In 2012, the USPSTF (United States Preventive Services Task Force) set up new guidelines for the nursing practitioners and other medical officers to follow in practice of cervical cancer screening. The screening helps most women in the early detection and cure of cervical cancer, which may accelerate and cause serious aggregate problems in the future. Women received the new regulations differently with most women interpreting the move to mean reduced frequency of pap smears and delayed first screening for cancer (Plescia, Richardson and Joseph, 2012). However, the implications of the recommendations mean reduced strain for women at average risk of contracting cervical cancer. However, women under greater risks of cervical cancer should consult their doctors for screening to avoid delayed reaction to cervical cancer. This paper analyzes the new recommendations for screening cervical cancer released by the United States Preventive Services Task Force (USPSTF) in March 2012. The paper also analyzes the extent of application of the new recommendations.
The task force recommended an extension in the screening times for cervical cancer. It is recommended that screening for women between 21 years and 65 years accompanied with cytology should take place every after three years. Cytology is majorly used for the detection of cervical cancer in women. In Pap smear, cytology functions to determine any causes of cervical cancer at the initial stages in order to permit treatment or diagnosis. The new recommendation means that the time for using Pap smear reduces and the women visit a clinic less regularly for checkups than the time before the recommendations (Andrews, 2012). The screening time also provides a balance between the benefits versus challenges of the screening process, which helps the women in maintaining good health throughout the screening time. The recommendation also allowed women to undertake co-screening in order to increase their screening intervals. However, co-testing was only allowed for women between ages of 30 years and 65 years. This involved a combination of human papilloma virus testing (HPV) and Pap smear. According to the recommendation reports, co-screening increased the efficiency of the tests and the ease of discovering cervical cancer in women.
The USPSTF also recommended that screening for cervical cancer would not involve any women under the age of 21 years. The task force referred to such women as minors in cervical cancer screening. The task force found no reasons for the women under the age of 21 to contract cervical cancer. Possibly, the women will get the cancer cells during their sexual encounters even at younger ages. However, the process of contracting cervical cancer is a multi-step process that takes time before the women can contract cervical cancer. Consequently, the task force found it necessary to begin the cervical screening process at 21 years old as this was the prime age for women to get into contact with cervical cancer easily.
Screening in women, who are still under the age of 21 years was also discouraged because it would lead to harm more than benefit to the women (Moonin, 2012). The regression time in sexual maturity and the development of cervical cancer is a critical element to put into consideration. During this time, the cells are forming and maturing in the reproductive system while the cervical cancer cells cannot multiply fast. This means that if screening is undertaken at this stage, it may affect the growth of the reproductive cells, which is a negative effect to the female genital growth. Any signs of cervical cancer at this stage resolve itself as the cells adopt an internal defense mechanism (Debbie et al. 2012). At the same time, screening for women below 21 years may cause problems to women during childbearing in the future.
The task force also recommended that screening should not be undertaken for women over 65 years old. The assumption made by the task force during this recommendation was that women at the age of 65 years had undergone adequate screening since their tender age; thus, no reason to continue such screening. Apart from the assumption by the task force, the health effects of such screening would be far reaching as most of the women would encounter late cervical problems in their old age. However, the cessation of screening would be undertaken on the basis of rules and regulations met by the women. First, the women must have undertaken regular screening throughout especially in the last 10 years prior to the cessation. This essentially ensured that women had absolutely no symptoms of cervical cancer and that they could live safely without future screening.
The women would also qualify to cease screening if they had sufficient prior screening in three years prior to the cessation of cervical cancer screening. Adequate screening is defined as three negative Pap smear screening tests or thee negative human papilloma virus tests (HPV) in a time of 10 years prior to cessation of cervical screening (Plescia, Richardson and Joseph, 2012). The careening should continue on a routine for at least 20 years, even if the time exceeds 65 years because this is the surest way that cervical cancer is not present in the blood of patients. When these conditions are met, the patient can cease screening at the age of 65 years without encountering problems in the future.
However, these rules apply only to people who have undertaken to screen on a consecutive basis for at least 20 years. The considerations for minority women support screening in women older than 65 years. The task force grouped women who could not access screening services when they were below 65 years, women from minority areas, and women from areas with no screening services and advised them to undertake screening for cervical cancer even when they were older than 65 years. This provided equality between the women from minority areas and other women in the society.
The United States Preventive Services Task Force recommended against cervical cancer screening for women who had undergone hysterectomy with the cervix being removed or women who have not previously recorded complications such as cervical intraepithelial neoplasia (CIN). The task force recognizes the fact that early screening provides the best results for the detection and cure of cervical cancer because the situation is arrested at initial stages (Levy et al, 2012). However, the task force also recognizes the fact that cervical cancer mostly affects women and rarely occurred at late stages of life. The task force discouraged screening in patients who had their cervixes removed in surgery because they stood zero risk of cervical cancer. Most of the patients who had undergone such tests and surgery would react to the screening through allergies and sickness, which the task force aimed at eliminating as much as possible.
Screening for cervical cancer in women who had undergone hysterectomy was also discouraged because it caused distress to the women (Plescia, Richardson and Joseph, 2012). Hysterectomy had strong emotional effects on women and most of them were opposed to the idea of screening for cervical cancer. The fact that they had no cervixes made it harder than expected because they would have emotional problems when screened. At the same time, women with no history of cervical intraepithelial neoplasia had the potential of getting false results on their first tests. This was scientifically proved to cause stress and emotional pressure among the women, which harmed the heath of such women enormously. Consequently, screening in women who had no history of cervical intraepithelial neoplasia was discouraged unless the patients had symptoms suggestive of cervical cancer.
Lastly, USPSTF discouraged screening with human papilloma virus tests (HPV) alone, or in combination with cytology. HPV was mainly used for co-screening meaning it mainly functioned in changing the screening intervals in women. The recommendation mainly aimed at covering the potential damages that would be caused by co-testing for women below 30 years old as the damages would outweigh the benefits.
Nursing theories suggested that women under the age of 30 years required only Pap smear testing because it uncovered all the possible symptoms of cervical cancer. Pap smear also had little effects on the health of young women, as it did not cause allergic reactions and nausea from the women (Andrews, 2012). At the same time, Pap smear caused little distress to the women and the possibility of false results was eliminated. However, when combined with HPV testing, cytology increased the potential of false results due to the level of hormonal balance in women under the age of 30 years. This would cause psychological distress to the women due to increased potential of false issues arising from body reactions (Debbie et al. 2012). In order to lower the risk of false results, the task force recommended that the HPV tests be repeated in women older than 30 years. However, this would not be possible in women younger than 30 years as the harmful effects of repeated HPV testing on women younger than 30 years were more than the benefits to women in the same age bracket.
Concisely, the USPSTF set recommendations for screening cervical cancer so that they could limit the effects of such screening on young women and old women alike. The recommendations were also set with the view of standardizing the screening process and making the nurses keener with the screening system they applied on different people. The recommendations set the limits, which the nurses would not exceed while undertaking cervical cancer screening. Firstly, screening was recommended for Pap smear for women in the age bracket (21-65) years because individuals in this bracket risked infection while others were either too young or too old for screening. Women below 21 years were not legible for screening because they did not meet the basic criteria. In this context, the harms of the screening process would outweigh the benefits for such women; thus, discouraged. Furthermore, women who had no history of CIN and women who had undergone an operation for removal of the cervix were discouraged from the screening. This is in consideration that the practice was likely to harm them.
References
Andrews, J. (2012).Cervix Cancer Screening Guideline Judgments Are Not Explicit and Transparent. J ClinPathol 138:618-619
Debbie, S. et al. (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, 516-542. doi: 10.1309/AJCPTGD94EVRSJCG
Levy AR, Bruen BK, Ku L. (2012). Health Care Reform and Women’s Insurance Coverage for Breast and Cervical Cancer Screening. DOI: http://dx.doi.org/10.5888/pcd9.120069
Moonin, C. (Sep 6, 2012). Health Watch: I Screen, You Screen: When it comes to a Pap test, less may be more. Portland Monthly Mag. Women's Health Annual
Plescia, M., Richardson, L. C. and Joseph, D. (2012). New roles for public health in cancer screening.CA: A Cancer Journal for Clinicians, 62: 217–219.doi: 10.3322/caac.21147
