From the U.S. Preventive Task Force

Week 2 Discussion

From the U.S. Preventive Task Force website https://www.uspreventiveservicestaskforce.org/BrowseRec/Index (Links to an external site.)Links to an external site., choose one screening test that might be considered in primary care.

Define the test, its positive predictive value, reliability and validity. Discuss patient medical or family history that may alter your recommendation for screening?

Hello Dr. Munoz & Class,

For this week I chose to discuss, cervical cancer screening. I chose this, because I checked to see which of the tests had higher rating, which indicated their helpfulness in providing protection. Cervical cancer screening for women is a test that has saved many women from a terminal diagnosis. Cervical cancer screening was first introduced by George Papanicolaou and Herbert Traut in 1941 (Thaxton & Waxman, 2015).

The cervical cancer screening or cytology is more commonly known as the Pap smear. This is done by a practitioner, they obtain a sample by scraping cells from the cervix and sending the tests out to cytology to be examined for cancerous cells. More recently the cytology examination has been performed in conjunction with HPV testing (U.S. Preventive Services Task Force, 2012). When the HPV test was ran in conjunction with the cytology examination a total of 99.7% of the cervical cancer cases that were positive for 2+ cells, had also been positive for HPV (Thaxton & Waxman, 2015).

After the introduction of cervical screening there was a reduction in mortality by 70-80% (Long et al., 2013). According to the U.S. Preventive Task Force (2012.), if cervical screenings were introduced into more rural areas , a benefit of up to 60-90% reduction in cancer rates could be seen in a three years time. With the addition of HPV added into the cervical cancer screening, a dramatic reduction was noted (U.S. Preventive Services Task Force, 2012). The CDC (2015), determined that the positive predictive value of the Pap smear with the addition of HPV screening is 20% for precancerous cells. The Pap smear in one study was seen to have a sensitivity of 83%, positive predictive value of 80% a specificity of 98%, and 97.9% negative predictive value (Hedge, 2011).

The cytology/Pap smear is recommended for women aged 21-65 years old every three years (U.S. Preventive Services Task Force, 2012). Or women aged 30-65 years old have the option to screen every 5 years when it is paired with HPV testing(U.S. Preventive Services Task Force, 2012). The screening is not recommended for women over the age of 65 or under the age of 21, and those that have had a total hysterectomy (U.S. Preventive Services Task Force, 2012). In order to end screening for a woman after age 65 she must first meet a few criteria. The woman would need to have three negative screenings in the last 20 years, and/or have had two pap smears with HPV testing consecutively in the last ten years, with the last being in the last five years (Thaxton & Waxman, 2015). Women that are post menopausal can have an increased number in false positive in testing, which can lead to unnecessary tests and procedures (Thaxton & Waxman, 2015).

Family history of cervical cancer shows less of an influence on screening than history of HPV infection (bellinger et al., 2013). People of underserved and lower socioeconomic status are at a higher rate of morality; this is thought to be because of access to services and education about importance (Bellinger et al., 2013). Practitioners recommend the use of HPV vaccination to prevent HPV infection (CDC, 2017). HPV vaccination is recommended to be administered to adolescents, both male and female, between the ages of 11-12 years old, with a total of two injections but can be up to three injections, the first two are 6-12 months apart (if received less than five months apart then the third is necessary), and the last can be a booster at 26 years old (CDC, 2017).

References:

Bellinger, J. D., Brandt, H. M., Hardin, J. W., Bynum, S. A., Sharpe, P. A., & Jackson, D. (2013). Original article: The Role of Family History of Cancer on Cervical Cancer Screening Behavior in a Population-based Survey of Women in the Southeastern United States. Women’s Health Issues, 23e197-e204. doi:10.1016/j.whi.2013.03.003

Center for DIsease Control and Prevention (CDC). (2015). Inside knowledge: Get the facts about gynecologic cancer. Retrieved from: https://www.cdc.gov/cancer/knowledge/provider-education/cervical/rationale.htm

Center for DIsease Control and Prevention (CDC). (2017). HPV vaccinations: Vaccinating your preteen or teen. Retrieved from: https://www.cdc.gov/hpv/parents/vaccine.html

Hedge, D., Shetty, H., Shetty, P. K., & Rai, S. (2011). Diagnostic value of acetic acid comparing with conventional Pap smear in detection of colposcopic biopsy-proven CIN. Journal of Cancer Research and Therapeutics, 7(4), 454-458. doi: 10.4103/0973-1482.92019

Long, S., Lei, W., Feng, Y., Lv, D., Cai, Y., & Yang, P. (2013). The feasibilities of TruScreen for primary cervical cancer screening: a self-controlled study. Archives of Gynecology and Obstetrics, 288(1), 113-118. doi:10.1007/s00404-012-2697-4

Thaxton, L., & Waxman, A. G. (2015). Cervical Cancer Prevention. Immunization and Screening 2015. Medical Clinics Of North America, 99(Women’s Health), 469-477. doi:10.1016/j.mcna.2015.01.003

U.S. Preventive Services Task Force. (2012). Cervical cancer: Screening. Retrieved from: https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/cervical-cancer-screening

Hello Wanda,

I too, chose a topic related to cancer, but I went with the classic for cervical cancer screenings. Oncology is a subject that I tried to familiarize myself with at a younger age, but have stayed away from in my nursing career. When I was seven, my grandmother died of cervical cancer, so I have always been intimidated by thesubject. I am fascinated on how the biology of it works, but hate to see the effects it takes on a person. Cancer has showed its face a few times in my family and at one point I had a scare with a false positive cervical screen, after I had my first child. In 1999, when I had my abnormal test, I had to have a biopsy of my cervix and go back for a screening every six months for two years. I was terrified after having my son, and receiving a positive screen for cancer. After, this scare and continually speak with my OB/GYN about hereditary cancer, I now know, that cervical cancer isn’t typically one that is high on the list for concern. I thought, that this was an interesting fact, and another reason why the biology of cancer is intriguing. Depending upon the location and the cells involved for the cancer, determines if genetics will play a role. There is so much about genetics that we are still figuring out, I would think it would make it harder for us to rule out familia traits in all disease processes.

Hello Christina,

I find your topic about colon cancer interesting, I believe that the screening should be encouraged more often. I like how you mentioned that you would suggest colon cancer screening to be done before the age 50. Would you have a guideline to help aid in that? Colon cancer is the 5th leading cause of death in patients with cancer (Ely et al., 2016). This faCT ALONE SHOULD ENCOURAGE INDIVIDUALS TO GET SCREENED, OR COULD HAVE THE OPPOSITE EFFECT, which is to run and hide. I feel that the fight or flight symptoms are more common in our actions than we know them to be. I also believe that they are not as pronounced as they would be, when an immediate danger is present. One thing I would like to stay focused on when I become a nurse practitioner, is that I would like to educate about the purpose of early intervention. Going back to the flight or fight response, individuals that feel threatened by the results may not want to participate in the screening, but if we educate about not screening early and the consequences, we might give them a better option. One day I would like to do a study about patients and their fight or flight response and compare it to their lifestyle habits and choices. I believe this might yield so interesting results.

Ely, J., Levy, B., Daly, J., Xu, Y., Ely, J. W., & Levy, B. T. (2016). Patient Beliefs About Colon Cancer Screening. Journal Of Cancer Education, 31(1), 39-46. doi:10.1007/s13187-015-0792-5