I was diagnosed with carcinoma in situ, which was confirmed by colposcopy, but there was questionable microinvasion. I had a cone biopsy that showed the margins were negative. Now my doctor says that I can either have Pap tests every three months for a year to watch it, or I can have a hysterectomy (with or without ovary removal). He recommends the Pap smear route, but the decision is up to me. I am 35 years old and not planning on having more children. I'm very confused about what to do. What are the chances of this recurring? It was agonizing waiting for biopsy results, and I don't know if I can do that again.

B.

If there was no microinvasion on the conization (cone biopsy), then following with Pap smears is very reasonable. Conization is curative almost 90 percent of the time, and if Pap smears remain normal for one year, then the risk of recurrance is only 0.4 percent, according to one Scandinavian study. If there is no invasion on the conization, and if margins are clear, then there is virtually no risk of recurrence. Recurrence rates after hysterectomy are not any different.

Hysterectomy is still considered an option in cases of carcinoma in situ. If you are sure you do not want any more children and if you have any other reason to consider a hysterectomy (fibroids, uterine prolapse, painful periods), then this may be the best option for you. It does not have to be done, however. Only you, with the input of your doctor, can make this choice.