Cervical cancer is the third most common diagnosed cancer in women. It develops in the thin layer of cells called the epithelium, which covers the cervix. It begins slowly with precancerous abnormalities, and even if the cancer develops, it progresses very gradually. Cervical cancer is preventable and is very treatable in its early stages. Cervical changes are first noted in the results of a Papanicolaou test also known as the “Pap smear”. This paper will discuss the history, applied nursing theorist, the procedure, current research, treatment and education related to the Pap smear.
History of the Pap Smear George Papanicolaou, in 1928, reported that he had found cells that were characteristic of cancer located on the cervix. His findings showed abnormal cytological findings could predict cancer incidence. The majority of his colleagues at the time were not interested in his findings, and they did not want to use them in cancer screenings (“History of Pap Smear”, 2009).
In 1937, Papanicolaou began research on vaginal smears taken from women admitted to gynecological services in New York Hospital. In 1943, he published his findings related to diagnosing uterine cancer by vaginal smears. In his research, Papanicolaou discovered cases of uterine cancer and a large majority of them were cervical cancers. Again, his colleagues were not interested in the importance of these results. However, Mary Lasker, enlisted her husband to help to reorganize the American Society for Cancer Control into a research-funding organization to support Papanicolaou’s cervical cancer research.
Under the leadership of Lasker, the American Society for Cancer Control changed its goals and became the American Cancer Society (ACS). PAPANICOLAOU (PAP) SMEAR TEST 3 The ACS supported Papanicolaou for finding gynecological pre-cancers and cancers (“History…”, 2009).
In 1948, Papanicolaou announced an enhancement of the procedures of how to detect gynecological cancers via his method now called the Pap smear. The ACS embraced the Pap smear as a cancer detection method for women. The Pap smear has become the gold standard diagnostic procedure for cervical cancer (“History…”, 2009). Applied Nursing Theorist Nursing continues to change with advancing knowledge of healthcare, tradition of practice and cultural view of health and medical care. It is a framework for caring for the sick and promoting wellness.
Throughout history, many theorists have left their mark on nursing; Dr.Nola J. Pender is one of those theorists whose work has shaped aspects of nursing practice and will continue to shape it. She believed by improving health and changing unhealthy behaviors; nurses can attain positive health outcomes and optimal well-being for their patients.
Dr. Pender wanted to see nursing, focus on a proactive approach when dealing with the healthcare of others. Doctors and nurses spend so much time and effort addressing the acute and chronic problems of patients that they were unable to tackle the issue of preventive measures. Dr. Pender created the Health Promotion Model as her nursing theory.
Health Promotion in Nursing Practice demonstrates how it focuses on health promotion and health protection. (Pender, 2009). She desired to see people live productive and happy lives and knew it is much easier to accomplish this through keeping people from being sick in the first place. Through education and development of healthy habits, nurses can empower individuals to move towards a healthy and productive live. PAPANICOLAOU (PAP) SMEAR TEST 4 Health care providers and nurses can encourage health screening tests as part of Pender’s Health Promotion Model. Health related problems are monitored through health screenings.
Health screening tests are conducted routinely as a preventive measure or done when there is reason to suspect a particular health problem exists. There are numerous health screening tests completed throughout a person’s life. One of these screening tests is the Pap smear. This test is for women during adulthood that screen for abnormal cervical cells that can lead to cervical cancer. Finding these abnormal cells early with a Pap smear is the first step in stopping the possible development of cervical cancer. Providers should educate women on the importance of this health screening test and the many others to help promote health.
The Screening Tool Prior to a Pap smear, the patient should understand the need for the procedure and given instructions on how the procedure is performed. The procedure is best performed during mid- cycle, and the patient should avoid douching, vaginal medications, and intercourse for 24 hours prior to the procedure decrease the chance of false findings. During a Pap smear procedure, the patient is put in the lithotomy position, and a speculum is used to help visualize the cervix to assess the area for any visual changes.
Then with a special tool the cells from the cervix are obtained from the transformation zone of the cervix, the sample is sent to the lab for examination for abnormalities. The abnormalities can include cancer cells and defective cells which increase the risk of cervical cancer (Pfenninger, & Grant, 2010). Research Studies There have been numerous research studies related to pap smears; three studies are described in this section. One study conducted among 27-37-year-old Korean women to further PAPANICOLAOU (PAP) SMEAR TEST 5 understand the underlying context of barriers to Pap smear.
The study performed because the efforts to increase the rates of the Pap smear have not been the effect among Korean women. The women were organized into four focus groups to analysis their feelings and attitudes toward Pap testing. The results analyzed, and the researchers developed contextual themes of barriers. The barriers identified under the categories of misunderstandings attribute to women’s experiences of Pap smear testing and issues related to the health care (Park, Chang, Chung, 2006). The findings of this research study provide a reflection of reality; nursing practice should
increase patient privacy and patient satisfaction, which were the two biggest barriers. In conclusion, the study successfully identified the Pap smear testing obstacles in Korean women, which can be applied to nursing practice today. The second research reviewed was completed in Australia. The National Cervical Screening Program (NCSP) in Australia recommended routine Pap smears every two years for sexually active women age 18-70 years. Due to health outcome and costs the researchers wanted to study if three years intervals would be sufficient.
The NSCP examined data from the Victorian Cervical Cytology Registry from 1997-2007 under current criteria and reviewed data from other countries registries with a three-year recommendation. The three-year recommendation did not reveal any substantial differences in the incidences of cervical cancer cases or deaths, and there was a significant cost saving (Creighton, Lew, Clements … & Canfell, 2010). The third research reviewed concurrent HPV testing and cervical cytology (co-testing), approved for women 30 years and older and it safety for a five-year screening intervals.
The researchers analyzed five-year cumulative incidence of cervical cancer and CIN 3+ in women 30 years or older enrolled in co-testing from 2003-2009. It was interpreted safely for women with a PAPANICOLAOU (PAP) SMEAR TEST 6 negative HPV/Pap test to have testing at three-year intervals. So it was suggested that five-year intervals would be safe to (Katki, Kinney, Fetterman … & Castle, 2011).
Education and Treatment A Pap smear screens for cervical cancer, but an abnormal result also can be caused by infection, menses, sexual activity, medication and other viruses. The 2006 Consensus Guidelines for the Management of Women with Abnormal Cervical Cancer Screening Tests are used to help guide the provider with an abnormal Pap test result (Buttaro, Trybulski, Polgar-Bailey, & Sandberg-Cook, 2012). Normal Test Results If a patient has a normal Pap smear results, follow up, and testing determined by the patient’s age.
The following addresses further testing according to age: ?<21 years old does not need cytology testing again until 21. ?21-29 years old will need cytology testing every three years. ?30-65 years old will need HPV and cytology “contesting” every five years is preferred or cytology screening every three years which is acceptable.?>65 years old no further testing if no CIN2 or severe diagnosis in the past. ?If a patient has a hysterectomy then no further testing required if no CIN2 or severe diagnosis in the past (Buttaro et al. , 2012).
Abnormal Test Results The Bethesda system of classifying Pap tests was developed by the United States National Cancer Institute to provide more comprehensive information about Pap test results. Lab personnel examine cervical cells; they use this system to report the lab results to healthcare providers. The lab report will describe the sample as normal or abnormal.
The most common abnormal Pap smear result is atypical squamous cells of undetermined significance (ASCUS) or PAPANICOLAOU (PAP) SMEAR TEST 7 atypical squamous cells that cannot exclude high-grade squamous intraepithelial lesion (ASC-H). These are cells show minor changes but the causes are unknown. Women with this result needs a repeat Pap at 6 and 12 months, or the provider may precede directly to colposcopy, either is an acceptable approach. The preferred approached by the American College of Obstetricians and Gynecologists (ACOG) is to test of HPV DNA, if positively do colposcopy or if negative repeat test in 12 months.
Atypical squamous cells, cannot rule out high grade (ASC-H), is associated with high-grade lesions and requires a colonoscopy (Buttaro et al. , 2012). Cells showed minor changes but weren’t likely to become cancer are typed as low-grade squamous intraepithelial lesion (LSIL). Cell was more severe and more likely to become cancer typed as high-grade squamous intraepithelial lesion (HSIL) or atypical glandular cells (AGC). Then there are also squamous cell carcinoma, endocervical adenocarcinoma in situ and adenocarcinoma which are cancers.
Someone with a result of LSIL will have a colposcopy to determine the extent of the cell changes. This result is not cancer, but it is likely to turn into cancer, if left untreated. HSIL is also not yet cancer, but a woman with this result will typically have an immediate loop electrosurgical excision procedure (LEEP) or Colposcopy with endocervical assessment to confirm the diagnosis. AGC will require a colposcopy and endocervical sampling if ? 35 years or at risk for endometrial neoplasia. Patients with a confirmed diagnosis of cancer will need to have a hysterectomy (Buttaro et al. , 2012).
If the biopsy of the cells from the cervix shows that the cells have CIN-2 or more severe abnormalities, further treatment is probably needed depending on a woman’s age, pregnancy status, and future fertility concerns. Without treatment, these cells may turn into cancer. Treatment options include the following: PAPANICOLAOU (PAP) SMEAR TEST 8 ?LEEP (loop electrosurgical excision procedure), in which an electrical current passed through a thin wire loop acts as a knife to remove tissue ?Cryotherapy (destroying abnormal tissue by freezing it ) ?
Laser therapy (use of a narrow beam of intense light to destroy or remove abnormal cells) ?Conization, the removal of a cone-shaped piece of tissue using a knife, a laser, or the LEEP technique. (National Cancer Institute, 2014) The screening guidelines call for women who have been treated for CIN-2 or more severe abnormalities to continue testing for at least 20 years, even if they are over 65 (National Cancer Institute, 2014) HPV Testing HPV, which is a sexually transmitted disease, is the leading cause of abnormal Pap results.
There are over 100 types of HPV, and about 30-40 types transmitted sexually and recognized as genital HPV. Most genital HPV types cause no harm, some cause genital warts, while others cause changes to the cells of the cervix that do not cause cancer. When a Pap smear is abnormal, an HPV DNA test is used to identify the presence of HPV. The test looks for types 16 or 18, which is present in the cause of 70% of cervical cancers. A vaccine has been developed to protect against HPV (Buttaro et al. , 2012).
Conclusion Tremendous strides in reducing the rate of cervical cancer. However, women continue to be stricken by a disease that is potentially preventable and curable. The women who remain most susceptible to the development of cervical cancer are those who are lost to screening or who do not receive screening at all. Healthcare providers need to review the Pap smear history for all women to make sure they are being screened as recommended References American Cancer Society (2014), Cervical Cancer:
Prevention and Early Detection, PAPANICOLAOU (PAP) SMEAR TEST 9 Retrieved from http://www. cancer. org/acs/groups/cid/documents/webcontent/ 003167- pdf. pdf Buttaro, M. , Trybulski, J. , Polgar-Bailey, P. , & Sandberg-Cook, J. (2012). Primary Care: A Collaborative Practice. Elsevier Health Sciences. Kindle edition. Creighton, P. , Lew, J. , Clements, M. , Smith, M. , Howard, K. , Dyer, S. , Lord, S. , and Canfell, K. (2010). Cervical cancer screening in Australia: modeled evaluation of the impact of changing the recommended interval from two to three years. BMC Public Health 10(7).
History of the Pap Smear (2009) Wellsphere. Retrieved from http://www. wellsphere. com/ women-s-health-article/history-of-the-pap-nbsp-smear/713904 Katki, H. , Kinney, W. K. , Fetterman, B. , Lorey, T. , Poitras, N. E. , Cheung, L. , Demuth, F. , Schiffman, M. , Wacholder, S. , & Castle, P. E. (2011). Cervical Cancer Risk for 330,000 Women Undergoing Concurrent HPV Testing and Cervical Cytology in Routine Clinical Practice. Lancet Oncology, 12(7), 663-672, doi:10. 1016/S1470-2045(11)70145-0.
National Cancer Institute (2014) Pap test fact sheet. Retrieved from www. cancer. gov/ cancertopics/ factsheet/ Detection/ Pap-test Park, S. , Chang S. , Ching C. (2006). Context of barriers to Pap testing in Korean women. Applied Nursing Research, 19 177-181. Pender, N. J. (2009). Most Frequently Asked Questions about the Health Promotion Model and my Professional Work and Career. Retrieved from http://sitemaker. umich. edu/pender. health. promotion. model/files/faqs. pdf Pfenninger, J. L. & Grant C. F. (2010). Pfenninger and Fowler’s Procedures for Primary Care: Expert Consult. Elsevier Health Sciences. Kindle Edition.