suspicious pap tests

[Lizzie04]

Is it routine to have a colposcopy after having an abnormal pap test. My came back s ASCU and my doctor order one because  ascu is associated with hpv. She did not say whether I was automatically tested for HPV but I am assuming I was because of the colposcopy or does the HPV test have to be done with a separate sampling. I am confused and scared. Last year I was fine. I am near menopause and lately have had some irregulare bleeding. My doctor said this is not related because the result are not in that grade. When I went for my exam,she also ordered  a
pelvic ultrasound and endometrial biopsy for the bleeding. She thinks its either a fibroid or irregluar hormones. She also does not think I have dysplasia and feels I am probably fine. If these are cancerous changes what are the chances it was caught early. I tried to grasp everything she told me but I was so shocked. If this HPV that causes cancer how fast does it grow and did I catch it early. Also how long does it stay dormant. I have been celebate for six months and before that tested fine while I was with my partner.

[Lizzie04]

Well, my pelvic ultrasound came back and it read my uterine lining is 5mm with some pockets of fluid of undetermined significance. My ovaries are fine. I am going for an endometerial biospy and a colposcopy in two days. this all started with some spotting which has stopped. What could the fluid be? My doctor said she would be able to evaluate this when I go in? Could this be related to Ascus and does this mean cancer. I can't seem to find anything on uterine fluid unless is relates to pregnancy and I am definetly no pregnant. There is no history in my family of anything.

[Fernando Roque, MD]

Hi.  A colposcopy after a diagnosis of ASCUS (atypical squamous cells of undetermined significance) is done to verify the presence of "dysplasia" or cancerous cells in the cervix.  Now, you're asking if this is a routine procedure.  Flynn, et al (2001) did a study on the proportion of women with a diagnosis of ASCUS who were found to have dysplasia on subsequent follow-up examinations.  They found that 29.5% of women under 50 and 12.8% of women over 50 years have dysplasia on follow-up.  So to answer your question:   a follow-up colposcopy is probably necessary for women who are under 50 and who have been diagnosed with ASCUS, since there's a high possibility that the ASCUS indicates dysplasia.  In women over 50 with ASCUS, the colposcopy is probably optional since the chance that there's no dysplasia is around 87%, but you may still want to take the option of having this done,  just to make sure you are not among the 12.8% who do have dysplasia.

HPV infection is a very common infection, particularly among women who have already started being sexually active.   Most HPV infection is asymptomatic and resolves spontaneously.  But a small proportion can become chronic (the virus stays in the body for a long time), and cause cancer by inducing mutations on the cells lining the cervix. Cervical cancer takes years to develop (usually decades) from the initial HPV infection.