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High Risk HPV, Abnormal Pap and No Cervix
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High Risk HPV, Abnormal Pap and No Cervix

I had cervical cancer 36 years ago and had a hysterectomy (cervix removed but left ovaries).
Since then, my paps were all normal and I was never told I had HPV.  I had a pap test the other
day and it was abnormal and said I have high-risk HPV.  From what I understand, high-risk means
you are at high risk for cervical cancer.  Since I had cervical cancer 36 years ago and my cervix
was removed, what does the abnormal pap and high-risk HPV mean for me?  Do I have anything
to worry about?  What might I get?  Out of the 13 strains, is there any way to know which strain(s)
I have?
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Medicine has come a long way in 36 years. It is possible that you had cancer but it is equally possible that you had a pre cancer—so hard to know without seeing actual biopsy reports or very little history from you on the internet. At that time they often did more invasive procedures such as total hysterectomies “just in case” to remove abnormal cells. At that time they did not know there was a relationship to HPV and I say relationship because there is only a relationship. HPV testing began in the early 2000’s and HPV does not cause cervical cancer only a persistent infection one that does not go away with added factors currently unknown may in some women cause cervical cancer.

Now there is some controversy with women such as you—and you did not state your age.

Paps are done looking for cervical cancer, you don’t have a cervix so this does not apply to you. Some physicians feel that if you had a prior cervical cancer or abnormal cells that you need to be followed yearly and they would be doing a Pap to check for vaginal/vulvar wall disease or vaginal/vulvar wall cancer. The current recommendation is: Women who have had a total hysterectomy because of abnormal cells or cancer should be tested yearly for vaginal cancer until they have three normal test results, then they can go to every 2-3 years. Since all your Paps have been normal, you would appear to be in a low risk category and only need a Pap every two to three years. The Pap test is imperfect and so is the HPV test which both can produce false positive results. If you are menopausal then the Pap can show inflammation or cell atrophy changes (caused by decreased estrogen) which are normal at your age. You may just need some estrogen crème. If you are over 65, there is some debate if you even need Paps if you have been normal for 36 years. For women over 65 with 3 normal Paps and no abnormals in the past 10 years, they can stop Pap testing but this is something that needs to be discussed with your Dr. Part of the reason for this recommendation is the imperfect tests and the more tests you have done the greater it is to have an abnormal result, thus causing “more harm” with more testing but less benefit to your health.

High risk does mean high risk for cervical cancer (but you don't have a cervix!) and I’m not sure where your Dr. took the Pap specimen from—maybe the vaginal wall; hard to know. You should ask and then the lab needed to know where the cells that he removed during the Pap came from. There is no way to know from the current HPV test which one the “one of thirteen” you “might” be positive for. That is one reason that I don’t like that test. This test is also not a 100% reliable which your Dr. may not tell you. It is very possible you had a false positive HPV test.

If you had a very mildly abnormal pap called ASCUS which is Atypical cells of Undetermined Significance I would think that your Dr. would only want to do a follow a year up Pap a year from now. You need to find out where he took the specimen from, what your Pap result was and you may want to request a copy of your Pap results and HPV test from your Dr. or the lab. Then you might want to sit down with your Dr. and have a discussion about them. I would not overly worry about this until you get all of the answers to the above. The fact that you have had normal Paps for 36 years is a good sign. Good Luck.
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