Introduction
According to the CDC (2016), each year over 12 000 women in the United States are diagnosed with cervical cancer (p. 1). It is a curable condition with a significant proportion of timely treatment resulting in success (CDC, 2016, p. 1). Cervical cancer is also highly preventable with regular recommended screenings (CDC, 2016, p. 1). The National Guideline Clearinghouse has collected and summarized the guidelines from two main organizations, U. S. Preventive Services Task Force (USPSTF) and American Cancer Society (ACS), on the screening and tests required for the diagnostics of cervical cancer.
Screening methodology and guidelines
The choice of screening option and its frequency is mainly based on the patient’s age, as well as the presence of risk factors and previous screenings history (USPSTF, 2012, p. 881-882). The most popular screening method to rule out the possibility of cervical cancer is cytology, or a Pap smear (CDC, 2016, p. 1). However, many clinicians recommend co-testing methodology where the patient is tested for both cervical cancer and HPV, using a Pap smear and a Digene Hybrid Capture 2 (HC2) respectively (USPSTF, 2012, p. 881). Both methodologies have been evaluated in clinical effectiveness trials and proved to be useful in diagnosing cervical cancer (USPSTF, 2012, p. 881).
Co-testing also allows lengthening the time intervals between routine tests to five years, whereas using Pap smear as a single method requires screenings at intervals of approximately three years (ACS, 2012, p. 148). However, co-testing cannot be used to diagnose cervical cancer in women before the age of 30 (ACS, 2012, p. 148). It also delivers positive results more often because not every patient with HPV develops cervical cancer; this causes the need for additional frequent testing for those who have a positive HPV result (USPSTF, 2012, p. 881). Nevertheless, ACS describes co-testing as the preferred screening method (ACS, 2012, p. 148). USPSTF (2012), on the other hand, states that both methodologies are effective and there is no preference towards one or the other (p. 881).
The patient to undergo cervical cancer testing is a 41-year-old white female with two children. The patient is a non-smoker and had negative results in all Pap smear screenings performed every three years since the age of 23, even though there is no cervical cancer history in the patient’s family. The results of the previous screening cannot be used to rule out cervical cancer as they are more than three years old, so new testing is required. The patient is also considering switching to co-testing to decrease the frequency of screenings.
For this patient, as well as for other females from a similar demographic background (non-smoker, 40+ years old, less than three children, no history of cancer), I would recommend the continued use of Pap smear screening every three years due to several factors. First, the population considered is regarded as having a low risk for cervical cancer (CDC, 2016, p. 1), so a Pap smear would be sufficient as a sole method of diagnostics. Furthermore, despite the history of negative cytology results, it is possible that co-testing would turn out to be positive due to the presence of HPV. Positive HPV results cannot be used as a sole measure for diagnosing cervical cancer if the cytology results are negative (USPSTF, 2012, p. 881). However, a positive score in HPV testing can lead to more frequent screenings and continued testing after the age of 65, which would be against the patient’s will to decrease the number of lifetime screenings (USPSTF, 2012, p. 881).
Conclusion
Overall, for the population considered, cytology screening every three years would be a better option. Cytology is proven to be useful for discovering cervical cancer even at the earliest stages, and it will also rule out the possible need for additional frequent screenings, which are not desired by the patient.
References
American Cancer Society (ACS) (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. CA: A Cancer Journal for Clinicians, 62(3), 147-172. Web.
CDC (2016). Cervical Cancer. Web.
U.S. Preventive Services Task Force (USPSTF) (2012). Screening for cervical cancer: U.S. Preventive Services Task Force recommendation statement. Annals of Internal Medicine, 156(12), 880-891. Web.