Pap+smear

toc As of January 2014 you will be able to offer your female patients ,with a cervix, 30 years of age and older, a Pap smear and HPV (co-testing).
 * Providers will continue to collect the pap smear in the SurePath vial using the collection device(s) they prefer AND will need to collect a separate ThinPrep vial for the collection of the HPV (with a broom only). The provider will need an extra collection device (broom type) in addition to the present “Spatula and brush/blue broom”. Please prepare two vials (SurePath and ThinPrep) and an additional broom collection device for the providers to do both tests in all patients 25 years and over. Please note you will need to collect 2 specimens for the 25 to 29 year olds as well, but this will only be reflex testing only.
 * If you have any clinical questions, please contact Grace Cavallaro, MD by inbasket, lotus notes, If you have lab/pathology questions contact Maria Ley, Pathology Lab, 925-370-5400.

The Updated Screening Guidelines for Cervical Cancer
2012 ACS, ASCCP, ASCP Screening guidelines*


 * 1) Screening should begin at age 21 years, regardless of the age of sexual initiation or other risk factors.
 * 2) Between age 21 and 24 years, screening with cytology alone is recommended every 3 years. HPV testing should not be used either as a stand-alone, co-test or reflex test.
 * 3) Between age 25 and 29 years, screening with cytology alone is recommended every 3 years with reflex testing if ASCUS/LGSIL.
 * 4) Between age 30-65 years, screening with cytology and HPV testing (Co-testing) is recommended every 5 years (3 years if high risk).
 * 5) After age 65, screening should be discontinued following 3 consecutive negative cytology or 2 consecutive negative co-test within 10 years with the most recent test within 5 years. (No recommendation to rescreen even with new sexual partner).
 * 6) Following adequate treatment of CIN2 or higher or adenocarcinoma, routine screening should continue for at least 20 years.
 * 7) Following removal of cervix for benign pathology screening should be discontinued. Following hysterectomy for CIN2 or higher or endometrial adenocarcinoma, yearly vaginal cuff cytology is recommended (WITHOUT HPV).

***Any screening specimen outside the above protocol may be hold for 7 days during notification to the provider through “in-basket” and cancelled without valid indicator or no response.

CCRMC 2014 Pap Smear Cheat Sheet: [[image:ccrmc/brush.JPG align="right"]][[image:ccrmc/PAP containers.JPG align="right"]]

 * AGE || Testing Guideline || Specimen Collection ||
 * < 21 || NO pap smear || No specimen collection indicated ||
 * 21 to 24 || ONLY (Never do HPV) || PAP, ONE SurePath collection bottle ||
 * 25 to 65+ || PAP plus HPV || Two bottles SurePath and ThinPrep, Handled by pathology according to age ||
 * COLLECT PAP SMEAR FIRST, THEN THE PAP: Use whatever specimen collection device(s) you usually use (brush, broom, spatula) and the SurePath container.
 * HPV: You MUST use a BROOM (blue or lilac handle) for the HPV and place it in the larger ThinPrep bottle. This will be used for contesting age 30 and over and for reflex testing age 25-29. For the HPV test you or your nurse need to push the broom into the bottom of the container, swish it around, drop the “broom” portion in the container, close the lid and shake the container. This is important so that the cells DO NOT stick to the broom and the cells can be evaluated for HPV.
 * Orders: Search for pap and select age appropriate order. Place orders by headers description. Use Screening in most cases. Diagnostic is not screening and is used primarily in dysplasia clinics for patients with prior cancer/dysplasia or cervical lesion
 * Please see specific [[file:ccrmc/Pap Smear Collection 140101.docx|collection instructions ]] **

Pap Screening and Pap Diagnostic (What is the difference?)
Pap screening: This is either routine or high-risk. Pap diagnostic: Unlimited coverage by insurance. Definition of a diagnostic Pap tests (basically these are Surveillance pap smears)
 * Routine: Definition of a screening (routine) Pap test (preventive health care visit), Routine screening per ASCCP guidelines. Insurance covers no more than one test every 24 months is covered
 * High risk: Insurance covers no more than one test every 11 months is covered. Definition of a screening (high-risk) Pap tests (NOT all inclusive),
 * Early onset of sexual activity (under 16 years of age)
 * Multiple sexual partners (≥ five in a lifetime)
 * History of sexually transmitted disease (including human immunodeficiency virus HIV)
 * Fewer than three negative Paps in the previous 7 years
 * Daughter of a woman given diethylstilbestrol during pregnancy
 * Abnormal Pap in the past 3 years (childbearing age women only)
 * Previously diagnosed cancer of the vagina, cervix, or uterus
 * Recent previous abnormal Pap