pretty big compared to just watching/waiting with a mildly abnormal pap. I'd ask your doc exactly what kind of abnormal you're dealing with.

Laura28 posted 9/21/2013 03:30 AM

Hi again NL

I really wouldn't worry about this honey.

The main thing is that you and your doc are watching it closely. I'm sure if there was a serious problem he/she would have taken more radical action.

I have no use for these organs any longer and having them removed would not be a problem for me.

Personally I would do this as a last resort or if the gyn recommended it. If there is no family history then my thoughts are "Why put myself through it?"

And you are not "coming off as seeking surgery if it's not warranted". You are reasonably concerned for your health.

HFSSC has given you sound advice and is clearly experienced in the field. Try to relax. Stay vigilant but try not to worry.

HUGS

Laura

fireproof posted 9/21/2013 07:30 AM

I didn't read all the posts but if it were a friend of mine I would say get a second opinion if it continues.

That being said if your OB/GYN is someone you can talk too then you could ask about the abnormal PAPS and let her know your concern. She can tell you if it is normal for either your age or medical history. Depending on her answer I would do the above.

After that many abnormal PAPs I would not only go to another Doctor for a second opinion but before state your concern if the abnormal PAPs so the new doctor can look possibly outside the box.

Doctors are people so good or bad you need to be your advocate. I went to the best doctor in town once and because it was major saw the other well known doctor who said my first doctor was the best surgeon. I felt confident in the need for surgery- I was looking to see if there was something else they could do because with surgery the risks can be high.

Good luck!

HFSSC posted 9/21/2013 08:25 AM

Fireproof,
It really isn't uncommon or terribly dangerous to have that many abnormal paps. Read my first post on this thread. In a nutshell, cervical changes are typically very slow. Many mildly abnormal paps will resolve themselves with time and the natural immune response. And there are many treatments, ranging in aggressiveness appropriate to the level of "threat" in the abnormal cells.

Some strains of HPV can cause the dysplasia/cancer process to develop much faster, and that's why the pap is repeated more frequently. If the doc sees an accelerated process, then s/he can treat more aggressively.

That's why I feel that it's SO important to ask questions and own your health care. Don't just take away "abnormal pap" from your discussion. Ask what type of atypical or dysplastic cells were seen? Is there any indication of HPV changes? In NL's situation those are the questions I would want answered before making any decision about further options.

InnerLight posted 9/21/2013 10:37 AM

Are you taking folate and B12 in therapeutic amounts? There is a strong correlation between deficiency in these nutrients and cervical dysplasia, see pubmed for many studies on this. Has your doctor discussed supplementation with you? Doctors often discount nutrition but this is important and something pro active you can do for yourself.

purplejacket4 posted 9/21/2013 19:14 PM

Do you know if your Gyn has tested you for high risk HPV? If you don't have it all those paps are not necessary.

Dr. PJ4

fallingquickly posted 9/23/2013 23:53 PM

I have had multiple abnormal results as well due to the HPV my STBXWH brought home. I have had two colposcopies. My advice, which others have given you as well, is to ask your gyn lots of questions. Write them down before you go in so you don't forget. Knowledge is a good thing. It's best to know exactly what you are dealing with.

In my case, after a couple go rounds with colposcopy, I'm finally having clear paps. One more and I no longer have to come in every three months. Not sure if I was going in more often than you because of my HPV. That has not been detected for a while.

Newlease posted 9/24/2013 11:51 AM

I just returned from my appointment. I asked my GYN what the protocol is. He says that due to the nature of the HPV virus, it is very slow growing and sometimes just clears on its own.

The approach we are taking is to watch it closely to make sure it doesn't get rapidly worse. He says after 2 years, if I am still having abnormal paps, we will do a procedure to eliminate the cells. I am coming up on 2 years so if this one is also abnormal, we will talk about what to do next.

Thanks for all the reassurance, I appreciate your advice very much.

NL