Question 1

Routine Health Periodicity for the Gynecologic and Clinical Breast Exam (CBE)

In order to maintain good reproductive and sexual health, females should visit a gynecologist for an exam about once per year, even if a Pap test isn’t performed. A well-woman visit provides an excellent opportunity to counsel patients about maintaining a healthy lifestyle and minimizing health risks (ACOG, 2017).

The periodic well-woman care visit should include screening, evaluation and counseling, and immunizations based on age and risk factors. Sexually active adolescents shouldn’t wait until age 21 to see a gynecologist for the first time. Recent recommendations state that girls should have their first gynecologic visit between the ages of 13 years and 15 years (ACOG, 2017).

According to the U.S. Preventive Services Task Force (2018) the current evidence is insufficient to assess the balance of benefits and harms of performing screening pelvic examinations in asymptomatic women for the early detection and treatment of a range of gynecologic conditions. The interval for specific individual services may differ for individual patients, and the scope of services provided may vary in different ambulatory care settings (USPSTF, 2018).

The Centers for Disease Control and Prevention (2018), states that the best way to find breast cancer is with a mammogram; having a CBE or a BSE has not been found to decrease the risk of dying from breast cancer. Even if the patient chooses to have annual CBEs and to perform regularly BSEs, it is essential to also get mammograms regularly. The USPSTF recommended that women begin mammograms at age 50, not 40, and decrease the frequency thereafter. The USPSTF stated that current evidence is insufficient on the additional benefits versus harms of CBE beyond screening mammogram in women older than 40 years (USPSTF, 2018).

Health Factors Utilized to Determine the Need for a Pap Test

The need for a PAP test depends on factors such as a woman’s age, health history, recent Pap test results, and whether or not she has had HPV. The American Cancer Society (ACS) and the USPSTF both recommend that women get their first Pap test at age 21. Co-testing with Pap and HPV begins at age 30 years. Current interim guidance for stand-alone HPV primary screening begins at age 25 years. Most women between age 21 and age 30 should have a Pap test every three years, assuming their previous Pap test results were normal (Carcio and Secor, 2015).

Women who are Pap/negative and HPV/positive should perform Pap and HPV in 12 months. HIV-infected women should have biannual Pap tests in the first year of diagnosis and then may reduce frequency to annual Pap tests based on the results. A woman who has been vaccinated against HPV should still follow the screening recommendations for her age group (Carcio and Secor, 2015).

When is the Pap test no longer necessary?

The PAP test is no longer necessary in women who have had a total hysterectomy, but if the hysterectomy was done because of cervical cancer or precancerous cell changes, she may still need Pap tests. Also, after age 65, most women may no longer need Pap tests if their last three Pap tests were normal, they are not at high risk for cervical cancer, and they have gone 10 years without an abnormal test (HHS.gov, 2019).

                                                          References

Carcio, H. & Secor, M.C. (2015). Advanced health assessment of women: Clinical skills and procedure. 3rd ed. New York: Springer.

Center for Disease Control and Prevention (2018). What are benefits and riskd of screening. Retrieved from https://www.cdc.gov/cancer/breast/basic_info/benefits-risks.htm

The American College of Obstetricians and Gynecologists (2017). First Gynocologic exam. Retrieved from https://www.acog.org/Patients/FAQs/Your-First-Gynecologic-Visit-Especially-for-Teens

U.S. Preventive Services Task Force (2018). Final recommendation Statement. Ginecological conditions. Retrieved from https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/gynecological-conditions-screening-with-the-pelvic-examination

US Department of Health and Human Services (2019). Cervical Cancer Screening (Pap Test). Retrieved from https://www.hhs.gov/opa/reproductive-health/fact-sheets/pap-test/index.html