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PAP SMEARS AFTER HYSTERECTOMY
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bettersafethansorry posted:
It is supposedly true that MOST cervical cancers are slow growing. I had a normal pap smear one year and then ONE year later had a pap smear that showed carcinoma insitu. I had a LEEP procedure that probably cured me, however, my cervix kept scarring over preventing the fluid from my periods from leaving my body. I subsequently had a total abdominal hysterectomy. I happen to work at a radiation oncology office and I have seen women come in with cancer of the cervix that was discovered far too late and women who have had cancer of the vagina. I would never skip a pap (even now) or a gynecological exam. I would NEVER tell any patient to skip an exam or that it is ok not to have a pap smear. Who says that pap smears can only be done on a cervix??? The doctor can take a tissue sample from the top of the vagina by a pap smear to make sure no cancer cells made it that far. Don't ever let a doctor tell you "we'll just keep an eye on something like that or something even slightly suspicious in the breast. Get with it people!! Take control of your own health and if something is bothering you, keep at it until you find out for sure that something is really something that you don't have to worry about!! Doctors have a way of not listening to a patient and by the time something has gone so far, it's too late!! Don't be afraid to tell your doctor no!! I want this checked out NOW!!!!!!!!!!!!!!!!!!!!!!
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Jane Harrison Hohner, RN, RNP responded:
Dear better: It's always helpful to hear from one who has had personal experience. You point is also well taken that, if a woman has had a hysterectomy for cervical or uterine cancer, a PAP smear scrape of the vaginal cuff should be done. The most current 2012 recommendations suggest a routine vaginal cuff PAP every three years for 20 years after the hysterectomy for cancer was performed.

It is also true that in RARE cases a woman can have a normal PAP which in the following year returns with a high grade or carcinoma in situ result. One always wonders if this was a super aggressive lesion or was missed by the GYN's PAP scrape/pathologist's reading in the prior year.

For other readers, the following are the American College of OB/GYN's 2012 recommendations for PAP smear screening. This list includes only those recommendations which had the strongest evidence to support their use:

---Cervical cancer screening should begin at age 21 years, regardless of the age of sexual initiation or the presence of other behavior-related risk factors.
---Women 21 to 29 years should be tested with cervical cytology studies alone, and screening should be performed every 3 years. Co-testing is not recommended in women younger than 30 years.
---For women 30 to 65 years old, co-testing with cytology and HPV testing every 5 years is preferred.
---Additionally, in women 30 to 65 years old, screening with cytology tests alone every 3 years is acceptable.
---Women who have a history of cervical cancer, have HIV infection, are immunocompromised, or were exposed to diethylstilbestrol in utero should not follow these routine screening guidelines.
---Both liquid-based and conventional methods of cervical cytology collection are acceptable for screening.
---In women who have had a hysterectomy with removal of the cervix (total hysterectomy) and have never had CIN 2 or higher, routine cytology screening and HPV testing should be discontinued and should not be restarted for any reason.
---Screening by any modality should be discontinued after age 65 years in women with evidence of adequate negative prior screening results and no history of CIN 2 or higher.

Yours,
Jane