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HPV-16 and abnormal HSIL pap smear
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HPV-16 and abnormal HSIL pap smear

I'm 44 years old and my doctor had recommended I move to getting a pap smear every 3 years as I've never had an abnormal one and have had the same partner for 22 years.  I just received my pap smear results and they were abnormal HSIL and I tested for HPV-16.  I've scheduled a biopsy, but am very worried that by following my doctor's recommendation to do a pap smear every 3 years, I may be at a much higher risk for cervical cancer.  Has anyone else had an HSIL pap after 3 years plus HPV-16?  My biopsy is in 3 weeks so the anxiety is high.

thanks,
Michelle
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Your age puts you at a little higher risk, but marginally. The fact that you have had one partner for 22 years and normal Paps would lower your risk. The new liquid Pap tests appear to be delivering some results (done by computer) that are not always reliable—understand in most cases a computer reads the result and then a cytotech checks it and often the pathologist does not see it. I’m not sure why you had an HPV test? And how do you know you have HPV 16? The HPV tests that are on the market in the US are usually the ones that tell you if you are positive for one of thirteen or fourteen HPV’s and are not specific to which one. Then in some offices they use the Cervista test after the first HPV test that will tell you if you have either 16 or 18 (this is a new test only approved in 2009) but they can’t tell which one. Do you know what test you had and did your Dr. tell you that you were positive for HPV 16? It may have been your Dr.’s recommendation to have the test but it is known that doing the HPV test does not usually enhance a diagnosis. It often just causes more testing. In your case with your HSIL, you would have been sent for a colposcopy anyway. And are you sure you had HSIL because there is a ASC-H diagnosis which means Atypical Cells, cannot exclude High Grade SIL, which also means they are not sure?

This is how it should work—You go into the office and you are over 30 and you have a Pap. When the result comes back as a low level abnormality, an ASCUS result they often will reflex and do an HPV test off of the first Pap. If you have LSIL, Low squamous Intraepithelial Lesion, they don’t do an HPV test because them presume you have HPV and some will do a colposcopy for this but most physicians are beginning to understand HPV they often just repeat a Pap in 6 months or a Pap and HPV test in a year. If your Pap came back as HSIL, High Squamous Intraepithelial Lesion then they do not do an HPV test, they usually just send you to have a colposcopy. However, I am guessing in your case that your Dr. recommended having an HPV test with the Pap before you had your Pap. This generates more money for the physician and the lab with the HPV test.

In your mind, I would try to discount that you had the HPV test because it really does not mean anything and only adds to your anxiety. They are actually finding out now that there are more false positives when these tests are done together. You need to have the colposcopy and they may find nothing—this is often the result, they may find some mild or moderate dysplasia and if they do that can be treated. The colposcopy is really the test to find out if there is anything there, not the Pap or the HPV test. You said that you have always had normal Paps and you had one 3 years ago. Cervical cancer is rare, rare and it is slow growing; usually 10-15 years. Just follow through with the colposcopy as recommended. The fact that you did not have a Pap for 3 years would not change this, even if found sooner. Remember, even “pre cancers” are slow growing.

Also, make sure if you have a colposcopy that you do not consent to a LEEP until the biopsies are back and you can make an informed decision. You may also need a second opinion because Dr.’s are doing procedures that can be harmful, simply because HPV is poorly understood and even abnormal cervical cells found on biopsy often clear up. And at 44, you may be entering perimenopause and there are cervical cell changes at this age that may be normal for you. Women enter this at different ages from late 30’s to late 40’s. Hope this helps.
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You should still of course get the biopsy and follow the recommendations. But, I wouldn't worry that it has been 3 years since your last PAP was negative.  Most likely if it does come up positive they will freeze it off and follow up with another PAP smear.
take care,
mkh9
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I'm not sure you understood what I said or the testing. A biopsy or several biopsies are done at the time of colposcopy. I also just recommended to her to not to have a LEEP, which would be the preferred treatment at her age, it is removal with electrical current and this treatment, only if needed has great results. I would also not recommend cryotherapy which would be freezing. I would want to know the results of the biopsy before I consented to any invasive procedures. I would want to read the actual biopsy and colposcopy report.
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