Cervical Cancer Prevention/Screening
An 18-year-old is accompanied by her mother for her first visit to the gynecologist. She has never been sexually active. She has no concerns with her menses. Her mom reports that she brought her in “because she is 18 and when I turned 18, I had to get my first Pap smear.” Her mother requests the patient have a Pap smear and be tested for HPV “just in case.” The patient is up to date on all vaccines “mandatory for school” but has never had the HPV vaccine.
1. What are the recommendations on the HPV vaccine?
2. How would you counsel this patient about the HPV vaccine?
3. What are the current ASCCP guidelines for Pap smears and HPV testing?
4. How will you explain the rationale to the patient and the mother?
Well Woman Health Screenings
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Well Woman Health Screenings
Cervical Cancer Prevention/Screening
Taking charge of your health begins with knowledge, and for women, regular well-woman health screenings are a vital step towards maintaining optimal physical and mental well-being. Well-woman health screenings are an essential component of preventive healthcare for women. These screenings are typically conducted by a healthcare provider and aim to identify potential health issues before they become serious problems. Some standard tests and examinations included in a sound woman health screening are Pap smears to check for cervical cancer, breast exams to look for signs of breast cancer, and pelvic exams to detect abnormalities in the reproductive system (Sanchez et al., 2019). Other tests may be recommended based on a woman’s age, medical history, and risk factors. Overall, well-woman health screenings are essential for maintaining optimal health and preventing severe illnesses in women. It is recommended that women begin regular well-woman health screenings in their early twenties or earlier if they have specific risk factors or concerns.
Cervical cancer is a severe health concern for women, but it can often be prevented or detected early through regular screening. Screening for cervical cancer typically involves a Pap test or a combination of a Pap test and an HPV test (Sinha et al., 2018). These tests can detect abnormal cells in the cervix that may develop into cancer if left untreated. It is recommended that women between the ages of 21 and 65 years old receive regular cervical cancer screenings (Fontham et al., 2020). Women with a family history of cervical cancer or other risk factors may need to be screened more frequently. In addition to regular screenings, women can reduce their risk of cervical cancer by vaccinating against HPV, practicing safe sex, and quitting smoking. By taking these preventative measures and undergoing regular screenings, women can protect themselves from the potentially life-threatening consequences of cervical cancer. The purpose of this essay is to address the concerns of an 18-year-old female patient and her mother about cervical cancer prevention and screening, specifically, the essay will discuss the recommendations on the HPV vaccine, counseling the patient about the vaccine, current ASCCP guidelines for Pap smears and HPV testing, and how to explain the rationale for these tests to the patient and her mother.
Human Papillomavirus (HPV) Vaccine Recommendations
Human papillomavirus (HPV) vaccines are highly effective in preventing infection, with the most common strains of HPV that can cause cancer and genital warts. The Centers for Disease Control and Prevention (CDC) recommends routine HPV vaccination for all boys and girls at age 11 or 12, although the vaccine can be given starting at nine years of age (Markowitz et al., 2018). The vaccine is also recommended for males up to age 26 and females up to age 45 who were not vaccinated when they were younger (Meites et al., 2019). The HPV vaccine is given in a series of two or three shots depending on the person’s age when they start the series. The vaccines are highly effective at preventing infection with the types of HPV they target, but they do not protect against all types of HPV. Therefore, it is essential for individuals who have been vaccinated to continue to practice safe sex by using condoms to reduce their risk of getting HPV or other sexually transmitted infections (Chow et al., 2019). It is also important to note that the HPV vaccine is most effective before a person becomes sexually active. Therefore, it is recommended that children receive the vaccine before they start engaging in sexual activity. However, individuals who have already been sexually active can still benefit from the vaccine, as they may not have been exposed to all types of HPV. The HPV vaccine is recommended for all boys and girls at age 11 or 12, males up to age 26 and females up to age 45 who were not vaccinated when they were younger. The vaccine effectively prevents infection with the types of HPV it targets. However, safe sex practices are still essential to reduce the risk of getting other types of HPV and sexually transmitted infections. It is most effective when given before a person becomes sexually active, but individuals who have already been sexually active can still benefit from the vaccine.
Counseling the Patient about Human Papillomavirus (HPV) Vaccine
First, it is essential to explain to the patient and her mother what HPV is and how it is transmitted. HPV stands for human papillomavirus, which is a common sexually transmitted infection. Most people who are sexually active will get HPV at some point in their lives, but in many cases, the infection will clear on its own without causing any problems. However, some strains of HPV can cause genital warts or lead to the development of certain types of cancer, such as cervical cancer (Bedell et al., 2020). Next, it is essential to discuss the benefits of the HPV vaccine. The HPV vaccine is highly effective at preventing the types of HPV that are most likely to cause cancer and genital warts. The patient can protect herself from these serious health problems by getting vaccinated. It is recommended that all girls and boys receive the HPV vaccine at age 11 or 12, but getting vaccinated later in life is still beneficial if someone has not yet received the vaccine. It is also essential to address any concerns the patient or her mother may have about the safety and side effects of the HPV vaccine. The HPV vaccine has been extensively studied and is safe and effective. Like all vaccines, there may be some mild side effects, such as pain or redness at the injection site or a low-grade fever. However, these side effects are usually temporary and go away independently. Finally, it is essential to emphasize that getting vaccinated against HPV is a personal choice, but it is a highly recommended and effective way to protect against serious health problems (Sundstrom et al., 2021). It is also essential to remind the patient that getting vaccinated does not replace the need for regular Pap smears or other routine gynecological care, as these screenings are still crucial for detecting cervical cancer or other issues.
Current ASCCP Guidelines for Pap Smears and HPV Testing
The American Society for Colposcopy and Cervical Pathology (ASCCP) provides guidelines for managing abnormal cervical cancer screening tests and precursors. The current ASCCP guidelines recommend that cervical cancer screening begins at age 25, regardless of sexual history (Fontham et al., 2020). Women aged 25 to 65 should undergo primary high-risk human papillomavirus (hrHPV) testing every five years. Co-testing with both Pap and hrHPV testing is an acceptable alternative for women aged 25 to 65 (Swid & Monaco, 2022). Routine cervical cancer screening is not recommended for women under 25 years of age, as most cervical cancer precursors regress spontaneously in this age group (Basu et al., 2018). Therefore, Pap smears and HPV testing are not necessary for this patient, as she is not sexually active and is under the age of 25. Additionally, since she has never received the HPV vaccine, it is recommended that she receive the HPV vaccine series to prevent future HPV-related diseases. The current ASCCP guidelines do not recommend routine cervical cancer screening for women under 25, regardless of sexual history. HPV testing is recommended as the primary screening method for women aged 25 to 65 years. Therefore, Pap smears and HPV testing are unnecessary for this patient, but she should receive the HPV vaccine series to prevent future HPV-related diseases.
The Rationale to the Patient and the Mother
As an 18-year-old female who has never been sexually active and has no concerns with her menstrual cycle, it is not necessary to undergo a Pap smear or HPV testing at this time. Current guidelines recommend that women begin Pap smear screening at age 21, regardless of sexual history (Curry et al., 2018). HPV testing is typically not recommended for women under 30 unless abnormal cells are detected during a Pap smear. Furthermore, the HPV vaccine is recommended for males and females aged 11 or 12 but can be administered until age 26. The vaccine protects against several types of HPV that can lead to cervical cancer, genital warts, and other cancers. While it is ideal to receive the vaccine before becoming sexually active, it can still protect those who have already become sexually active or have been exposed to HPV. It is important to note that while cervical cancer is a significant health concern, the majority of cases are caused by HPV strains that are not covered by the vaccine (Ikeda et al., 2019). Therefore, routine Pap smear screening starting at age 21, or earlier if there are abnormal symptoms or medical history, is the most effective way to detect and prevent cervical cancer. The 18-year-old patient does not need a Pap smear or HPV testing. The HPV vaccine is also recommended for males and females at a younger age, but can still be administered until age 26. Routine Pap smear screening starting at age 21, or earlier if there are abnormal symptoms or medical history, is the most effective way to detect and prevent cervical cancer.
Conclusion
In conclusion, well-woman health screenings are essential for the early detection and prevention of various diseases that affect women. Cervical cancer screening, in particular, is crucial in preventing this disease’s incidence and mortality rates. As shown in this essay, there are clear recommendations for the HPV vaccine and current guidelines for Pap smears and HPV testing. When counseling patients, educating them about the benefits and potential risks of screening and vaccination is crucial. Healthcare providers must also communicate the rationale behind these recommendations to patients and their families effectively. Healthcare providers can help promote better health outcomes for women by emphasizing the importance of regular screening and vaccination.
References
Basu, P., Mittal, S., Vale, D. B., & Kharaji, Y. C. (2018). Secondary prevention of cervical cancer. Best Practice & Research Clinical Obstetrics & Gynaecology, 47, 73-85. https://doi.org/10.1016/j.bpobgyn.2017.08.012
Bedell, S. L., Goldstein, L. S., Goldstein, A. R., & Goldstein, A. T. (2020). Cervical cancer screening: past, present, and future. Sexual medicine reviews, 8(1), 28-37. https://doi.org/10.1016/j.sxmr.2019.09.005
Chow, E. P., Grulich, A. E., & Fairley, C. K. (2019). Epidemiology and prevention of sexually transmitted infections in men who have sex with men at risk of HIV. The lancet HIV, 6(6), e396-e405. https://doi.org/10.1016/S2352-3018(19)30043-8
Curry, S. J., Krist, A. H., Owens, D. K., Barry, M. J., Caughey, A. B., Davidson, K. W., … & US Preventive Services Task Force. (2018). Screening for cervical cancer: US Preventive Services Task Force recommendation statement. Jama, 320(7), 674-686.
Fontham, E. T., Wolf, A. M., Church, T. R., Etzioni, R., Flowers, C. R., Herzig, A., … & Smith, R. A. (2020). Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society. CA: a cancer journal for clinicians, 70(5), 321-346. https://doi.org/10.3322/caac.21628
Fontham, E. T., Wolf, A. M., Church, T. R., Etzioni, R., Flowers, C. R., Herzig, A., … & Smith, R. A. (2020). Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society. CA: a cancer journal for clinicians, 70(5), 321-346. https://doi.org/10.3322/caac.21628
Ikeda, S., Ueda, Y., Yagi, A., Matsuzaki, S., Kobayashi, E., Kimura, T., … & Kudoh, K. (2019). HPV vaccination in Japan: what is happening in Japan?. Expert Review of Vaccines, 18(4), 323-325. https://doi.org/10.1080/14760584.2019.1584040
Markowitz, L. E., Gee, J., Chesson, H., & Stokley, S. (2018). Ten years of human papillomavirus vaccination in the United States. Academic pediatrics, 18(2), S3-S10. https://doi.org/10.1016/j.acap.2017.09.014
Meites, E., Szilagyi, P. G., Chesson, H. W., Unger, E. R., Romero, J. R., & Markowitz, L. E. (2019). Human papillomavirus vaccination for adults: updated recommendations of the Advisory Committee on Immunization Practices. American Journal of Transplantation, 19(11), 3202-3206. https://doi.org/10.1111/ajt.15633
Sanchez, C., Israel, R., Hughes, C., & Gorman, N. (2019). Well-woman Examinations: Beyond Cervical Cancer Screening. The Journal for Nurse Practitioners, 15(2), 189-194. https://doi.org/10.1016/j.nurpra.2018.09.005
Sinha, P., Srivastava, P., & Srivastava, A. (2018). Comparison of visual inspection with acetic acid and the Pap smear for cervical cancer screening. Acta cytologica, 62(1), 34-38. https://doi.org/10.1159/000484036
Sundstrom, B., Cartmell, K. B., White, A. A., Well, H., Pierce, J. Y., & Brandt, H. M. (2021). Correcting HPV vaccination misinformation online: evaluating the HPV vaccination NOW social media campaign. Vaccines, 9(4), 352. https://doi.org/10.3390/vaccines9040352
Swid, M. A., & Monaco, S. E. (2022). Should screening for cervical cancer go to primary human papillomavirus testing and eliminate cytology?. Modern Pathology, 35(7), 858-864. https://doi.org/10.1038/s41379-022-01052-4
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