There is an identified problem of an increasing number of young women diagnosed with cervical cancer, mostly linked to HPV. There are limited screening tools used to help identify the risk of cervical cancer in adolescents. The feasibility of this topic is to monitor cervical cancer screening with the use of the NP in the primary care setting. HPV vaccination beginning at the age of 11 or 12 is ideal. The HPV vaccine is an acceptable secondary preventative measure for girls and women 11-26.
P : Young adolescent women ages 11-18 seen in a primary care setting by a NP. Identify risks of cervical cancer, provide education to screening, treatment, causes of cervical cancer and encourage early prophylaxis with the HPV vaccination.
I : Screening and treatment of adolescent females in the primary care setting by the NP
C : Lack of education currently provided to adolescents and parents
O : Improved cervical cancer screening in primary care and developed by Nurse Practitioners, decreased risk of cervical cancer caused by HPV, improved education for adolescent females, modify risks and educate on behavior modification
Evaluation of current standard of practice indicated by the CDC
Cervical cancer screening is to start 3 years after onset of vaginal intercourse, but no later than 21 years old
Young females aged 11 or 12 are recommended by the CDC to receive the HPV vaccination. It is pertinent that they also begin receiving screening for HPV that includes counseling and education followed by a physical examination which includes the Papillomavirus test once sexually active.
HPV vaccine does not eliminate the need for screening as 30% of cervical cancers are related to HPV types not covered by the vaccine
Women should continue being screened regardless of vaccine status -The use of a NP in the primary care setting can facilitate the screening of young woman against cervical cancer with appropriate screening tools
A nurse’s role in cervical cancer prevention is to facilitate communication with obtaining a detailed sexual history, provide sexual education, stress the importance of compliance and scheduling follow-up appointments.
The articles that highly contributed to this EBP were two Systematic Reviews and a Meta Analysis
1. Hartman, K., Halls, S., Nanda, K., Boggess, J., Zolnoun, D. (2002). Systematic Evidence Review: Screening for Cervical Cancer. Agency for Healthcare Research and Quality. Retrieved March 19, 2010 from http://www.ahrq.gov/clinic/3rduspstf/cervcan/cervcanrr.htm.
2. La Torre, G., Waure, C., Chiaradia, G., Mannocci, A., Ricciardi, W. (2007). HPV vaccine efficacy in preventing persistent cervical HPV infection: a systematic review and meta-analysis. Vaccine, 25(50). DOI: 10.1016/j.vaccine.2007.09.027
3. Saint, M., Gildengorin, G., Sawaya, G. (2005). Current cervical neoplasia screening practices of obstetrician/gynecologists in the US. American Journal of Obstetrics and Gynecology. 192, 414-421.
4. Smith, J., Backes, D., Hoots, E., Kurman, R., Pimenta, J. (2009). Human Papillomavirus Type-Distribution in Vulvar and Vaginal Cancers and Their Associated Precursors. American Journal of Obstetrics and Gynecology,113(4), 917-924.
5. Stone, E., Morton, S., Hulscher, M., Maglione, M., Roth, E., Grimshaw, J. (2002). Interventions that increase use of adult immunization and cancer screening services: a meta-analysis. Annals of Internal Medicine , 136 (9), 641-651. Retrieved from CINAHL Plus with Full Text database.
6. Sussman, A., Helitzer, D., Sanders, M., Urquieta, B., Salvador, M., & Ndiaye, K. (2007). HPV and cervical cancer prevention counseling with younger adolescents: implications for primary care. Annals of Family Medicine , 5 (4), 298-304. Retrieved from CINAHL Plus with Full Text database.
7. Wheeler, C., Hunt, W., Joste, N., Key, C., Quint, W, Castle, P. (2009). Human Papillomavirus Genotype Distributions: Implications for Vaccination and Cancer Screening in the United States. Journal of the National Cancer Institute, 101(7)475-487.