what if i don't follow up with an abnormal pap smear?

	Asked by Unregistered on Sun 09, Mar 2008 04:47am :
	I had an abnormal pap smear eight years ago, i ended up having to have a cone biopsy "leep procedure" done. i had normal pap's for over 7 years now. a couple months ago i had another pap done and it came back abnormal again, my doctor said to come back in a few months to see if the abnormalty went away or not. i decided not to go back. am i at any danger of this getting worse? i was told that after five years of normal pap's then i had nothing to worry about, it's been 7 years and now it's abnormal again. I've also had several surgeries to remove endometriosis, would that be the cause of the abnormalties? I just have so much scare tissue that i have pain in my pelvis and stomach all the time and would love to avoid any more surgeries if possible. please let me know if this can be avoided or not. I also have a family history of cancer, i don't know if that would matter or not. thanks for any information.
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	Answer by Dr Heinrik M, MD (doctor) on Mon 10, Mar 2008 08:19am: Hi, The screening for cervical cancer could reduce your risk for getting invasive cervical cancer from 24 to 70% and reduce risk of death by 22%. If you decide to forego the tests, you will lose this advantage. These numbers are a bit hard to imagine. If we consider US data, for a total population of 304 million, assuming half are women that would be about 152 Million women at risk for cervical cancer. About 11000 are estimated to be diagnosed in 2007. This would mean a risk of 1 for every 13800 women. With screening, you could belong in a risk group with odds of 1 for every 48000 women. It confers about a 1 to 3 fold reduction. This may seem modest, however as a whole screening has led to a 70% decline in mortality since the 1940s. Endometriosis has no clear relationship to cervical cancer, but I do understand that this is a factor in your decision making due to the symptoms that this condition and/or its treatment. Family history is also not an issue. The sexual history is. I think you need to explore what elements of the screening you do not like. If it is a matter of discomfort/pain associated with the procedure – you may consider taking some pain medications around the time of the procedure. If it is the frequency of having it done per year, you could explore a liquid-based cytology which would make the interval 2 years. However, what is crucial now is that there is an abnormal preliminary finding. While there is indeed a high false positive rate with current screening (going back to the 11000 who will be diagnosed, there are about 2 to 3 million women would have further evaluation), your risk now increases from the baseline risk of 1 in 13800 women to 1 in 180 women. I think an evaluation is better than no evaluation, even if it seems the abnormality has a good spontaneous resolution rate (since the doctor was willing to observe its course). There is no reason to believe, that the history of 7 years normal Pap will guarantee another normal finding although the chances are in favor of a normal finding. You could also discuss cervical cancer vaccines and how they may afford some added protection. The final analysis regarding its use in a therapeutic rather than a prophylactic setting is promising but is yet to be completed.
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