Flashcards in Well woman check Deck (11):
Current pap smear guidelines
Women who have ever had sex and have an intact cervix between ages 18-20, or 1-2 years after first having sex, whichever is later.
Can cease at 70 if normal smears in las 5 years.
>70 no negative smear/request->pap smear
LSIL result management
1. Repeat Pap test in 12 months (Practice Point).
If the repeat test at 12 months shows LSIL (definite or possible) the woman should be referred for colposcopy.
2. A woman aged 30 years or more with a Pap test report of LSIL, without a history of negative smears in the preceding 2–3 years, should be offered either colposcopy or a repeat Pap smear at 6 months
HSIL result management
Colposcopy and biopsy if necessary
Commencing the consultation
Contraception, sexual history (PPPPP), screening
Risk assessment->early coitus, multiple partners, not protective sex, smoking, immunosuppressed
Advice about the pill risks
Major changes in formulation
Smaller doses of progesterone and estrogen
Most of information comes from earlier formulations
Three main concerns: thromboembolic, cardiovascular and breast cancer.
TE risk->3 X the risk, 15/100 000 in second gen, 30/100 000 in third gen. Risk in pregnancy is 300/100 000
Breast cancer->+risk in >40. Of localised disease, may be due to progression of pre-existing disease. Good prognosis.
Slight increase in cervical cancer.
If young, second generation, non-smoker->absolute risk very low
Risks and benefits and ultimately her decision
When are estrogen + anti-androgen particularly useful
For women with acne
Evidence of PCOS
Pearl index of COCP
PI of 0.1
PI= method failure rate/100 woman-years= total accidental pregnancies X 1200/total months of exposure
Contraindications to the COCP
History of TE disease
Existing CV/CerebroV disease or history
Known liver disease/markedly abnormal liver function tests, jaundice
Poorly controlled/vascular disease diabetes
Hx of frequent migraine with aura
Women >35 smoking >15 cigarettes
Active gall bladder disease
Advice about pap smear and HPV
HPV is common and generally transient
At time of becoming sexually active
More than 100 subtypes, some may cause visible warts, some are high risk for causing pre-malignant lesions on cervix, vagina, vulva.
Other risk factors necessary- smoking ++ associations
Most of the time, temporarily infected, immune system deals with the virus.
3% may progress to HSIL and eventually cancer. Time for this is minimum for 6 years.
Chance of detecting premalignant change is very high with pap smear.
Also do chlamydia screen as standard.
Are pap smears 100% effective at preventing cancer
No, but very effective
Occasionally can develop cancer/endometrium not detected on pap smear.
They are screening tests.
Cervical cancer went from ++killer of women, to rare.