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We've set up this page to talk about important women's health issues. While most of them will be focused on breast and cervical health, occasionally they may go beyond that to address other important health issues for Alaskan women.

If you have questions about anything listed in this section, you can call BCHC's Women's Healthcare Nurse Practitioner, Mike VonAh at (907)-269-8077 or email him at Michae.VonAh@alaska.gov

The ASCCP 2006 Consensus Guidelines for the Management of Women with Abnormal Cervical Screening Tests

Looking at Follow-up Differently
When it comes to Adolescent Women
Posted July 7, 2009

Old habits are difficult to change and today many providers are considering what the new guidelines mean to the care of their patient(s). The current guidelines represent the effort of many work groups that reviewed literature, sought input from other professionals and met to discuss evidence that would support the changes under consideration.  A rating system allowed recommendations to be quantified. They follow a standard rating system that looks at the a) strength of the recommendation, b) quality of the evidence, and c) the terminology which provides a description of the strength of the recommendation. 

At the conference it was determined that in certain circumstances the guideline should be further delineated to provide for separate follow up for adolescent women (20 years of age or younger).  Such is the case for screening tests that have a result of Atypical Squamous Cells of Undetermined Significance (ASC-US) or Low-grade Squamous Intraepithelial Lesion (LSIL). 

Let’s compare the two ways of addressing ASC-US based upon the population affected. 

Management of Women with Atypical Squamous Cells of Undetermined Significance (ASC-US)

The guidelines provides for three options for follow-up.  (Cytology = Pap test)

A. Repeat cytology

  1. Repeat cytology at 6 & 12 months.
  2. If the tests at 6 & 12 months are negative then the patient returns to routine screening
  3. If either the 6 month or 12 month test is ASCUS or greater in significance then the patient should have colposcopy performed

B. HPV DNA Testing

  1. HPV testing with preference for liquid-based cytology or using co-collection at the time of the pap
  2. If HPV positive then do colposcopy
  3. If HPV negative then repeat the cytology at 12 months       

C. When the colposcopy result indicates

  1. No CIN (cervical intraepithelial neoplasia) and is HPV unknown – repeat cytology at 12 months or
  2. NO CIN and HPV is positive
    • do cytology at 6 months and at 12 months - if either cytology is ASC-US or greater then do colposcopy or 
    • do HPV DNA testing at 12 months –  HPV DNA test is negative then routine screening. If HPV DNA test is HPV + then repeat colposcopy
  3. f any colposcopy result is CIN – follow guidelines for CIN

Management of Adolescent Women with Either Atypical Squamous Cells of Undetermined Significance (ASC-US) or Low-grade Squamous Intraepithelial Lesion (LSIL)

  1. Adolescent women ASC-US or LSIL (females 20 years or younger) – do repeat cytology at 12 months
    • a. If less than High Grade Intraepithelial Lesion (HSIL) then do repeat cytology at 12 months – if negative then go to routine screening
    • If greater than or equal to Atypical Squamous Cell (ASC) then go   to colposcopy
  2. If repeat cytology greater or equal to (HSIL) then go to colposcopy

So why the difference in follow up for those women 20 years and younger versus those women over 20 years for essentially the same result?  Essentially it is that:

  • Young women “have a high prevalence of HPV infections” (Wright, Massad, Dunton, Spitzer, Wilkinson, and Solomon. 2006)
  • They have a “very low risk for invasive cervical cancer” (Wright, et al. 2006)
  • The “vast majority of HPV infections spontaneously clear within 2 years after infection”  (Wright, et al. 2006)
  • Colposcopy for “minor cytological abnormalities in adolescents” has the potential to “result in harm through unnecessary treatment” (Wright, et al. 2006)
  • And a special note is that pregnant women are a special population. The only indication for “therapy of cervical neoplasia in pregnant women is invasive cervical cancer”  (Wright, et al. 2006)

Reference:

Wright, T.C. Jr., Massad, S., Dunton, C.J., Spitzer, M., Wilkinson, E.J., Solomon, D. (2006). 2006 consensus guidelines for the management of women with abnormal cervical cancer screening tests. Philadelphia: Mosby

Diagnosing Breast Cancer using Magnetic Resonance Imaging (MRI)

Posted April 20, 2007

There has been information in the news lately about using Magnetic Resonance Imaging (MRI) to detect breast cancer. While the use of MRI to find breast cancer has been called a “potential life saving technology,” it is important to know that there are only certain situations where using MRI technology can be justified:  

  1. If you are a woman who has had breast cancer in one breast, an MRI might help diagnose cancer earlier in your other breast.
  2. If you are a woman considered at high risk for breast cancer, an MRI might help diagnose breast cancer earlier.  “High risk for breast cancer” means you:
    • Have a breast cancer (BRCA) gene mutation; or,
    • Have two first-degree relatives (for example, your mother and sister) who have breast cancer; or,
    • Have had previous chest irradiation; or
    • Have one first-degree relative with breast cancer (for example, your mother) and have had one previous breast biopsy yourself.

At this point MRI technology is not something that can be used for everyday screening. It
can be up to 10 times more costly that mammography and ultrasound, and at present the State’s Breast & Cervical Health Check Program cannot pay for it.

For more information about using MRI to detect breast cancer, click on the links below.

Elevated Blood Pressure (Hypertension) and you

Posted February 22, 2007

Your blood pressure (BP) is based on the amount of blood your heart is pushing out and how much resistance it meets in the vessels. When your blood pressure is continuously raised over a long period of time, it is called hypertension. There are many, many serious  problems that can result from hypertension. They include cardiovascular (heart) problems, renal (kidneys) problems, headaches, seizures, chest pain, painful breathing, swelling, diabetes, and retinal (eye) problems.  Hypertension is sometimes called a silent killer because people often don’t know they have it.   

How can I get my BP checked?

  1. You can go to a store such as Fred Meyer or Wal-mart to use an automatic BP machine. These are usually located next to, or in the pharmacy.
  2. You can be checked during an appointment with your health care provider.
  3. You can take advantage of free BP checks at Health Fairs.
  4. If you have a family member who is a nurse or other health care professional, they can take your BP.

How do I know if my BP is normal?

When your BP is checked, two numbers are given. To see if your BP is normal, compare it to the table below. Use this table only as a guide – if you have other health conditions these general numbers might not apply to you.

Normal:
Less than 120 over less than 80 (Example 119/79)

Pre-hypertension:
120-139 over 80-89 (Example 132/88)

Stage 1 hypertension:
140-159 over 90-99 (Example 152/97)

Stage 2 hypertension:
160 or more over 100 or more (Example 174/110)

What can I do to keep my BP low?

The best way to keep your BP low is to exercise and watch the foods you eat. Decrease the amount of salt and fat you eat. Increase the amount of fiber and protein that you eat. If you are overweight, work on losing weight through diet and exercise. Ensure moderate or less alcohol intake. The DASH diet has been shown to help people keep their BP low. For information on that read Your Guide to Lowering Your Blood Pressure with DASH.

What should I do if I think my BP is high?

Take some random blood pressures over a period of several days using one of the ways listed above. Record the arm you used, the blood pressure, and the time of day.  Take those with you to your next medical appointment.

Hypertension can be a very serious problem.  If you suspect your BP is high, please have a health care professional check for sure, then follow all of their recommendations which will help get, and keep you healthy.

HPV and Gardasil Vaccine

Posted February 22, 2007

Question: What is HPV?

Answer:  HPV stands for Human Papilloma Virus. There are many types of HPV, some of which are “high risk” and some of which are “low risk.”  Exposure to certain “high risk” types can cause abnormal cervical cells which can lead to cervical cancer in some women. Exposure to certain “low risk” types can cause genital warts.

Question: How do I know if I’ve been exposed to HPV?

Answer: When you have your Pap test, your medical provider is testing for HPV. HPV is considered the cause of abnormal cervical cells in almost all cases.  If you do have HPV, a separate test can be done to determine which type of HPV you have. Remember, there are many types of HPV and not all of them cause cervical cancer or genital warts.   

Question: What is Gardasil?

Answer: Gardasil is a new vaccine which protects girls and women against several types of HPV, including two types which can cause up to 75% of cervical cancers and two types which cause nearly 100% of genital warts.

Question: I’ve heard HPV goes away by itself. Why do I need to get vaccinated? 

Answer: Often times HPV does clear and you might not even know you were exposed. But sometimes that doesn’t happen, and your exposure can lead to cervical cancer and/or genital warts.  

Question: When should I get vaccinated?

Answer: Females aged 26 and younger (down to age 9) should consider getting vaccinated. 

Question: I’ve already had sex. Should I still get vaccinated?

Answer: Yes.  It’s possible you’ve been exposed to HPV but if you have, it’s also possible that you’ve not been exposed to all the types of HPV that Gardasil protects against.  

Question: Are their any drawbacks to the vaccine?

Answer: The vaccine is very safe and contains no live/active virus.  The side effects experienced mainly result from mild pain at the injection site. 

Question: Is the vaccine costly? 

Answer: The vaccine’s cost varies and probably is between about $140.00 and $170.00 per dose. You need three vaccine doses to be completely immunized.  The doses are given at day 1, 2 months, and 6 months.

Question: Does insurance cover the cost?

Some insurance companies are covering the cost and the cost is covered for eligible Medicaid recipients.

Question: Should I get vaccinated if I’m pregnant?

Answer: No. The vaccine is currently not recommended for pregnant women. 

Question: Will the vaccine cure an already established infection of HPV?

Answer: No, the vaccine can’t cure infection, it can only protect against getting it.

For more information, go to:

If you have questions, please contact:

Micheal Vonah, RN, WHNP, Nurse Consultant II
The Section of Women’s, Children’s and Family Health,
Division of Public Health,
State of Alaska at
269-3400