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New Guidelines Developed for Treating Abnormal Pap Smears

A panel of 121 experts from the medical community convened at a conference last year sponsored by the American Society for Colposcopy and Cervical Pathology to discuss treatment guidelines for women with abnormal pap smears. Their results, which may hasten diagnosis of the human papillomavirus (HPV), appear in today’s issue of the Journal of the American Medical Association (JAMA).

Each year 3.5 million American women will have an abnormal pap smear, which could signal the presence of HPV, a sexually transmitted infection that can lead to cervical cancer. The new treatment guidelines would allow women and their doctors to identify the presence of HPV quickly and to determine the risk of developing cervical cancer. According to the new guidelines, women whose test results show atypical squamous cells of undetermined significance (ASC-US), the least serious of the abnormalities, are encouraged to undergo DNA testing for HPV if the pap test was liquid-based, as the DNA test could be done on the same sample used for the pap test. Barring the DNA test, these women are encouraged to have two repeat pap tests or a colposcopy, a procedure performed in a doctor’s office in which the cervix is examined and biopsied. Under the new guidelines, women with more serious abnormalities, including low-grade squamous intraepithelial lesions (LSIL) or high-grade squamous intraepithelial lesions (HSIL), should have an immediate colposcopy to remove any precancerous lesions that may exist.

HPV is one of the most common sexually transmitted infections in the U.S. According to the Centers for Disease Control (CDC), approximately 20 million people are infected with HPV, and up to 75 percent of sexually active men and women will contract an HPV infection at some point in their lives. An overwhelming majority of women with HPV will not develop cervical cancer, but persistent infections with specific strains of HPV is “the key risk factor for cervical cancer.” Women should use condoms to help prevent the transmission of HPV and should receive annual pap smears to test for abnormalities caused by the infection.

Sources:

JAMA. 2002;287:2120-212; CDC Fact Sheet, 5/01; HealthScout News, 4/23/02; Associated Press, 4/24/02; Kaisernetwork.org, 4/24/02

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