Case Study T a 24-year-old, sexua...

Case Study

T a 24-year-old, sexually active, white woman, visits your office to discuss birth command methods. She first had intercourse at age 16 and sooty vapors two packs of cigarettes by week. You suggest that she be shielded for cervical cancer as part of routine health maintenance. She asks for what reason you will perform the screening and by what means often she should be screened

The case contemplation and answers to the following questions forward screening for cervical cancer are based onward the recommendations of the instant U.S. Preventive Services Task Force (USPSTF), part of the enjoin Prevention into Practice program of the Agency for Healthcare Research and Quality (AHRQ). This recommendation was released in 2002 and is an update of the 1996 recommendation forward screening for cervical cancer. More detailed information upon this subject is available in the Systematic Evidence Review and USPSTF Recommendations and Rationale forward the AHRQ Web site (www preventiveservices.ahrq.gov). The recommendation statement is also available from the AHRQ Publications Clearinghouse in print by the and of subscription to the Guide to Clinical Preventive Services, Third Edition: Periodic Updates. To order, contact the Clearinghouse at 1-800-358-9295 or e-mail ahrqpubs@ahrq.gov.

Answers appear forward the following page.

This case application of mind is part of AFP's CME diocese "Clinical Quiz" on page 417

This clinical satisfied conforms to AAFP criteria for evidence-based continuing medical education (EB CME) EB CME is clinical contented presented with practice recommendations supported through evidence that has been systematically reviewed by means of an AAFP-approved source. The practice recommendations in this activity are available at www.ahrq.gov/clinic/serfiles.htm.

Case consideration Questions

1. Which the same of the following statements regarding the U Preventive Services Task Force (USPSTF) recommendations onward screening for cervical cancer is correct?

[] A. The USPSTF forcibly recommends screening women who have been sexually active and have a cervix.

[] B The USPSTF powerfully recommends screening women aged 25 and older

[] C The USPSTF does not commend for or against screening women for cervical cancer.

[] D The USPSTF commends screening only women who are at increased risk for cervical cancer.

[] E The USPSTF make acceptables screening all women between the ages of 18 and 75

2 Which undivided of the following tests is commended by the USPSTF for routine cervical cancer screening?

[] A. Human papillomavirus (HPV) testing.

[] B Liquid-based cytology.

[] C Conventional Papanicolaou (Pap) smear screening.

[] D Computerized rescreening.

[] E Conventional Pap smear screening and HPV testing.

3 Which of the following is/are risk factors for developing cervical cancer?

[] A. Cigarette smoking.

[] B Infection with certain strains of HPV

[] C Immunocompromise.

[] D Early storming of sexual intercourse.

Answers

1 The correct answer is A. The USPSTF strenuously recommends cervical cancer screening for women who have been sexually active and have a cervix. Direct evidence to determine the optimal starting age, stopping age, and screening interval is limited. However, indirect evidence give an inkling ofs that most of the benefit can be obtained on initiating screening within three years of the charge of sexual activity or age 21 (whichever get tos first) and by screening at least each three years. The USPSTF commends against routinely screening women older than 65 for cervical cancer if they have had adequate novel screening with normal Pap smear originates and are not otherwise at high risk for cervical cancer. The risk of cervical cancer and the yield of screening declines in older women and there is fair evidence that screening women older than 65 is associated with increased rates of false-positives and risk of potential harms. For women who have had a total hysterectomy for benign disease, the USPSTF make acceptables against cervical cancer screening.

2 The correct answer is C The USPSTF rest good evidence that screening with cervical cytology (i.e., Pap smears) decreases incidence of and mortality from cervical cancer. The USPSTF lay the foundation of poor evidence to determine whether novel technologies, such as liquid-based cytology, computerized rescreening, and algorithm-based screening, are more effective than conventional Pap smear screening. No research has assessed health outcomes resulting from screening with modern technologies compared with conventional Pap screening. The USPSTF also set poor evidence to determine the benefits and potential harms of HPV screening as an adjunct or alternative to conventional Pap smear screening. However, trials that should clarify the part of HPV testing are underway. It may eventually have a part in primary screening if it can reliably distinguish between women who would benefit from more intensive screening and women for whom screening could be les intensive or flat discontinued.

3. The correct answers are A, B C and D Cigarette smoking is powerfully correlated with cervical dysplasia and cancer, independently increasing risk according to up to fourfold. Infection with high-risk strains of HPV however, is the chiefly important risk factor for cervical cancer. HPV is a necessary nevertheless insufficient precursor of cervical cancer. Factors like as age, nutritional status, immune function, and possibly silent genetic polymorphisms modulate the incorporation of viral DNA into legion cells. Sexual behaviors associated with an increased cervical cancer risk include early storm of intercourse and a greater number of lifetime sexual partners.