Dr Grabinski, a generalist OBGYN, is System Chief of OBGYN & Perinatology at Swedish Medical Center, and a clinical adjunct Professor at UW in Seattle WA
Learning Objectives: Upon completion of this activity, participant should be better able to
The new ASCCP management guidelines provide recommendations on the management of cervical cancer screening abnormalities. But sometimes, we have to deal with unusual or more challenging situations. The key point to remember with the following, less typical clinical scenarios is that successful outcomes hinge on not only following best practices but individualizing care.
17 year old recently became sexually active, wants to discuss contraception options. She has a history of Crohn’s disease that is well controlled with a biologic. You suggest cervical cancer screening, but the patient is surprised – she thought Pap screening didn’t start until age 21
Who to Screen
How to screen
How to Manage
32 year old new patient presents for pelvic pain discussion. They deny previous abnormal Pap results, but you do not have records. They are unsure when they last had a Pap. Current screening results show ASCUS and hrHPV+
52 year old established patient, presents for colposcopy due to a report that is negative for intra-epithelial lesions and malignancy (NILM) and hrHPV+. This is their 4th consecutive colposcopy for the same result. Current and previous colposcopy does not show CIN 2/3+. She is frustrated and wonder if they need to continue doing colposcopy
Counseling Options for This Patient
A 47 year old patient presents 5 years after radical hysterectomy for Stage 1(b)i squamous cell carcinoma of the cervix. They have ‘graduated’ from follow up with gyn oncology and are here for a preventive exam. They wonder whether they should still have pap smears.
Hysterectomy for CIN 2/3
Endometrial Cancer
Ovarian Cancer
Cervical Cancer
Vulvar/Vaginal Cancer
44 year old presents with a 6 month history of abnormal bleeding. On evaluation, the bleeding is occurring mainly after penetrative intercourse. She reports her last Pap was 3 years ago and was normal
Cervical cancer is very unlikely in the following situations and therefore colposcopy may not be clinically appropriate if pelvic exam benign
Consider colposcopy if the following applies, regardless of screening results
This educational activity is supported by Hologic
Dr. Grabinski reports that she has no relevant financial relationships to disclose
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presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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