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Repeat Pap smear in 1 year
16%
8/50
Repeat Pap smear in 3 years
2%
1/50
Perform an HPV DNA test
64%
32/50
Perform colposcopy
14%
7/50
Perform a Loop Electrosurgical Excision Procedure (LEEP)
Select Answer to see Preferred Response
Patients 25 years of age and older with pap smear results showing atypical squamous cells of undetermined significance (ASCUS) should undergo an HPV DNA test. If the HPV DNA test is positive after ASCUS on Pap smear, colposcopy is recommended to biopsy cervical tissue; however, if the HPV DNA test is negative, a Pap smear should be repeated in 3 years. In contrast, for patients under 25 years of age with a Pap smear showing ASCUS, a Pap smear should be repeated in 1 year. Pap testing is recommended every 3 years for patients under 30 years of age. For patients 30 years of age and over, screening may be either a Pap smear every 3 years or a combination Pap smear and HPV DNA test every 5 years. Spitzer et al. review the management of abnormalities detected on colposcopy after Pap smear. For patients with CIN 1 and a satisfactory colposcopy, it is recommended to repeat cytology and HPV DNA at 6 and 12 months. For CIN 2 and 3 and a satisfactory colposcopy, treatment with either ablation or an excisional procedure is recommended. However, this treatment should be delayed for pregnant patients. Saslow et al. review the American Cancer Society screening, prevention, and early detection of cervical cancer by age group. Patients under 21 years of age do not need routine screening. Patients 21-29 years of age should receive initial screening with cytology alone (no HPV DNA testing unless positive Pap smear results) every 3 years. Patients 30-65 years of age should receive co-testing every 5 years with both a Pap smear and HPV DNA test. Patients older than 65 years of age with prior adequate negative screening do not need to undergo screening. Additionally, patients with a prior total hysterectomy do not need any screening. Illustration A depicts the different cervical cancer screening recommendations from various organizations. Incorrect Answers: Answer 1: Pap smear should be repeated in 1 year for patients under 25 years of age who receive a result of ASCUS on Pap smear. Answer 2: Pap smear should be repeated in 3 years for a patient 25 years of age or older who receive a result of ASCUS on Pap smear and a negative HPV DNA test. Answer 4: Colposcopy is recommended for patients 25 years of age and older who receive an ASCUS result on Pap smear and a positive HPV DNA test. Answer 5: LEEP is a treatment option for cervical carcinoma in situ.
5.0
(3)
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