There are many cancers prevalent in women in the US that have various risk factors depending on age, and as nurses it is crucial to advise patients on recommended screening procedures according to their demographics. This is key in helping prevent cancer, or in some cases detect it early so it can be adequately treated. Let’s look at the recommended screening guidelines for the prevention of cancer (specific to women), according to the 2008 Current Practice Guidelines in Primary Care:
Women aged 20-39 are recommended to perform a self breast exam each month, and get a yearly clinical breast exam with their primary physician. For women without family history, it is recommended to start annual mammography from the age of 40, however, many practitioners believe that a baseline mammo should be performed between 35-40 years of age.
For those with a family history, however, your should advise the patient to start screening either 10 years before the detection age of the relative, or at 35, whichever comes first. You should also urge these women to get genetic testing done to look for the BRCA gene.
Cervical cancer is a bit tricky as it is difficult to detect it prior to the irreparable phase of the disease. The number one cause of this cancer is HPV, which is why, after the age of 30 HPV DNA testing is a large part of the general pap test, whether or not any cervical cell changes become apparent. HPV tests are typically not done in women under 30 because it is fairly common to test positive, and this usually resolves itself without any long-term repercussions. Females between the age of 9 and 26 are recommended to get the 3-shot vaccine, Gardasil, developed by Merck to prevent cervical cancer.
More specific guidelines include getting a baseline Papanicolaou (pap) smear to detect cervical changes within three years of first sexual intercourse or by the time a woman is 21, whichever arrives first, and getting annual pap smears between the age of 18-30, especially in the presence of certain risk factors which include multiple sexual partners or HIV infections.
In case the HPV tests come out positive after the age of 30, but cytology is normal, then it is recommended that the pap smear be conducted every six to12 months, and if the cytology is abnormal at this point, you should refer the patient to her gynecologist for a colposcopy.
You should make sure to encourage women who are at high risk for endometrial cancer to get screened annually from the age of 35. A pap smear is designed to detect atypical endometrial cells, at which point you can recommend further diagnostic tests. Endometrial risk factors include:
- Family history of nonpolyposis colorectal cancer-associated genetic mutations, or autosomal dominant predisposition to colon cancer present within the family.
- Post-menopausal status
For ovarian cancer there exist no routine screening procedures for women who do not present with any symptoms. Women without family history of this cancer have a 1 in 70 chance of developing it, but those with a first-degree family history have a 5% chance. This is increased to 40% if the cancer appears in more than one family member.
If you find one or more of the following risk factors in a patient, she should be referred for genetic testing:
- Age of 60 years or above
- Low parity
- History of endometrial, colon or breast cancer
- A family history of ovarian cancer
- Hereditary ovarian cancer syndrome
While these are not the only cancers women are prone to, these are the ones that are exclusive to the gender and you should increase the awareness and need for routine screening among your patients. Cancers like Colorectal cancers are among those that both men and women are at risk for and should be screened for after the age of 40. Apart from this there are certain cancers that do not need routine screening if there are no risk factors, such as bladder, lung, liver, oral, pancreatic, and thyroid cancer.
Prevention is always better than cure, especially with something like cancer, and so healthcare professionals should always be safe rather than sorry and recommend routine testing to their patients.