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still worried about my pap smear..need clarification.

Mar 31, 2012

Hi Dr Young,

I need some good advice regarding my recent anal cancer screening. I am a positive male (4 years with virus, 3.5 years suppressed) who recently had a high resolution anoscopy with pap smear. The HRA found no lesions but the pap smear came back with AIN2 (moderate dyskaryosis). Now, I am getting conflicting advice. My consultant says go back in a year or so and is not worried. He is one of the best in the field, so his opinion means a lot, however, on the UCSF anal cancer website, it suggests going back fairly quickly for a second HRA given the high specificity of a high grade cytology result (as opposed to lowish specificity from a low grade cytology result). What to do? If an AIN2 lesion was missed during the HRA, is it safe to wait a year? Will it grow to hard to treat dimensions or even invasive? I have a lowish CD4 count (220) and a previous (15 months) HRA and smear were normal. Thanks for your great advice. Best, John.

Response from Dr. Young

Hi and thanks for your post.

There's no etched-in-stone approach to dealing with screening for anal cancer. I'd suggest simply expressing your concern to your best-in-field doctor. I don't think that there's a wrong answer, other than to not do a follow up exam.

It's unlikely that the difference between detection at 6 or 12 months would make a significant difference in the grade of any lesion.

I hope that helps. Let us know how things turn out. BY

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