Unusual, Brand New Treatment for Abnormal PAP Smears:

Austin family medicine happy-young-female-over-skyAs many of you already know, the medical field has been changing a lot of its guidelines, treatment regimens, and screening programs for women over the past 10 years.  There has been an extraordinary amount of media attention to the mammography debacle, and every society has a different opinion on mammography screening.  I even wrote a blog about it a few weeks back (Harms of Mammography).  I remember in residency only a few years ago that the PAP smear guidelines changed every year, so I was frequently looking it up in order to remember the details.  These PAP smear guideline changes were overdue, and many women still do not know that they are getting PAP smears too frequently.  Cervical cancer grows exceedingly slow, and it can be caught many years in advance.  Moreover, many women spontaneously clear abnormal cervical cells, called dysplasia, without any intervention from their doctor.  Therefore, there are new studies being released showing physicians that it is acceptable to not be aggressive with many abnormal PAP smears.

Wait.  Patiently.  These are not words that physicians are used to hearing, especially with the legal ramifications of missing something that could harm a patient.

Waiting makes some women uncomfortable, and as physician, we have the ability to modify recommendations based on patient expectations and desires.

For the most up to date guidelines on PAP smears and how often you should be getting them, you should read my previous blog post:  PAP Smears – Why and How Often?

You only need yearly PAP smears if you have had an abnormal finding or family history of cervical cancer despite what some physicians may tell you.

A new study released just a few months ago in April 2014 was able to demonstrate that surgery may not always be needed for more advanced dysplasia, or early cancer cells.  This study looked at women less than 30 years old who had an abnormal PAP smear and subsequent colposcopy which led them to a diagnosis of CIN2.  This is an early stage of abnormal cervical cells that may or may not progress to cervical cancer.  CIN2 is usually eradicated by a LEEP procedure which involves cauterizing a significant portion of the cervix.  It requires anesthesia of the cervix and is quite uncomfortable.  This study had 2 treatment arms in order to compare outcomes.  One arm was purely observation and had no treatment.  The other treatment arm used 5-Fluorouracil (5-FU) cream which is an anti-cancer drug.  It has been used on the skin for many years for people with frequent skin cancers.  The treatment group placed 5-FU cream into their vagina every two weeks for 4 months.  At 6 months, 84% of the women had regression of the CIN2 with the 5-FU treatment.  Interestingly enough, 52% of the women who did NOT receive any treatment managed to cure themselves.

This raises a significant question:  After reading this study, if you were diagnosed with CIN2, would you be willing to watch it for 6 months without treatment?  Or, would you jump on the treatment bandwagon of 5-FU?  Keep in mind that 5-FU causes burning, irritation, and birth defects.  This goes along with my current motif that sometimes less is more in medicine.  It takes a confident physician to “watch” certain diagnoses.  If your physician advises you to be patient and recheck in 6 months, do not write them off as careless and reckless – maybe, just maybe, they are the first physician in your life that is the most current in their medical knowledge.

Click here to read the 5-FU for CIN2 Study.


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