Oops

I went for a PAP in October which came back abnormal.  I declined a retest.  I'd had abnormal PAPs before due to infections and knew a retest would be normal.  Besides, Christmas was coming and I had better places to invest $30 than my gynecologist's Christmas fund.  The nurse called back to tell me this abnormal result wasn't indicative of infection.  This finding required a different test, not another PAP.  The doctor urged me to follow-up, sooner rather than later.  He's not an alarmist, so I heeded his concern and enjoyed my first colposcopy.  Positively lovely.  

As I had predicted, albeit with the wrong information, the test came back completely normal.  That was November.  

The last week of February, I heard my gynecologist's voice on my voice mail.  Unsettling.  The doctor's voice, rather than his nurse's, is never a good sign.  Even more unsettling, he left me his cell phone to contact him.

He told me the lab had an audit system for quality control and my slide was pulled.  The two pathologists who reviewed my slide found abnormalities and sent the sample to Harvard to confirm the diagnosis:  adenocarcinoma in situ.  The next step was a consult with a gynecological oncologist. While my physical exam showed nothing of concern, the oncologist said the diagnosis can't be made conclusively from the colposcopy.  Due to the topography of the cervix, a conization has to be performed for a definitive diagnosis to be made.  If the diagnosis is confirmed, then the conization will double as a diagnostic measure and the only treatment that will be needed.  The doctor expects this outcome.  I echo his optimism.  

I've always gone for routine PAPs, mainly because I'm a by the book kind of person.  When I told my sister, an ex-hospice social worker, about my diagnosis and how I almost didn't get the follow-up test done, she said that cervical cancer typically has no symptoms and often goes from diagnosis to death in a year.  That's why they drill yearly PAPs into our heads.

I am grateful for a doctor who urged me to share my Christmas money with him.  I am  grateful for the lab's audit system and the providence that had my slide pulled.  I am grateful for two pathologists who weren't too prideful to seek a second opinion.  Turns out a full 1/3 of these diagnoses are missed on first pass.  Partly because the diagnosis is so rare.  The abnormal PAP result I had accounts for less than 1% of abnormal PAP slides.  The colposcopy diagnosis is similarly uncommon.  I'm glad the profession recognizes the potential for missed diagnosis, admits there is an issue, and takes measures to safeguard the patient.  

If you are one of those women who puts off screening tests, I urge you to make a deposit into your gynecologist's Christmas fund this year.