Cancer Screening
Breast Cancer Screening
What are the mammogram recommendations from the American College of Obstetrics and Gynecology (ACOG), American Cancer Society (ACS), and the United States Preventive Services Task Force (USPSTF)?
Breast cancer is a type of cancer that affects the breast tissues in both men and women. Signs that a patient may have breast cancer include lumps in the breast, changes in the shape of the breast, scaly patches on the skin around the breasts, fluid from nipples, and inverted nipples. According to the American College of Obstetrics and Gynecology (ACOG), breast cancer screening should start at the age of 40 to reduce the breast cancer mortality rate n women who are at average risk (Pearlman, Jeudy & Chelmow, 2017). Mammograms, however, can expose patients to overdiagnosis and false-positive reports. According to ACOG, for women between the ages of 40 to 49, the doctor can initiate a mammogram after counseling. The procedure can then be carried out annually or biannually. After the age of 75, the procedure should only be carried out or stopped after shared decision making between the doctor and patient.
American Cancer Society (ACS) recommends that the doctor initiates the mammogram testing from the age of 40. For patients who are 50 and over, the procedure should be carried out twice a year and only stopped when the patient’s life expectancy is less than 10 years (Pearlman, Jeudy & Chelmow, 2017).
United States Preventive Services Task Force (USPSTF), on the other hand, recommends that the patient starts the mammogram at the age of 50. If the patient is below the recommended age, the procedure should be based on individual decisions. SPSTF lack sufficient evidence to support guidelines for persons over the age of 75(Pearlman, Jeudy & Chelmow, 2017)
What is meant by shared decision-making regarding screening for breast cancer?
Shared decision making refers to the inclusion of patients in making choices about their health matters. According to guidelines provided by The USPSTF and American Cancer Society, physicians should make breast cancer screening an individualized patient decision (Keating & Pace, 2018). Physicians should consider the patient’s medical history. For instance, if the immediate patient’s family had breast cancer then the patient may require screening because they are at a higher risk of developing breast cancer (Keating & Pace, 2018). The doctor should discuss the harms and benefits of the procedure and allow the patent the autonomy to decide if they need the screening.
What are the screening recommendations regarding self-breast exams and clinical breast exams?
A self-breast examination can help an individual to understand their breasts. This makes it easier to note any changes in breast size, tissues, and shape. In most cases, breast cancer is discovered due to lumps found on the breast during a self-examination. The American Cancer Society recommends that women familiarize themselves with their breasts, and in case any unusual changes are discovered, they should report to a medical officer for testing and diagnosis (Oeffinger et al., 2015). Self-exam is, however, not recommended as the breast cancer screening tool; the procedure s, however, helpful for the patient to know when to see a doctor.
Based on the scenario provided, what recommendations would you give this patient?
Based on the provided scenario, I would recommend that the patient waits another 5 years before considering the screening. This is because the patient is still below the recommended age to initiate testing. Although the patient has a family history of breast cancer, she does not show any symptoms. In this case, the patient should continue with the regular self-exams and report any changes to the physician.
What factored into your decision making?
My decision to not carry out the screening is based on the recommended age guidelines as well as the effects that regular testing may have on a healthy patient.
Cervical Cancer Prevention/Screening
What are the recommendations on the HPV vaccine?
The HPV vaccine is usually given to women and female children to prevent cervical cancer caused by Human papillomavirus. The virus is sexually transmitted and can be carried by men who then transmit it to the woman trough unprotected sex (Saslow et al., 2012). According to guidelines given by the CDC, the HPV vaccine should be given as a routine to children from the age of 9. (CDC, 2020). The CDC recommends that the vaccine be administered up to the age of 26 (CDC, 2020). For adults and children who have not had adequate vaccination. The vaccination is not recommended after the age of 26. Still, the patient may decide to get the immunization through a shared decision-making process whereby the patient and doctor discuss the patient’s need for the vaccine and its effects.
How would you counsel this patient about the HPV vaccine?
Because eth patient is still young (18 years old), I would recommend that she gets vaccinated to prevent her from contracting the virus. The patient is said to be sexually inactive; however, because of her age, she might engage in sexual activities shortly, which puts her at risk of getting HPV. I would, therefore, advise the patient to use protection when having sex, especially if the patient has multiple sexual partners.
What are the current ASCCP guidelines for Pap smears and HPV testing?
The current ASCCP guidelines on Pap smears and HPV testing recommend that for patients below the age of 21, the HPV testing should not be conducted as a mode of screening. If the patient is between 21 and 30, then cytology should be done instead of HPV tests. This should be carried out every year for three years. Patients above the age of 30 up to the age of 60 should undergo a cytology co-test every 5 years. For women who have undergone hysterectomy, there is no need for screening (Petrosky et al., 2015).
How will you explain the rationale to the patient and the mother?
For this patient, I would recommend that she gets an HPV vaccine but forego the screening because she has minimal chances of having been infected. The virus is spread through sexual fluid, and since the patient is not sexually active, the procedure is unnecessary.
References
CDC. (2020, March 17). HPV Vaccine Recommendations. Retrieved July 23, 2020, from https://www.cdc.gov/vaccines/vpd/hpv/hcp/recommendations.html
Keating, N. L., & Pace, L. E. (2018). Breast cancer screening in 2018: time for shared decision making. Jama, 319(17), 1814-1815.
Oeffinger, K. C., Fontham, E. T., Etzioni, R., Herzig, A., Michaelson, J. S., Shih, Y. C. T., … & Wolf, A. M. (2015). Breast cancer screening for women at average risk: 2015 guideline update from the American Cancer Society. Jama, 314(15), 1599-1614.
Pearlman, M., Jeudy, M., & Chelmow, D. (2017). Breast cancer risk assessment and screening in average-risk women. Obstetrics and Gynecology, 130(1), E1-E16.
Petrosky, E., Bocchini Jr, J. A., Hariri, S., Chesson, H., Curtis, C. R., Saraiya, M., … & Markowitz, L. E. (2015). Use of 9-valent human papillomavirus (HPV) vaccine: updated HPV vaccination recommendations of the advisory committee on immunization practices. MMWR. Morbidity and mortality weekly report, 64(11), 300.
Saslow, D., Solomon, D., Lawson, H. W., Killackey, M., Kulasingam, S. L., Cain, J., … & Wentzensen, N. (2012). American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. American journal of clinical pathology, 137(4), 516-542.