US Preventive Services Task Force (USPSTF) Recommendation for Screening for Cervical Cancer in Women: The Papanicolaou or Pap Smear
For the early screening of cervical cancer (secondary prevention), the USPSTF recommends that women aged between 21 and 29 years undergo cervical cytology examination (Pap smear) only every three years. For those who are 30 to 65 years the recommendation is a Pap smear only every 3 years, high-risk human papillomavirus (hrHPV) screening alone every 5 years, or a combination of both Pap smear and hrHPV screening every five years (USPSTF, n.d.). Early detection of cervical cancer leads to better therapeutic outcomes and the malignancy can be successfully eradicated. Screening for cervical cancer in women aged 21 years and above has shown promise in reducing the incidence, morbidity, and mortality related to it (Bickley, 2017). The USPSTF also recommends that above 29 years, women should also get screened for the HPV at the same time that a Pap smear is taken (Ball et al., 2019; Bickley, 2017; LeBlond et al., 2014). This is because in almost all cases of cervical cancer there is also comorbidity with the HPV subtype 16 and subtype 18 are particularly responsible for causing up to 70% of all cervical cancers in women. The purpose of this paper is to present the Pap smear (cervical cytology) as a recommended cervical cancer screening test by the USPSTF. Recommendation for Screening for Cervical Cancer in Women Essay Example
The Need for Pap Smear Testing in Women
According to the American cancer Society (ACS, 2020), there were 4,290 deaths in the year 2020 attributable to cervical cancer. The Pap smear test facilitates the collection of cervical scrapings or cells which are then looked at under the microscope for any signs of abnormal cells. It has been seen that most diagnoses of cervical cancer are made on women who never had any Pap smear tests at the intervals that are recommended by the USPSTF. The prevailing incidence of cervical cancer at the moment is pegged at 7.8 cases in every 100,000 women (Bickley, 2017). The screening test that is the Pap smear test is actually meant to discover abnormal cells before they even start to replicate. This is why it is important in the definitive treatment of cervical cancer in the stage known as carcinoma-in-situ. And as the USPSTF recommendations state, co-testing at the same time together with the HPV test is the best approach. The ACS (2020) has stated that almost all cervical cancers are caused by infection with the different strains of the human papillomavirus.
Performing the Pap Smear Cytological Examination
Like with all other tests, there is first to the explanation to the patient of what the test is about before asking for informed consent. The lady then lays supine with the knees flexed and the genital area exposed. The vulva is disinfected and a warmed speculum is inserted into the vagina gently to expose the cervix. A spatula is used to collect scrapings from the exocervix. These are fixed with the collection fluid for later examination. After that a special brush is used to collect another specimen from the cervical os by rotating it inside the os 360°. The collected specimen is put in the appropriate medium and both are taken to the laboratory for cytological examination (ACS, 2020; Ball et al., 2019).
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Pathological Information from a Papanicolaou Test
The reporting of Pap smear results usually follows a particular universal convention. The convention most commonly used in the US and around the world is referred to as the Bethesda system and appears as follows (ACS, 2020):
- Negative for intraepithelial lesions
- Positive for abnormal epithelial cells
- Positive for other abnormal cell proliferations
Validity, reliability, Sensitivity, and Predictive Value
Test validity is the measure of how accurate the particular test measures what it is intended to measure. On the other hand, reliability refers to the degree of correctness of the test within its acceptable margin of error. Applied to the Pap smear cytology examination, it has been found to be valid and reliable to a statistically acceptable degree. Its sensitivity ranges from an impressive 55 percent to 80 percent (PDQ, 2020). For instance, in a study by Yunes-Díaz et al. (2015) that was conducted in Mexico it was found that the Pap smear test indeed had a sensitivity of up to eighty percent. But like with any other test that relies on human judgment, mistakes of omission can be made from time to time resulting in a false negative or false positive result. These drawbacks are however rare and far in-between. Recommendation for Screening for Cervical Cancer in Women Essay Example To take care of this possibility of error however small, a recommendation of three yearly testing (screening) for women aged 21 years and above is made by the USPSTF, the American College of Obstetricians and Gynecologists (ACOG), and the ACS.
Screening is one of the most important secondary prevention measures that assure the health of populations as one of the quadruple aim objectives. This is especially true with cancer because if not caught in the early stages cancer will invariably lead to mortality. For cervical cancer, the Pap smear cytology and the HPV tests are recommended together for women aged 21 years and above. The two co-tests need to be done together at least every three years, especially for those women above 29 years.
American Cancer Society [ACS] (July 30, 2020). Key statistics for cervical cancer. https://www.cancer.org/cancer/cervical-cancer/about/key-statistics.html#:~:text=The%20American%20Cancer%20Society’s%20estimates,will%20die%20from%20cervical%20cancer
Ball, J., Dains, J.E., Flynn, J.A., Solomon, B.S., & Stewart, R.W. (2019). Seidel’s guide to physical examination: An interprofessional approach, 9th ed. Elsevier.
Bickley, L.S. (2017). Bates’ guide to physical examination and history taking, 12th ed. Wolters Kluwer.
LeBlond, R.F., Brown, D.D., & DeGowin, R.L. (2014). DeGowin’s diagnostic examination, 10th ed. McGraw Hill Medical.
PDQ (August 12, 2020). Cervical cancer screening. https://www.ncbi.nlm.nih.gov/books/NBK65734/#:~:text=Accuracy%20of%20the%20Pap%20Test&text=Such%20studies%20have%20rarely%20been,is%2055%25%20to%2080%25
US Preventive Services Task Force [USPSTF] (n.d.). A and B recommendations. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics/uspstf-and-b-recommendations
Yunes-Díaz, E., Alonso-de Ruiz, P., & Lazcano-Ponce, E. (2015). Assessment of the validity and reproducibility of the Pap smear in Mexico: Necessity of a paradigm shift. Archives of Medical Research, 46(4), 310-316. http://dx.doi.org/10.1016/j.arcmed.2015.05.013
Review the clinician provider guidelines and recommendations of the United States Preventive Services Task Force A and B Recommendations. https://www.uspreventiveservicestaskforce.org/Page/Name/uspstf-a-and-b-recommendations/
For the MSN prepared nurse, knowledge of epidemiology and its application to preventive screening guidelines is important in many clinical areas: administrative, education, and nurse practitioner fields. Consider you are working in a clinic and need to order a preventive screening on a patient for one of the conditions listed below. (While this is a preventative measure, it also can be a diagnostic tool in other circumstances. For this Assignment the screening is a secondary prevention measure.)
Please select one screening. Your screening methodology must come from the United States Preventive Services Task Force guidelines.
• Abdominal Aortic Aneurysm
• Breast Cancer
• Cervical Cancer
• Colon Cancer
• Diabetes Mellitus II
• Lung Cancer
Find the Final Recommendation Summary for the screening you are evaluating. Explain the guideline, the correct application of the screening, and the epidemiology behind the guidance. Content should include epidemiologic data such as statistical information as available ex. morbidity, mortality, incidence and prevalence of condition. Identify the methodology and measures for screening. Include the risk factors, risk assessment, testing interval, description of the patient population, screening test recommendations and other factors relative to the guideline. Discuss the guideline’s support in a critical analysis, based on the outcomes of studies used in the screening guidance publication. What key factors are supported by evidence, such as age, methods, measures and intervals? Consider using the rubric sections as level one headings within the paper.
Master’s-prepared nurse educators, leaders, nurse practitioners and all specialty nursing fields are contributors to health promotion in populations across the life span. You will demonstrate understanding and correct interpretations of preventive screening guidelines. You should be able to apply this knowledge to your specialty focus as it relates to health promotion and epidemiology.
This paper should be 3–4 pages, excluding your title page, and references. This paper should adhere to appropriate APA formatting and citation style Recommendation for Screening for Cervical Cancer in Women Essay Example