IL BCCP Questions
Managing treated CIN2+
• A client has treatment for CIN2 or CIN3, cotesting at 12months and 24 months is
recommended. If both co-tests are negative,
retesting in 3 years is recommended. What if
the client has had 1 or 2 negative pap tests in
the last 2 years but no HPV test, should we cotest for 2 years and then return to screening in
3 years?
Managing treated CIN2+
• A client has treatment for CIN2 or CIN3. Client
was out of program for 2 years then comes
back to IBCCP, we have no record of paps or
hpv during this time. Should this client be cotested this year and next year?
Managing remotely treated CIN2+
after hysterectomy
• New client age 58 reported hysterectomy due
to “cysts” and no paps since. Obtained
records for hysterectomy which was done
5/25/89. Per History and Physical
hysterectomy was done due to severe
dysplasia of cervix. Pathology results were
severe dysplasia with free surgical
margins. The cervix was removed. Should this
client have a pap and hpv?
No diagnostic excision for cancer
• The client was referred into the program with a
Pap with an ASC-H (PT4) result on 1/14/2013. On
2/12/2013 the client had a colposcopy with
biopsy and ECC. The results of the colposcopy
were “invasive poorly differentiated nonkeratinizing squamous cell carcinoma at both the
2 o’clock and 10 o’clock uterine cervix”. This was
the final diagnosis and the client was approved
for a medical card and later received radiation
and chemo. Why didn’t they do a diagnostic
excisional procedure?
AGC in women 25-29yo
• Occasionally, I saw a few patients between 25-29y/o with
AGC.
• Since these patients can have endometrial cancer too and
we do not want to miss that, should we do Colpo only or
Colpo with EMB?
• If the EMB is done based on the patient’s history and risk
factors, are these risk factors reliable?
• Is there any harm with doing the EMB at this young age
range?
• Since AGC could also be an indicator for other cancers of
the female reproductive system, should we do more
extensive tests for these patients such as pelvic ultrasound,
EMB, etc…?
LSIL without CIN
• 49 y/o with a 2 year history of LSIL pap with
benign colpo w/bx.
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5/2011 LSIL Pap
5/2011 Colpo w/bx benign
11/2011 Negative Pap
6/2012 LSIL Pap
Client refused colpo
11/2012 LSIL Pap
1/2013 Colpo w/bx benign
3/2014 LSIL HPV positive
• Provider ordering treatment: cryocautery
LSIL without CIN
• 44 year old woman with a history of abnormal paps.
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12/15/10 – Pap LSIL/+HPV
1/12/11 – colpo/biopsy negative
5/30/12 – Pap ASC-US/+HPV
6/28/12 – colpo/biopsy CIN1
1/10/13 – Pap LSIL
2/26/13 – colpo/biopsy CIN1
8/28/13 – Pap negative
• She is now scheduled for cotesting this month to follow the new
algorithm stating women with CIN1 preceded by “Lesser
Abnormalities” should have cotesting at 12 months.
• Since her follow-up pap after her 2/26/13 biopsy was only six
months and didn’t include HPV we advised her to have cotesting at
12 months.