SPC Tentpeg has an LSIL Pap.

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SPC Tentpeg has an LSIL Pap.
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Mount up.
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On the move.
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(No Transcript)
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Action left.
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SPC Tentpeg got her Colposcopy for her LSIL pap.
Was this clinical situation worth the risk?
Two other soldiers were injured!
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Womens Deployment Readiness

• LTC Louis A. Dainty, MD
• Gynecology Oncology
• Madigan Army Medical Center
• USAFP - 2009

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Objectives

• Describe the Womens Readiness Classification
  system
• Apply the Womens Deployment Readiness Guidelines
• Describe currently available medical assets in
  theater and challenges to reaching those assets

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Do we provide quality care to our female soldiers?

• Not always

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Women's health care in Operation Iraqi
FreedomA Survey of Camps with Echelon I or II
Facilities

• 22 had no annual or pap within 1 year
• 26 received pre-deployment menstrual hygiene
  counseling
• Irregular bleeding was most common complaint

Thomson BA, Nielsen PE. Mil Med. 2006
Mar171(3)216-9
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Women's health care in Operation Iraqi Freedoma
survey of camps with echelon I or II facilities

• Ortho Evra patches fell off in 58
• 23 of soldiers changed contraceptive methods
  because of unavailability
• 21 experienced gynecologic problems

Thomson BA, Nielsen PE. Mil Med. 2006
Mar171(3)216-9
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Women's health care in Operation Iraqi Freedoma
survey of camps with echelon I or II facilities
44 could not access gynecologic care
Thomson BA, Nielsen PE. Mil Med. 2006
Mar171(3)216-9
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7 Days from deployment

• 21 year old Soldier gets LSIL Pap result
• NCO and patient are in your office
• We fly out next Friday, Whats the deal?!

Womens Readiness Class 3
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Women over 20
PAP/Cytology
Abnormal
Normal
Age 30 over with 3 consecutive normal Paps and
no h/o dysplasia
ASC-US HPV(-)
ASC-US HPV() or Greater (LSIL,HSIL,CIN,CIS,AIS,AG
C)
Unknown Status
NO
Yes
Cytology w/I 6 mos for those Deploying 6 months
and w/in 9 months for those deploying
Cytology w/I 24 months of deployment
Cytology w/I 6 mos for those Deploying 6 months
and w/in 9 months for those deploying
Class 3 (Non- Deployable)
NO
Yes
NO
Yes
Yes
Class 4 (Non- Deployable)
NO
Class 2 (Deployable)
Class 4 (Non- Deployable)
Class 1 (Deployable)
Class 1 (Deployable)
Refer to a provider Credentialed in Colpo
Refer for cytology
PAP upon re- deployment
PAP yearly
PAP Q 3 years
Refer for cytology
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7 Days from Deployment

• 19 year old Soldier with LSIL pap
• Can I deploy with my unit Doc?

Womens Readiness Class 2
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Women 20 younger
PAP/Cytology
Abnormal
Normal
Cytology w/I 6 mos for those Deploying 6 months
and w/in 9 months for those deploying
HSIL, CIN (CIS,AIS,AGC)
ASC-US HPV(/-) LSIL, CIN 1
Unknown Status
NO
Yes
Cytology w/I 6 mos for those Deploying 6 months
and w/in 9 months for those deploying
Class 3 (Non- Deployable)
Class 1 (Deployable)
Yes
Class 4 (Non- Deployable)
NO
Class 2 (Deployable)
PAP upon re- deployment
Refer to a provider Credentialed in Colpo
Refer for cytology
PAP yearly
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7 days from deployment

• 21 year old soldier, friend of the nurses
• ASC, HPV with CIN 2 on biopsy
• Can she deploy?

Womens Readiness Class 3
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Women over 20
PAP/Cytology
Abnormal
Normal
Age 30 over with 3 consecutive normal Paps and
no h/o dysplasia
ASC-US HPV(-)
ASC-US HPV() or Greater (LSIL,HSIL,CIN,CIS,AIS,AG
C)
Unknown Status
NO
Yes
Cytology w/I 6 mos for those Deploying 6 months
and w/in 9 months for those deploying
Cytology w/I 24 months of deployment
Cytology w/I 6 mos for those Deploying 6 months
and w/in 9 months for those deploying
Class 3 (Non- Deployable)
NO
Yes
NO
Yes
Yes
Class 4 (Non- Deployable)
NO
Class 2 (Deployable)
Class 4 (Non- Deployable)
Class 1 (Deployable)
Class 1 (Deployable)
Refer to a provider Credentialed in Colpo
Refer for cytology
PAP upon re- deployment
PAP yearly
PAP Q 3 years
Refer for cytology
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Background

• Based on new ASCCP guidelines
• Placed into MODS for deployment implementation
  http//www.mods.army.mil/
• The guidelines are different for women 20 years
  of age and younger
• MEDCOM follow national guidelines for Mammography
  and Chlamydia screening

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Operational objective

• Prevent overtreatment of young women to allow
  deployment
• Prevent deploying women who need follow up care
  in theater

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Responsibilities

• Regional Medical Commands (RMCs)
• execution of policy
• Local Medical Treatment Facilities (MTFs)
• Results entered into MEDPROS
• Unit commands
• get soldiers to appointments well before
  deployment
• Soldier
• show up to appointments

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All Female Soldiers will have annual pap smears
unless
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Exception 1

• Soldiers 30 years of age or older
• With no history of abnormal dysplasia
• Has had 3 consecutive normal paps documented in
  medical record

These soldiers need pap smears every 3 years!
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Exception 2

• Post-hysterectomy for reasons other than
  cervical dysplasia or cervical cancer.
• (removing both uterus and cervix)

These soldiers do not need to have pap smears!
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Womens Readiness Class 1

• Normal pap within 1 year
• Soldier who meets one of the exceptions

MEDPROS
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Womens Readiness Class 2

• H/O ASC-US, high-risk HPV / -, LSIL, or CIN 1
• Deploying 6 months
• Pap within 6 months
• Deploying
• Pap within 9 months

MEDPROS
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Womens Readiness Class 2

• Abnormal pap fully evaluated
• Cleared by provider

MEDPROS
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Womens Readiness Class 3

• Soldier
• HSIL
• CIN 2 or CIN 3
• CIS or AIS
• Atypical glandular cells (AGC)

MEDPROS
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Womens Readiness Class 3

• Soldier 20 years of age
• ASC-US HPV Positive
• LSIL or HSIL
• Any CIN grade
• CIS or AIS
• AGC
• Invasive cancer

MEDPROS
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Class 3 continued

• Temporary profile
• T3 in P portion of PUHLES
• Block 5f - no
• Block 10
• Soldier may not deploy to area where gynecologic
  care is not available. Iraq and Afghanistan are
  not considered theaters where this follow up can
  occur.

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T
NO
Soldier may not deploy to area where gynecologic
care is not available. Iraq and Afghanistan are
not considered theaters where this follow up can
occur.
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Womens Readiness Class 4

• No pap smear within the last
• 365 days
• Unless she falls into one of
• the exceptions

MEDPROS
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Guidelines for PCMs and Unit Commanders

• Counsel all female Soldiers about womens health
  during deployments
• Unit commanders will ensure female Soldiers have
  access to a copy of Female Guide to Readiness
• http//chppm-www.apgea.army.mil/documents/TG/TECHG
  UID/
• PCMs should counsel all female Soldiers up to
  age 26 about the benefits of the HPV vaccine and
  offer the vaccine

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Guidelines for Unit Commanders and Surgeons

• Get female soldiers to see their PCM or
  gynecologist at least a month before deployment

The Other LTC Dainty
Dr. Matt Fargo
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Women 20 younger
PAP/Cytology
Abnormal
Normal
Cytology w/I 6 mos for those Deploying 6 months
and w/in 9 months for those deploying
HSIL, CIN (CIS,AIS,AGC)
ASC-US HPV(/-) LSIL, CIN 1
Unknown Status
NO
Yes
Cytology w/I 6 mos for those Deploying 6 months
and w/in 9 months for those deploying
Class 3 (Non- Deployable)
Class 1 (Deployable)
Yes
Class 4 (Non- Deployable)
NO
Class 2 (Deployable)
Cytology yearly. .PAP upon re-deployment
Refer to a provider Credentialed in Colpo
Refer for cytology
PAP yearly
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Women over 20
PAP/Cytology
Abnormal
Normal
Age 30 over with 3 consecutive normal Paps and
no h/o dysplasia
ASC-US HPV(-)
ASC-US HPV() or Greater (LSIL,HSIL,CIN,CIS,AIS,AG
C)
Unknown Status
NO
Yes
Cytology w/I 6 mos for those Deploying 6 months
and w/in 9 months for those deploying
Cytology w/I 24 months of deployment
Cytology w/I 6 mos for those Deploying 6 months
and w/in 9 months for those deploying
Class 3 (Non- Deployable)
NO
Yes
NO
Yes
Yes
Class 4 (Non- Deployable)
NO
Class 2 (Deployable)
Class 4 (Non- Deployable)
Class 1 (Deployable)
Class 1 (Deployable)
Refer to a provider Credentialed in Colpo
Refer for cytology
PAP upon re- deployment
PAP yearly
PAP Q 3 years
Refer for cytology
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Fact or Fiction?
Units commanders dont have to worry about
abnormal paps before going down range because
there are gynecologists and colposcopes in
theater!
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Women's health care in Operation Iraqi Freedom a
survey of camps with echelon I or II
facilities.Thomson BA, Nielsen PE. Mil Med. 2006
Mar171(3)216-9.
44 could not access gynecologic care
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Assets available in theater?

• "Water, water, everywhere,     And all the
  boards did shrinkWater, water,
  everywhere,     Nor any drop to drink."

The Rime of the Ancient Mariner  Samuel Taylor
Coleridge (born 1772 - died 1834)