Past Issue: January 2010 Vol. 8, No. 12
Starting with this issue of Women’s Health Care, we will be publishing some of the posters and abstracts presented at the NPWH Conference held in Providence, Rhode Island, in October 2009. We begin with the three prize-winning entries: two posters sharing first place and one poster in second place.… Read More
Of the more than 40 strains of human papillomavirus (HPV) transmitted directly from sexual activity, 14 are associated with more than 99% of cervical cancers and high-grade cervical precancerous lesions detected in the United States. The incidence of cervical cancer ranks among the top 5 types of cancers… Read More
This abstract was tied for first place. The study's objectives were to: describe the issue of non-compliance with Pap smear surveillance in high-risk adolescents; understand the significance of inadequate follow-up for abnormal Pap smear findings in adolescents; discuss strategies to improve overall… Read More
This second prize winnting poster's purpose was to study the advice that women whose child had died before birth are given concerning a suitable time in the future to become pregnant again, and to investigate how these women interpreted this advice. Read More
Following publication of the results of the Women’s Health Initiative (WHI) hormone studies, numerous articles were written about the benefits and risks of postmenopausal hormone therapy (HT). Although limited by the facts that only one dosing regimen of one type of oral estrogen (conjugated estrogens,… Read More
Despite the high prevalence and mortality of cardiovascular disease (CVD) in the United States, many members of the public and the healthcare community still view CVD as a problem primarily affecting men. Awareness of women’s cardiovascular health risks may help nurse practitioners take advantage of… Read More
Human papillomavirus (HPV) infection is the most common sexually transmitted infection (STI) in the United States; more than half of sexually active females in this country contract it at some point in their lifetime. The incidence of other STIs is rapidly rising in young females, which may have implications… Read More
Other Features
Loretta Goodwin, NPWH’s corporate liaison from Solvay Pharmaceuticals, died on October 22, 2009, at the age of 57. She had breast cancer. Loretta was a firm supporter of nurse practitioners and their important role in providing women’s health care. Loretta was kind and caring, and always focused… Read More
Unity is Just Good Business
Since it is customary for nurse practitioners (NPs) to encourage each other in the workplace,
... Read MoreFrom the Editorial Co-Directors
In the past month, two sets of screening guidelines for women have been issued—one about Pap tests and the other about mammograms. The Pap test guidelines seemed to slip below the radar, but the mammography guidelines have created quite an uproar.
Starting with the less controversial recommendation…the cervical cancer screening guidelines issued by ACOG have increased both the age at which screening begins and the intervals between tests. This past summer, two NPWH board members and I attended a meeting at the NIH to review data about cervical cancer screening for adolescents. Starting at age 21 actually makes sense. Cervical cancer before age 21 is extremely rare. Abnormal Pap test results in this age group are primarily the result of a transient HPV infection. Furthermore, when abnormal results are found, clinicians are duty bound to do something about it. When that something is a LEEP or other procedure, it can compromise a woman’s future ability to achieve and maintain a healthy pregnancy. Cervical cancer is a slow-growing disease. The downside of delaying screening until age 21 and increasing the inter-screening interval is small.
Mammography and self-breast exam (SBE) guidelines from the US Preventive Services Task Force are another story. Teaching SBE enables women to know their own body, and it conveys the message that body awareness is good and healthy. Also, the recommendation against teaching SBE was based on a large study in Shanghai and one in Russia.
The most controversial recommendation was the one that women, unless they are “high risk,” should defer getting a baseline mammogram until age 50. The rationale is that the number of false-positives in women in their 40s has caused unnecessary anxiety, follow-up procedures, and extra costs. I’d be willing to bet that, if put to a vote, most women would be happy to deal with a false-positive test result if it meant that another woman’s life would be saved by earlier detection of a potentially lethal breast cancer.
Data underlying the new breast cancer screening recommendation are quite different from those underlying the cervical cancer screening guideline changes. The diseases are very different. Breast cancer may take 8-10 years, on average, to become detectable, but when it is detected, it needs to be treated—not in 10 years, but now. According to the National Cancer Institute, 1 of every 69 women aged 40-49 years will get breast cancer. Also, only 80% of breast cancers are related to a family history and only 10% are due to BRCA1/2. If only “at-risk” women in their 40s are screened, some women with potentially treatable breast cancer will not be diagnosed until after their first baseline mammogram at age 50, at which point the disease may have progressed too far to ensure a good outcome. The American Cancer Society is strongly opposed to the USPSTF recommendations. Even the DHHS says that women should continue doing what they’ve always done.
So, I suggest that we NPs keep doing what we’ve been doing for our patients in terms of breast cancer screening, but that we adjust our practice for cervical cancer screening. I direct you to the NPWH website (http://www.npwh.org/) so that you can keep up with the latest screening recommendations and the reactions of major health organizations to them.
Best wishes for a healthy and happy holiday season!
Susan Wysocki, WHNP-BC, FAANP
President and CEO, NPWH