Return of abnormal paps 13 years after laser ablation

[Vickie A.]

Hi. In 1993 I received laser ablation to cervix for severe grade cervical dysplasia. (It was not carcinoma in situ, but I was told it was a fine line between that and my severe dysplasia) At least 2 paps since then were completely normal. In 2003, 3 years ago, my PAP came back as atypical cells (i'm assuming squamous) - but the HPV test was negative and they did not suggest any further testing. I did not have another PAP for 3 years, and my PAP came back again as abnormal, but again with HPV being negative. I have not seen the pathology report, but I asked if it was dysplasia, and the assistant to the doc said no, just abnormal cells like last time. They recommened that I do not need to return for at least a year.

I know that HPV is currently beleived to cause nearly all cases of cervial carcinoma- but perhaps not 100%, or perhaps there are other strains not currently tested for. In addition, I recently read an article in the British Medical Journal published in Nov 2005 that found women treated for CIN continued to be at risk for cancer at least 20 years after successful treatment.

Given that the abnormal cells have not gone away after 3 years, and given my history, and given that before the dysplasia in 1993 I had a couple of paps that were mildly abnormal (including marked glandular atypia) that were ignored, and given the recent BMJ article, is there anything else I can do besides asking for the pathology report?

thanks

[Vickie A.]

ok, thanks anyway. What's the false negative rate of the HPV test from a PAP smear? (2 negative results from PAPs 3 years apart). That info will help decide if I should insist on a biopsy.

[H. Hunter Handsfield, M.D.]

With apology, I really cannot help.  Like most STD specialists, I lack expertise on the long term management of abnormal pap smears, especially in the absence of HPV infection.  And few STD specialists are expert in interpreting pap smear results.  The best I can say is that if your recent negative HPV test was from the pap smear or a cervical scraping, a biopsy might be needed and would be a more definitive test.  In any case, your gynecologist is a better source of advice than I can be.  If uncertain about his or her expertise, ask for referral for a second opinion.

Best wishes--  HHH, MD