HPV Support Group
Human papillomavirus is a diverse group of DNA-based viruses that infect the skin and mucous membranes of humans. More than 100 different human papillomavirus (HPV) types have been characterized. Some HPV types cause benign skin warts, or papillomas, for which the virus family is named. HPVs associated with the development of such "common warts" are transmitted...
Hi you guys
Many of you send me messages about this and I wanted to talk specifics since there are published guidelines for management of abnormal paps FOUND to be CIN 1 on biopsy.
Hang in there while reading and Ill do it in a stepwise fashion.
1) CIN 1 on biopsy that was PRECEDED by low grade abnormalities on pap (ASCUS or LGSIL) CAN be managed with "Expectant management" which means no additional procedures and following you closely (more details below)
2) Since spontaneous regression is observed in most women in this setting (ASCUS pap or LSGIL pap followed by CIN 1 on biopsy) expectant management is generally preferred for the reliable patient (someone who will come to follow up appts)
3) INTERESTING FACT: Approximately 80 to 85 percent of women referred for colposcopy because of LSIL or HPV DNA positive ASCUS have CIN 1 or LESS.
4) Studies show that 9 to 16 percent of these women (who have CIN 1 on biopsy and we do repeat paps ONLY) will have CIN 2 or 3 within two years of follow-up....so that is PROGRESSION of the abnormalities.
IF YOU DO CHOOSE MANAGEMENT WITH ONLY SURVEILLANCE AND NOT CRYOSURGERY OR LEEP:
1) It is recommended that HPV testing after 12 months with repeat colposcopy done IF the HPV results are positive for high risk types IS more efficient than every 6 month PAPS or PAP (+) HPV DNA
2) BASED ON THE DATA the American Society for Colposcopy and Cervical Pathology (ASCCP) consensus guidelines recommend expectant management ("watchful waiting") of women with biopsy proven CIN 1 using follow-up with HPV testing at 12 months or repeat PAP at 6 and 12 months.
3) THEN WHAT? Colposcopy should be repeated if repeat pap shows ASCUS or greater or HPV DNA testing is positive for a high risk type.
After two negative smears or a negative HPV DNA test, routine screening may be resumed.
4) WHAT ABOUT DOWN THE LINE? Follow-up of women with CIN 1 beyond 24 months has shown that spontaneous regression or progression can occur. There are no data to suggest that it is unsafe to continue close clinical follow-up of a compliant patient with persistent CIN 1, with treatment planned if there is evidence of disease progression or if the women chooses to be treated.
5) OH WAIT THERE IS MORE: If CIN 1 PERSISTS FOR MORE THAN 24 months, treatment becomes an acceptable option. In addition, patients may elect to have treatment of the CIN 1 lesion to relieve anxiety.
A WHOLE DIFFERENT STORY:
FOR CIN 1 preceded by high grade cytological abnormalities (HGSIL or High Grade Squamous Intrapeithelial Lesion) on pap, an excisional diagnostic procedure has traditionally been recommended.
The exception to this is adolescents: even with HGSIL pap that shows CIN1 on biopsy watchful waiting is a reasonable approach given younger age, less likely to progress to worrisome lesion AND the problems down the line when excisional procedures are done.
Hope this helps
Dr O.
Many of you send me messages about this and I wanted to talk specifics since there are published guidelines for management of abnormal paps FOUND to be CIN 1 on biopsy.
Hang in there while reading and Ill do it in a stepwise fashion.
1) CIN 1 on biopsy that was PRECEDED by low grade abnormalities on pap (ASCUS or LGSIL) CAN be managed with "Expectant management" which means no additional procedures and following you closely (more details below)
2) Since spontaneous regression is observed in most women in this setting (ASCUS pap or LSGIL pap followed by CIN 1 on biopsy) expectant management is generally preferred for the reliable patient (someone who will come to follow up appts)
3) INTERESTING FACT: Approximately 80 to 85 percent of women referred for colposcopy because of LSIL or HPV DNA positive ASCUS have CIN 1 or LESS.
4) Studies show that 9 to 16 percent of these women (who have CIN 1 on biopsy and we do repeat paps ONLY) will have CIN 2 or 3 within two years of follow-up....so that is PROGRESSION of the abnormalities.
IF YOU DO CHOOSE MANAGEMENT WITH ONLY SURVEILLANCE AND NOT CRYOSURGERY OR LEEP:
1) It is recommended that HPV testing after 12 months with repeat colposcopy done IF the HPV results are positive for high risk types IS more efficient than every 6 month PAPS or PAP (+) HPV DNA
2) BASED ON THE DATA the American Society for Colposcopy and Cervical Pathology (ASCCP) consensus guidelines recommend expectant management ("watchful waiting") of women with biopsy proven CIN 1 using follow-up with HPV testing at 12 months or repeat PAP at 6 and 12 months.
3) THEN WHAT? Colposcopy should be repeated if repeat pap shows ASCUS or greater or HPV DNA testing is positive for a high risk type.
After two negative smears or a negative HPV DNA test, routine screening may be resumed.
4) WHAT ABOUT DOWN THE LINE? Follow-up of women with CIN 1 beyond 24 months has shown that spontaneous regression or progression can occur. There are no data to suggest that it is unsafe to continue close clinical follow-up of a compliant patient with persistent CIN 1, with treatment planned if there is evidence of disease progression or if the women chooses to be treated.
5) OH WAIT THERE IS MORE: If CIN 1 PERSISTS FOR MORE THAN 24 months, treatment becomes an acceptable option. In addition, patients may elect to have treatment of the CIN 1 lesion to relieve anxiety.
A WHOLE DIFFERENT STORY:
FOR CIN 1 preceded by high grade cytological abnormalities (HGSIL or High Grade Squamous Intrapeithelial Lesion) on pap, an excisional diagnostic procedure has traditionally been recommended.
The exception to this is adolescents: even with HGSIL pap that shows CIN1 on biopsy watchful waiting is a reasonable approach given younger age, less likely to progress to worrisome lesion AND the problems down the line when excisional procedures are done.
Hope this helps
Dr O.
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My 6mo twin DD's are EBF and just started rice cereal on the first. Everything has been going fine except this morning one of them had a diaper rash (lots of redness around her anus). I read this as one of the signs of an allergy. BUT I did just buy a different brand diaper yesterday (which they have used randomly before w/no issues). Do you think its the cereal or the diaper? Im ready to start...
Dr O.