Screening Guidelines: Mammography
Breast cancer is one of the central concerns of the US healthcare system. According to the Breast Cancer Research Foundation (2020), in 2019, there were 271,270 new cases of invasive breast cancer diagnosed in women and 2,670 cases diagnosed in men in the United States. Mammography is used as a primary tool for diagnosing breast cancer in women of all ages. According to the U.S. Preventive Service Task Force (USPSTF, 2016), mammograms can be utilized as a primary preventive measure of breast cancer. Women between 50 and 74 are recommended to have mammography tests once every two years (USPSTF, 2016). This recommendation is rated “B,” as there is a high certainty that the preventive measure will have a moderate impact on women’s health based on the current body of evidence (USPSTF, 2016). Women aged 40-49 should base their decision about starting screening for breast cancer based on individual risk factors, such as family history and environmental concerns (USPSTF, 2016). There are no specific recommendations concerning mammography among other age groups, as there is not enough scientific evidence that potential harms surpass the possible benefits of mammograms (USPSTF, 2016). In particular, there is a high possibility of false-positive results, that may cause psychological harms and financial implications (Whitman & Cantor, 2018). Healthcare professionals are to be aware of screening standards to decrease the burden of breast cancer in the US.
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Women’s Health Resources
Women’s health is among the primary concerns for the US healthcare system and society. Therefore, there are numerous federal, state, and nonprofit organizations that are designed to improve the health of women. According to Office in Women’s Health (OWN, 2019), federal agencies concerned with women’s health are Administration for Children and Families (ACF), Administration for Community Living (ACL), Agency for Healthcare Research and Quality (AHRQ), Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA), National Institutes of Health (NIH), and many others. For vulnerable populations, Health Resources and Services Administration (HRSA) is the most advantageous agency, as it aims to “improve access to quality health care for those who are uninsured or living with HIV/AIDS and for pregnant women, mothers, and children” (OWN, 2019, para. 12).
Among nonprofits, the most widely recognized organizations are the International Women’s Health Coalition (IWHC) and Breast Cancer Research Foundation (BCRF). IWHC (n.d.) is concerned with advancing policies, building young leaders, and provide grants for the advancement of women’s health around the world. BCRF (2020) raises money to create an effective measure for addressing the problem of breast cancer. At the state level, there are also some agencies, like Women’s Care Florida (n.d.), that can link women with local services to address their health concerns. In summary, there are numerous organization both in the US and worldwide that aim at improving women’s health.
Contraception is a vital topic for women’s health as it helps to prevent unwanted pregnancy and sexually transmitted diseases. There different methods of contraception that can be offered to patients depending on their preferences and health conditions. There are various methods of contraception, including long-acting reversible contraception, hormonal contraception, barrier methods, emergency contraception, fertility awareness, and permanent contraception (Curtis et al., 2016). Patients desiring pregnancy in 1-2 years, should limit their contraception options to short-acting reversible options, while postpartum options are limited only by counter-indications (Centers for Disease Control and Prevention [CDC], 2016). Common counter-indications include cardiovascular diseases, metabolic conditions, oncology, inflammatory diseases, smoking, genital bleeding of unknown cause, and pregnancy (CDC, 2016). At the same time, certain types of contraception may be recommended if non-contraceptive indications are present, such as polycystic ovary syndrome, menstrual migraine, premenstrual dysphoric disorder, acne, and hirsutism (CDC, 2016). Some of the contraception methods may be more cost-efficient than others. Healthcare professionals are to be aware of all methods of contraception and recommendations about them provided by CDC to improve women’s health.
Some patients may have prejudice about certain methods of contraception for various reasons. According to Lopez et al. (2016), brief educational strategies are extremely helpful for addressing the misconceptions about contraceptives. Therefore, I will use them in my practice to improve women’s health in the US.
Hepatitis C Prevention
Hepatitis C is a liver infection caused by the hepatitis C virus. The disease may have different representation varying from a mild episodic illness to a life-long condition. Centers for Disease Control and Prevention (CDC, 2020a) acknowledges two types of hepatitis, which are chronic and acute. While a patient may live with the disease for years without any noticeable symptoms, untreated hepatitis C causes severe complications, such as cirrhosis, liver failure, rheumatoid arthritis, or even type 2 diabetes (Tartof et al., 2018). Therefore, it is of extreme importance to utilize efficient preventive methods to support early diagnosis and treatment of the disease.
CDC provides comprehensive recommendations for hepatitis C screening based on recent evidence. CDC (2020b) recommends universal testing at least once in a lifetime among adult patients with rare exclusions. Moreover, people with some conditions or exposures, such as HIV, pregnancy, injection drug abuse, hemodialysis, and organ transplantation, are also recommended to be screened for hepatitis C (CDC, 2020b). Moreover, people with ongoing risk factors and everyone who request a test should be checked for the condition (CDC, 2020b). Populations at risk of the disease are drug misusers, recipients of clotting factor concentrates made before 1987, blood transfusion patients, people who receive body piercing or tattoos, children of mothers infected with the virus, and healthcare workers exposed to hepatitis C patients.
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Pelvic Pain: STIs
There are numerous causes of pelvic pain, including menstrual pain, ovulation, cystitis, pelvic inflammatory diseases, endometriosis, irritable bowel syndrome, and sexually transmitted infections (STIs). One of the most prevalent STIs that cause pelvic pain is chlamydia, which affects around 2.86 million people each year in the United States (CDC, 2016). Chlamydia is often called a silent disease, as many people who have it are asymptomatic (CDC, 2016). In women, the disease infects the cervix and sometimes urethra, and spreads to the upper reproductive tract (CDC, 2016). The common symptoms of the disease are pelvic pain, pain during urination, abdominal pain, abnormal vaginal discharge, and bleeding between periods (Patel et al., 2018).
If a patient demonstrates the symptoms of chlamydia, I will refer her to be tested for all prevalent STIs, as they often have similar symptoms. At the same time, I would refer the patient to the gynecologist to examine for other possible reasons for pelvic pain. When writing a referral, I would include all the relevant information about the patient, such as name, address, phone number, age, gender, and relevant contracts. I would also include information about myself and mention referral destination, any special requirements, presenting complaints, history of each complaint, past medical history, management until the day, reasons for referral, urgency, risk factors, and results of investigations. As a nurse practitioner, I would also make phone calls and schedule a visit after treatment to make sure that the patient adheres to all the recommendations, which is central according to Norful et al. (2018).
Screening for Depression
Depression is one of the most prevalent psychological conditions among women in the US, as almost 10% of women reported that they experienced symptoms of major depression last year (CDC, 2020). Depression is characterized by lasting anxious mood, feeling hopeless, helpless, or worthless, and losing interest in hobbies and activities. Nurse practitioners are to be able to identify depression as it can cause severe complications. According to SAMHSA (n.d.), the most frequently used screening tool for depression is the Patient Health Questionnaire, also known as PHQ-9. The screening tool is of high validity and sensitivity, which implies that it can be used in primary care settings (Beard et al., 2016). However, the screening tool cannot be used to diagnose depression, and the patient needs to be examined to confirm the diagnosis (SAMHSA, n.d.).
My responsibilities as a primary care provider are identified by the organization. However, in general, nurse practitioners are not responsible for treating the patient. As soon as the disorder is identified, I would refer the patient to a mental health specialist for further treatment. I will also schedule a follow-up visit and make a call to the patient to assess if there are any changes in the patient’s condition and identify if further interventions are needed.
- Beard, C., Hsu, K. J., Rifkin, L. S., Busch, A. B., & Björgvinsson, T. (2016). Validation of the PHQ-9 in a psychiatric sample. Journal of Affective Disorders, 193, 267-273.
- Centers for Disease Control and Prevention. (2020). Depression among women. Web.
- SAMHSA. (n.d.). Patient Health Questionnaire (PHQ-9). Integration SAMHSA. Web.
- Breast Cancer Research Foundation. (2020). Breast cancer statistics and resources. Web.
- USPSTF. (2016). Breast cancer: Screening. U.S. Preventive Service Task Force. Web.
- Whitman, G., & Cantor, S. (2018). Effect of screening mammography on other Preventive Services in Older Women. Radiology, 288(3), 669-670. Web.
- Breast Cancer Research Foundation. (2020). Breast cancer statistics and resources. Web.
- International Women’s Health Coalition. (n.d.). What we do.
- Office in Women’s Health. (2019). HHS and women’s health: Agency and office descriptions.
- Women’s Care Florida. (n.d.). Our services. Web.
- Centers for Disease Control and Prevention. (2016). US medical eligibility criteria (US MEC) for contraceptive use. Web.
- Curtis, K.M., Jatlaoui, T.C., Tepper, N.K., Zapata, L.B., Horton, L.G., Jamieson, D.J., & Whiteman, M.K. (2016). U.S. selected practice recommendations for contraceptive use. Recommendations and Reports, 65(4), 1-66.
- Lopez, L. M., Grey, T. W., Tolley, E. E., & Chen, M. (2016). Brief educational strategies for improving contraception use in young people. Cochrane Database of Systematic Reviews, 3.
- Centers for Disease Control and Prevention. (2020a). Hepatitis C questions and answers for the public. Web.
- Centers for Disease Control and Prevention. (2020b). Testing recommendations for Hepatitis C virus infection. Web.
- Tartof, S. Y., Hsu, J. W., Wei, R., Rubenstein, K. B., Hu, H., Arduino, J. M., Horberg, M., Derose, S.F., Qian, L., & Rodriguez, C. V. (2018). Kidney function decline in patients with CKD and untreated hepatitis C infection. Clinical Journal of the American Society of Nephrology, 13(10), 1471-1478.
- Centers for Disease Control and Prevention. (2016). Chlamydia – CDC fact sheet.
- Norful, A. A., de Jacq, K., Carlino, R., & Poghosyan, L. (2018). Nurse practitioner–physician comanagement: a theoretical model to alleviate primary care strain. The Annals of Family Medicine, 16(3), 250-256.
- Patel, C. G., Trivedi, S., & Tao, G. (2018). The proportion of young women tested for chlamydia who had urogenital symptoms in physician offices. Sexually Transmitted Diseases, 45(9), e72-e74.