HPV 16, Abnormal Colposcopy
April 29, 2015 10:26 AM   Subscribe

My gyno says to wait until my next yearly appointment for a pap smear and HPV test. That's 10 months away. Should I wait that long?

This is the second time (in six years) that I've been diagnosed with HPV 16. And I've now had two colposcopies. Both slightly abnormal. After the first one, I had pap smears every six months and all turned out ok. At last yearly exam, they did an HPV test (it's a yearly thing with my gyno). Then the colposcopy showed slightly abnormal cells. The gyno says I can wait until my next yearly appointment for a pap smear and retest for HPV. Is that reasonable? Should I be having six month checks instead?
posted by byjingo! to Health & Fitness (9 answers total) 2 users marked this as a favorite
Personally, I would go after 6 months just for my own sanity.
I had issues many moons ago now and was monitored every 6 months for 2 years and luckily everything went back to normal on it's own.

Nowadays, my GP insists I don't need a Pap every year and should be doing it every 2 years.... I respectfully disagreed with her and continue to come yearly.

The thing is, it's your body. If you're uncomfortable with the advice they have given, either get a second opinion or ignore their advice and have a 6 monthly check instead of coming back in 10 months.

If you got terrible news at the 10 monthly check up, you'd never forgive yourself for ignoring your gut instinct.
posted by JenThePro at 10:41 AM on April 29, 2015

JenTheProd I'm so surprised and really horrified at your GPs advice.
I grew up in England and I was told I wouldn't need a PAP until 25. I moved to the US at 24 and my PCP was horrified. Women are told to be tested as soon as they become sexually active. I just recently tested positive for HPV.
It's just unthinkable to me.
posted by shesbenevolent at 11:10 AM on April 29, 2015 [1 favorite]

Response by poster: Thank you JenThePro for your advice. I will make an appointment for August! Peace of mind is almost as important.
posted by byjingo! at 11:13 AM on April 29, 2015 [1 favorite]

Nowadays, my GP insists I don't need a Pap every year and should be doing it every 2 years.... I respectfully disagreed with her and continue to come yearly.

Yes, the new recommendation is that most women only need regular pap smears ever 3 years. While it may or may not be appropriate for any individual person, and it certainly sounds like there are a ton of reasons why this wouldn't be appropriate in OP's case, this recommendation is based on recent peer-reviewed studies that show that the harm from false positives arising from such frequent testing is greater than the very small amount of harm that could be avoided with slightly earlier detection:

"We achieve essentially the same effectiveness in the reduction of cancer deaths, but we reduce potential harm of false positive tests," said Dr. Wanda Nicholson, a task force member and an associate professor of obstetrics and gynecology at the University of North Carolina at Chapel Hill. "It’s a win-win for women."
posted by dialetheia at 11:42 AM on April 29, 2015 [10 favorites]

I actually once had this exact diagnosis, and my first doctor was so stumped about what I should do that she actually prescribed my getting a second opinion; and the second doctor was indeed of the opinion that I should wait for my next pap smear.

She explained that this was because: yes, my colposcopy had come back abnormal, but the abnormalities were so small and minor, that actually doing the biopsy would cause more of a problem than simply waiting to see if things went away on their own. And - sure enough, at my next pap smear, they had. (This matched what my first doctor said - the whole reason why my first doctor was so confused was precisely because "well, this is an abnormal colposcopy, but the abnormal parts are REALLY small.")

So being told to just wait by your doctor isn't totally out of nowhere and isn't necessarily nuts. However, I also agree that your peace of mind is important, and if having an earlier appointment will help you sleep at night, then go for it.
posted by EmpressCallipygos at 11:46 AM on April 29, 2015 [4 favorites]

You might check with your insurance company and ask about coverage for more frequent tests. If your doctor doesn't think that a more frequent test is warranted then it might not be covered by insurance. I'm not sure how this sort of thing works with the Obamacare requirements for covering wellness visits, so I could be wrong about this being a potential issue.
posted by gatorae at 11:46 AM on April 29, 2015

It's reasonable. Most people clear hpv within 8-13 months, so if you retest too soon, you're not giving your body enough time. You just had a colposcopy that showed only minor cell abnormalities, not high-grade ones.

(This is also part of why screening less often is better, and why it would be better to up the screening age in the US to 25. Annual screening puts too many people through proceedures for minor cell changes that usually resolve on their own.)
posted by Violet Hour at 2:43 PM on April 29, 2015 [2 favorites]

Response by poster: Thank you all for your insight and recommendations. I've decided to talk to my internist about the colposcopy (get the records sent over to that office) to get a second opinion on the frequency of pap smears needed. What scares me the most is the HPV 16, which is one of the cancer-causing HPVs. I'll get that second opinion and then make a decision based on both doctors.
posted by byjingo! at 9:59 AM on April 30, 2015

In younger women, abnormal cells are very common and usually resolve spontaneously.

The problem of going looking for them is you may end up getting a procedure to remove something that would have gone away on its own. And the procedure isn't innocuous: it can increase your chances of 2nd trimester miscarriage.
posted by kevinsp8 at 8:31 AM on May 1, 2015 [1 favorite]

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