scholarly review

Introduction

Cervical cancer is the presence of abnormal cells in the narrowing between the vagina into the uterus and develops slowly over time. It is estimated that 12,000 women in the United States will be diagnosed with cervical cancer every year (Baker, Assessing the impact of new cervical cancer screening guidelines, 2013), which is why it is important for providers to understand the newly updated cervical cancer screening guidelines presented by the U.S. Preventive Services Task Force (USPSTF). The new guidelines recommend that women between the ages of 30 to 65 be screened for cervical cancer using cytology or co-testing every 3 to 5 years depending on the screening option (Agency for Healthcare Research and Quality, 2014). Due to the implementation of the new guidelines in 2012, research has show a decrease in the number of newly diagnosed cervical cancer cases among those receiving co-testing screenings between the ages of 30 to 65 and a decrease in overall medical costs.

Main Causative Factor of Cervical Cancer

Human papillomavirus (HPV), a sexually transmitted illness, has been linked to the majority of cases of cervical cancer (National Cerivcal Cancer Coalition, 2017). HPV genotype 16 and 18 are identified as the most severe forms of HPV, placing women diagnosed with these types of HPV at high-risk for developing cervical cancer (Baker, HPV and Pap: shifting roles in cervical cancer screening, 2013). Women born before 2006 are at increased risk for testing positive for HPV due to incomplete or no vaccinations (Gardasil) against HPV, early age of sexual intercourse, and multiple partners (National Cervical Cancer Coalition, 2017). Most women who have the low-risk forms of HPV do not end up developing cervical cancer, as the body tends to naturally resolve those abnormal cells within a 2-year timespan.

Cervical Screening Methods: Cytology and Co-Testing

For most of the 1900’s and early 2000’s, annual pap smear cytology testing has been the recommended course of preventive cancer screening. However, the USPSTF has published new guidelines for cervical cancer screening among women, regardless of sexual activity, between the ages of 30 to 65 to receive cytology testing every 3 years or co-testing every 5 years (U.S. Preventive Services Task Force, 2012). There is still some controversy as to which form of testing a provider should order or recommend to women in this age group. Research has found that co-testing, cytology and HPV testing, is more accurate at detecting all forms of cervical cancer and is therefore the best type of screening for this population group (Felix, 2016). Pap smear testing is where the provider inserts a speculum into the vagina and inserts a small brush-like probe into the cervical opening to obtain cells (National Cervical Cancer Coalition, 2017). HPV testing is performed the same way and many providers actually perform these test simultaneously. Baker (2013) explained that pap smear testing mainly picks up cells where squamous cell cancers typically originate, whereas HPV testing detects cells that cause adenocarcinomas that pap smears do not detect. If cytology and HPV testing are both negative, a woman can be fairly certain she will not develop cervical cancer within the 5 years between retesting. However, if the HPV is positive and the cytology is negative, it is recommended to have co-testing again within a year (Baker, Assessing the impact of new cervical cancer screening guidelines, 2013).

Strengths and Weakness of Recommended USPSTF Guidelines

While the USPSTF guidelines say a woman can opt to have just a cytology screening every 3 years, Teoh (2016) discusses how annual pap smears alone have an increased incidence of false-positives resulting in the need for diagnostic colposcopies. A colposcopy can cause undue stress, cervical scaring, alteration of the cervix, preterm labor, or miscarriage (Teoh, 2016). Felix (2016) conducted research to determine the cost-saving initiative of co-testing as the preferred form of cervical cancer screening among this age group. Co-testing can save “$39 per woman over the 40-year screening period (Felix, 2016, p. 3)”, whereas cytology or HPV testing separately, can cost over $4 million over the 40-year screening timeframe. Research by Felix (2016) also revealed that co-testing would produce fewer false-positives, fewer colposcopies, and continue to decrease the number of cervical cancer diagnoses every year.

Boone et al. (2016) conducted research in California that revealed decreased provider compliance with the new USPSTF guidelines. This resulted in reverting back to old practices or decreasing the recommended timeframe of screening. It was found that providers are non-compliant for many reasons: providers feel that the rapid push and complete change of guidelines was a ploy to save money nationally; providers have to take more time to explain to patients why guidelines have changed, therefore, delaying appointment times; patients perceive the new guidelines as a decrease in quality of care due to infrequent visits; and with woman not visiting providers for yearly GYN exams, they are financially suffering a lost revenue from those patients (Boone et al., 2016).

Conclusion

Cervical cancer is considered the most preventable type of cancer in women between the ages of 30 to 65, which is why routine screenings are important in accordance to the recommended guidelines by the USPSTF, of co-testing every 5 years. Co-testing provides for best detection of squamous cell cancers and adenocarcinomas. Co-testing is also cost effective over all if adhered to specific timeframes, for both the patient and medical community. Providers need to continually recommend yearly well-woman visits (minus pap/HPV testing) as a way of detecting any other female related issues and maintaining a healthy female lifestyle.

References

Agency for Healthcare Research and Quality. (2014, June). Guide to Clinical Preventive Services, 2014. (U.S. Department of Health & Human Services) Retrieved April 3, 2017, from https://www.ahrq.gov/professionals/clinicians-prov…

Baker, E. (2013, February). Assessing the impact of new cervical cancer screening guidelines. Medical Laboratory Observer, 28-29.

Baker, E. (2013, November). HPV and Pap: shifting roles in cervical cancer screening. Medical Laboratory Observer, 24-26.

Boone, E., Lewis, L., & Karp, M. (2016). Discontent and Confusion: Primary Care Providers’ Opinions and Understanding of Current Cervical Cancer Screening Recommendations. Journal of Women’s Health, 25(3), 255-262.

Felix, J. (2016, September). Primary HPV Testing vs. Co-testing for Cervical Cancer Screening. Contemporary OB/GYN, 1-5.

National Cerivcal Cancer Coalition. (2017). Cervical Cancer Overview. (American Sexual Health Association) Retrieved April 3, 2017, from National Cerivcal Cancer Coalition: http://www.nccc-online.org/hpvcervical-cancer/cerv…

National Cerivcal Cancer Coalition. (2017). Cervical Cancer Screening: Pap and HPV Testing. (American Sexual Health Association) Retrieved April 3, 2017, from National Cervical Cancer Coalition: http://www.nccc-online.org/hpvcervical-cancer/cerv…

National Cervical Cancer Coalition. (2017). HPV Vaccine. (American Sexual Health Association) Retrieved April 3, 2017, from National Cervical Cancer Coalition: http://www.nccc-online.org/hpvcervical-cancer/cerv…

Teoh, D. (2016). A new Era in Cervical Cancer Screening: Balancing the Risks and Benefits of Screening. Journal of Women’s Health, 25(3), 207-208.

U.S. Preventive Services Task Force. (2012, June 19). Screening for cervical cancer: U.S. Preventive Services Task Force recommendation statement. (A. f. Quality, Producer, & U.S. Department of Health and Human Services) Retrieved April 3, 2017, from National Guideline Clearinghouse: https://www.guideline.gov/summaries/summary/36624

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