Dear OncoLink "Ask The Experts,"
My doctor has performed three Colposcopies in the past three years and now wants to do a fourth. I feel this is excessive I have never had pre-cancerous cells or dysplasia. The Paps show inflammation and ASCUS. I feel that I should have more frequent Paps as opposed to yet another colposcopy. Any suggestions?

Christina S. Chu, MD Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System responds:

Persistent ASCUS is a frustrating problem. ASCUS stands for "atypical squamous cells of undetermined significance" and denotes an abnormality that exceeds the usual changes of an inflammatory process, but is not severe enough to qualify for dysplasia (precancerous changes). While the ASCUS diagnosis on a Pap test is only rarely associated with an invasive cancer, dysplasia may eventually be detected in up to 20% of patients. A single diagnosis of ASCUS on Pap usually warrants a repeat Pap in 3-6 months. If the diagnosis of ASCUS persists, colposcopy is warranted.

In your case, frequent pap smears (at least every 6 months) are certainly indicated. If the ASCUS diagnosis persists, your gynecologist should perform periodic colposcopy to make sure a more serious problem is not present. An interval of every one to two years for colposcopy would seem reasonable. Also, if inflammation is present, your gynecologist may want to check for treatable infections that may cause the inflammation.