Clinical Corner - Cervical Expansion Case Study #1

Question: We had a 37 year old with self-reported history of abnormal Paps 9 years ago, but no documented follow-up. Current Pap was NILM and HPV genotyping 16 positive. I referred her for a colposcopy. The patient presented for a scheduled colposcopy with a different provider. This provider advised her the recommendation was to co-test in one year. The patient presented 6 months later with irregular bleeding and questions about the colposcopy. Her colposcopy was rescheduled, but through scheduling error, was scheduled with the provider who advised against colposcopy. My understanding is that if the Pap was normal, but HPV 16 or 18 were identified, that colposcopy is recommended per 2012 guidelines. Could you please clarify?

Answer: You are correct that colposcopy is recommended for patients with cytology that is NILM and genotyping positive for HPV 16. This patient is concerning because she has a history of abnormal cytology 9 years ago and irregular bleeding. She definitely needs a colposcopy.

(Adapted from ASCCP Advisor July 21, 2016) 

This is a new Q&A series of the Clinical Corner that will focus on cervical cancer services in the 21-39 year old woman in preparation for cervical expansion. If you have a clinical question that you would like answered, please email Angela.FellersLeMire@state.co.us