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. – – – – – – – – 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. – – – – – – – 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.