ÿþ<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN" "http://www.w3c.org/TR/1999/REC-html401-19991224/loose.dtd"> <html xmlns="http://www.w3.org/1999/xhtml" xmlns:v="urn:schemas-microsoft-com:vml" xmlns:o="urn:schemas-microsoft-com:office:office" xmlns:(null)0="http://www.w3.org/TR/REC-html40"><head><title>Rocky Mountain OB-GYN .::. Riverton, Wyoming</title> <meta content="text/html; charset=unicode" http-equiv="Content-Type"> <meta name="description" content=""> <meta name="keywords" content=""> <script language="JavaScript" type="text/javascript"> <!-- function clickmail(domain,mailto) { var url = "mailto:" + mailto + "@" + domain; self.location.href = url; return; } //--> </script> <link rel="stylesheet" type="text/css" href="styles.css"> <meta name="GENERATOR" content="Microsoft FrontPage 5.0"> </head> <body> <!-- DHTML Menu Builder Loader Code START --> <div style="POSITION: absolute" id="dmbri"> <img name="dmbif" alt="" src="layout/dmb_i.gif" width="1" height="1"> <img name="dmbjs" alt="" src="layout/dmb_m.gif" width="1" height="1"> </div> <!-- <script type="text/javascript"> var rimPath=null;var rjsPath=null;var rPath2Root=null;function InitRelCode(){var iImg;var jImg;var tObj;if(!document.layers){iImg=document.images['dmbif'];jImg=document.images['dmbjs'];tObj=jImg;}else{tObj=document.layers['dmbri'];if(tObj){iImg=tObj.document.images['dmbif'];jImg=tObj.document.images['dmbjs'];}}if(!tObj){window.setTimeout("InitRelCode()",700);return false;}rimPath=_gp(iImg.src);rjsPath=_gp(jImg.src);rPath2Root=rjsPath+"../";return true;}function _purl(u){return xrep(xrep(u,"%%REP%%",rPath2Root),"\\","/");}function _fip(img){if(img.src.indexOf("%%REL%%")!=-1) img.src=rimPath+img.src.split("%%REL%%")[1];return img.src;}function _gp(p){return p.substr(0,p.lastIndexOf("/")+1);}function xrep(s,f,n){if(s) s=s.split(f).join(n);return s;}InitRelCode(); </script> <script type="text/javascript"> /* <![CDATA[ */function LoadMenus() {if(!rjsPath){window.setTimeout("LoadMenus()", 10);return false;}var navVer = navigator.appVersion; if(navVer.substr(0,3) >= 4) if((navigator.appName=="Netscape") && (parseInt(navigator.appVersion)==4)) { document.write('<' + 'script type="text/javascript" src="' + rjsPath + 'nsmenu.js"><\/script\>'); } else { document.write('<' + 'script type="text/javascript" src="' + rjsPath + 'iemenu.js"><\/script\>'); }return true;}LoadMenus();/* ]]> */</script> DHTML Menu Builder Loader Code END --> <div align="center"> <table border="0" cellspacing="0" cellpadding="0" width="800"> <tbody> <tr> <td height="171" valign="top" width="400" align="left"> <img id="MenuSpacer" name=MenuSpacer alt=MenuSpacer src="layout/spacer.gif" width=413 height=68><img border=0 alt="Rocky Mountain OB-GYN" src="layout/logo.jpg" useMap=#Map align="left" width="339" height="77"></td> <td height="171" valign="top" width="400" align="left" bgcolor="#8DB2CD"> <p align="center"><br> <font face="Verdana" size="5" color="#005591">WHEN AND HOW OFTEN SHOULD YOU GET A PAP SMEAR?</font></p> <p align="center"><font face="Verdana" size="5" color="#005591">HERE ARE THE LATEST RECOMMENDATIONS</font></td> </tr></tbody></table> <table class="body-table-right-bottom" border="0" cellspacing="0" cellpadding="0" width=800 height="1335"> <tbody> <tr> <td valign="top" background="layout/body-bg-left.jpg" width="8" align="left" bgcolor="#A75F5F" height="1335"> <img alt="Rocky Mountain OBGYN" src="layout/body-top-left.jpg" width="8" height="27"><img alt="Rocky Mountain OBGYN" src="layout/spacer.gif" width=8 height=400></td> <td class="body-bg" valign="top" colspan="2" align="left" height="1335"> <table border="0" cellspacing="0" cellpadding="10" width="790" height="836"> <tbody> <tr> <td valign="top" align="left" height="17" colspan="2" bgcolor="#C9DAE7"> <font size="5">New information about Pap smears and HPV have caused various organizations to update their guidelines...</font></td> </tr> <tr> <td valign="top" align="left" height="106"> <p class="body-text"><br> <font size="3">When should a woman get her <b>first Pap smear?</b>&nbsp; The American Congress of Obstetricians and Gynecologists (ACOG) now recommends that a woman have a pap smear <b>3 years after starting sexual activity</b> or at <b>age 21,</b> regardless of when she started having sex.</font></td> <td valign="top" width="200" align="left" height="106"> <p align="center"> <img border="0" src="images/normal-pap-cells.jpg" width="71" height="56"><p align="center"> Normal cells on a Pap.</td></tr> <tr> <td valign="top" align="left" height="40"> <hr> <font size="5">What about HPV Testing?</font></td> <td valign="top" width="200" align="left" height="40"> <hr> <p align="center"> <a title="MedlinePlus Info on HPV" target="_blank" href="http://www.nlm.nih.gov/medlineplus/hpv.html#cat57">HPV Information</a></td></tr> <tr> <td valign="top" align="left" height="108"> <font face="Arial">Since HPV infection is known to be the <u>primary</u> cause of Pap smear abnormalities, many women wonder if they should be tested for it.&nbsp; In teens, 9 out of 10 HPV infections will clear spontaneously.&nbsp; Clearing an HPV infection may take 24 to 36 months.&nbsp; ACOG does not recommend screening women under 21 for high risk HPV.</font></td> <td valign="top" width="200" align="left" height="108"> <p align="center"> HPV testing can be done from the same specimen that the Pap smear is taken from and does not require another exam.</td></tr> <tr> <td valign="top" align="left" height="27"> <hr><font size="5">What if I am more than 20 years old?</font></td> <td valign="top" width="200" align="left" height="27"> <hr> <p>&nbsp;</td></tr> <tr> <td valign="top" align="left" height="150"> <font face="Arial">A woman 21 to 29 should have a Pap smear at least every two years if they remain negative.&nbsp; If the Pap smear is ASCUS, reflex HPV testing should be done.&nbsp; Any Pap abnormality greater than that will result in colposcopy, because it is assumed that there is a persistent HPV infection which could lead to precancerous change.</font><p><font face="Arial">Women in this age group do not have to be screened primarily for HPV infection.</font></td> <td width="200" align="left" height="150" bgcolor="#C9DAE7"> The term &quot;reflex testing&quot; means that the lab automatically will do a screen for high-risk HPV types if the Pap result is ASCUS.&nbsp; Your provider can use this information to direct what steps should be done next.</td></tr> <tr> <td valign="top" align="left" height="27"> <hr><font size="5">Women 30 to 64...</font></td> <td valign="top" width="200" align="left" height="27"> <hr>&nbsp;</td></tr> <tr> <td valign="top" align="left" height="111"> <font face="Arial"><b>Women with no history of CIN </b>(and certain other conditions) can be screened with a Pap smear only, but should have 3 negative Paps before screening is done at 3 year intervals.&nbsp; However, if screening is done with a Pap <b>and</b> an HPV test and <b>both are negative</b>, then screening can be done every 3 years.</font><p> <font face="Arial">If the <b>HPV</b> test (for high risk types only) is <b>positive but the Pap was negative</b>, the <a title="Patient Education from ASCCP" target="_blank" href="http://www.asccp.org/patient_edu.shtml"> ASCCP</a> recommends a repeat of the Pap and HPV test in 12 months, with colposcopy performed if the HPV is again positive.</font></td> <td width="200" align="left" height="111"> Smoking, multiple sex partners, and certain medical conditions put a woman at higher risk for getting HPV at any age.</td></tr> <tr> <td valign="top" align="left" height="27"> <hr><font size="5">Women 65 and older...no history of hysterectomy</font></td> <td valign="top" width="200" align="left" height="27"> <hr>&nbsp;</td></tr> <tr> <td valign="top" align="left" height="137"> <font face="Arial">Because HPV infection is significantly lower in older women, this group can be <b>considered for discontinuing Pap </b>smears IF:</font><ol> <li><font face="Arial">There have been 3 negative paps in a row (not necessarily every year)</font></li> <li><font face="Arial">No abnormal tests within the past 10 years</font></li> <li><font face="Arial">No history of being HIV positive</font></li> <li><font face="Arial">No history of having had cervical cancer</font></li> <li><font face="Arial">Not immunosuppressed (ie, on medications after a transplant)</font></li> <li><font face="Arial">No risk factors for acquiring STDs</font></li> </ol> <p><font face="Arial">Assuming the woman has ovaries, it is still recommended that there be an annual pelvic exam, although this recommendation is not &quot;evidence-based&quot;.&nbsp; Pap smears in women after menopause can be false-positive due to the loss of hormone affect on the vagina (atrophy) and should be managed carefully to avoiding over-treatment of the patient.</font></td> <td width="200" align="left" bgcolor="#FF99FF" height="137" valign="top"> <p align="center">Even though a pap smear may not be indicated, older women should have annual check-ups if they are on hormone medications, are at risk for osteoporosis, have ovaries, or other female problems.</p> <p align="center">Also, it is important to get regular mammograms and have a breast exam to check for breast cancer.</td></tr> <tr> <td valign="top" align="left" height="45"> <hr> <p><font size="5">Pap Smears in pregnancy...</font></td> <td width="200" align="left" height="90" rowspan="2"> <hr> <p align="center"> <img border="0" src="images/j0370438[1].wmf" width="105" height="132"></p> <p>&nbsp;</td></tr> <tr> <td valign="top" align="left" height="45"> <font face="Arial">Pregnancy remains an excellent time to screen a woman for pre-cancerous change, but the pregnancy causes her immune system to be suppressed and at greater risk for acquiring HPV infection.&nbsp; Even if a woman has had two or more negative paps in previous years, a pap smear is recommended.&nbsp; If the result is abnormal, there are special recommendations for further evaluation.&nbsp; Treatment with LEEP procedure is generally not acceptable.</font></td> </tr> <tr> <td valign="top" align="left" height="45"> <hr> <p><font size="5">Following hysterectomy...</font></td> <td valign="top" width="200" align="left" height="45"> <hr> <p>&nbsp;</td></tr> <tr> <td valign="top" align="left" height="45"> <font face="Arial">If a woman's hysterectomy was done for &quot;benign&quot; reasons (such as fibroid tumors, bleeding, etc) and there is no history of pre-cancerous changes prior to the surgery, then a Pap smear is not necessary.&nbsp; </font> <p><font face="Arial">If the hysterectomy was done for early cancer or pre-cancerous changes, <b>annual </b>Pap smear testing should continue.&nbsp; How long?&nbsp; While there is no evidence to support it, most cancer specialists recommend continuing indefinitely.</font></td> <td width="200" align="left" bgcolor="#C9DAE7" height="45"> <font face="Times New Roman">(Women who have had a hysterectomy with the cervix left behind -- so-called &quot;sub-total&quot; hysterectomy -- need to discuss the matter of a Pap with their doctors.)</font></td></tr> <tr> <td valign="top" align="left" height="45"> <hr> <p><font size="5">After HPV vaccination...</font></td> <td valign="top" width="200" align="left" height="45"> <hr>&nbsp;</td></tr> <tr> <td valign="top" align="left" height="45"> <font face="Arial">HPV vaccination (Gardasil) has been shown to be effective in preventing cervical cancer and pre-cancerous changes caused by HPV Types 16 &amp; 18, as well as genital warts caused by Types 6 &amp; 11, but the guidelines for cervical cancer screening are not different for vaccinated women.</font></td> <td width="200" align="center" bgcolor="#FF99FF" height="45"> <p align="center"><font size="4"> <a target="_blank" href="http://www.cdc.gov/std/hpv/STDFact-HPV-vaccine-young-women.htm">Information on HPV vaccination</a></font></p> <p align="center"><font size="4"><a href="pap-central.htm">Back to &quot;Pap Smear Central&quot;</a></font></td></tr></tbody></table></td></tr></tbody></table> <table border="0" cellspacing="0" cellpadding="0" width="798"> <tbody> <tr> <td colspan="3" align="middle"><br><br><a href="./"><span class=footer-links>HOME</span></a> &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 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