NR 503 Week 2: Descriptive Epidemiology, Screening, Prevention and the Importance of the Randomized Control Trial

A Papanicolaou test or better known as Pap smear testing is a method of cervical cancer screening. It is used to detect cervical epithelial changes that can be pre-cancerous and cancerous (Sachan, Singh, Patel, & Sachan, 2018). There are two forms of cervical screening testing, conventional and liquid-based cytology. There is no clinical or significant difference in the results. As with any testing and results, there can be a potential false-positive or a false-negative. In essence, one is not better than the other. Both methods share the same high accuracy rate. If further testing is needed a colposcopy is performed as the diagnostic test.

Cervical cancer screening consist of cytology (Pap smear) for women with a cervix at ages 21-29 every 3 years and for women 30 to 65 cytology every 3 years or cytology with human papilloma virus (HPV) every 5 years. There has been a large reduction rate of cervical cancers in the United States. Early screening and detection reduces cervical rates 60% to 90% within 3 years of interventions (U.S. Preventive Services Task Force [USPSTF], 2012). Unfortunately, for developing countries cervical cancer is higher due to the lack of knowledge, technology, and experience.

“The overall sensitivity of the Pap test in detecting a high-grade squamous intraepithelial lesion (HSIL) is 70.2%. A Pap screening done in association with a HPV DNA test increases the sensitivity for early detection of precancerous lesions” (Sachan, Singh, Patel, & Sachan, 2018). There can be 6 different pap results, I will list the severity in ascending order: negative, atypical squamous cells (ASC-US), low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HSIL), atypical squamous cells-cannot exclude HSIL (ASC-H), and atypical glandular cells (ACG) (The American College of Obstetrician and Gynecologists [ACOG], 2016). Depending on the results and the patient’s age will depend on if a colposcopy, biopsy, or an endocervical sampling is needed.

Situations that can alter the screening for this patient is having a total hysterectomy (medical history). It is not recommended a pap smear be performed on someone without a cervix due to a lack of cervical precancerous lesions. Another alteration could be if their immediate family member has been diagnosed with cancer early in life (family history). If a patient is HIV positive they may require more frequent screening. Also, the patient’s age. Studies have found screening prior to age 21 and after age 65 with previous normal Pap smear results is not beneficial. The risk outweighs the benefits and can potentially cause physical and/or psychological damage.

Reference

The American College of Obstetrician and Gynecologists. (2016). Abnormal cervical cancer screening test results. Retrieved from https://www.acog.org

Sachan, P.L., Singh, M., Patel, M.L., & Sachan, R. (2018). A study on cervical cancer screening using pap smear test and clinical correlation. Asia-Pacific Journal of Oncology Nursing, 5(3), 337-341. U.S. Preventive Services Task Force. (2012). Cervical Cancer: Screening. Retrieved from https://www.uspreventiveservicestaskforce.org

I enjoy reading your post, it was quite informative. Cancer is the second leading cause of death globally, and was responsible for 8.8 million deaths in 2015. Globally, nearly 1 in 6 deaths is due to cancer (WHO, 2018). Approximately 15% of cancers diagnosed in 2012 were attributed to carcinogenic infections, including Helicobacter pylori, Human papillomavirus (HPV), Hepatitis B virus, Hepatitis C virus, and Epstein-Barr virus (Plummer, Martel, Vignat, Ferlay, Bray, & Franceschi, 2016). More specifically, cervical cancer was a known cause of death for American women. However, this rate of death was decreased due to the use of the Pap test (WHO, 2018). It has been my experience that many young women visit the ED with vaginal complaints and have never obtained a Pap smear, let alone visit the gynecologist for these complaints. The challenge as a nurse is educating these young women on the importance of this screening. The views or beliefs held by the young ladies are that they are not in need of this test, embarrassed, or just lack of knowledge. To enable a positive moment where the information presented is grasped by the female patient, the nurse should strive to provide education that stresses the importance of the Pap smear and strategies allowing greater understanding of one’s own body (Plummer et.al, 2016). Additionally, continue to build trust and allow for opportunities to plant the seeds of knowledge.
Screening aims to identify individuals with abnormalities suggestive of a specific cancer or pre-cancer who have not developed any symptoms and refer them promptly for diagnosis and treatment. Screening programms can be effective for select cancer types when appropriate tests are used, implemented effectively, linked to other steps in the screening process and when quality is assured. In general, a screening program is a far more complex public health intervention compared to early diagnosis.

Examples of screening methods are:
visual inspection with acetic acid (VIA) for cervical cancer in low-income settings;
HPV testing for cervical cancer;
PAP cytology test for cervical cancer in middle- and high-income settings; and
mammography screening for breast cancer in settings with strong or relatively strong health systems.

Plummer, M., Martel, C., Vignat, J., Ferlay, J., Bray, F., & Franceschi, S. (2016). Global burden of cancers attributable to infections in 2012: a synthetic analysis. Lancet Glob Health. 4(9):e609-16. doi: 10.1016/S2214-109X(16)30143-7.

World Health Organization (2018). Cancer. Retrieved from http://www.who.int/news-room/fact-sheets/detail/cancer on 07/18/2018

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