73. Follow-Up

At 26 Gwen's Pap smear shows “severe dysplasia” (which means the presence of cellular changes that carry a 10-15% risk of progressing to cancer). She was referred for a gynecologic consult to confirm the diagnosis and to make recommendations for management (usually a simple office procedure that removes a button-size segment from the tip of the cervix).  She did not make an appointment.

3 months later: patient encouraged by phone to make gyn appointment. She replied that she was waiting for the new year because she had used up her deductable for the current year.

Over the course of the next 3 years, 8 more telephone calls were made from the family practice office, and three letters sent, all reminders of the importance of follow-up.  

She finally comes in for STD screening because of an abnormal discharge.  These screening tests were negative, but a Pap smear obtained at the same time diagnoses cervical cancer

Next week she  will start radiation therapy, then a radical (i.e. extensive) hysterectomy.  She may survive the cancer, but the effects of radiation and surgery will be permanent and potentially disabling