Module 2 (a) Flashcards
1
Q
Reasons for Health Promotion?
A
- Modifiable, behavioral risk factors are the leading causes of death for women
- Smoking-related illness
- Overweight or obesity
2
Q
Preventive Health Services for women Under the AÇA?
A
- Well-woman physical exam (W/ recommended counseling, screening, and immunizations
- Contraceptives
- Breastfeeding support (including breast pumps)
- Maternity and newborn care
3
Q
Heart Disease, Cancer and Women
A
- Heart disease is the leading cause of death in women in the US
Risk Factors
-Obesity
-Smoking/Tobacco Use
-At-risk drinking (greater than 3 drinks per day or 7 drinks per day)
4
Q
Immunization Considerations
A
- HPV - Males and females ages 9-26 — Shared Decision making is utilized above age 26 to weigh risks and benefits
- Influenza - given yearly to all women, including pregnant women
- Hep B - Given at birth or age 11-18 — Booster required if woman is not immune or is high risk (IV drug use, healthcare)
- Tdap booster every 10 years and during pregnancy (Given between 27-33 weeks)
- Pneumococcal — Given to women >65 yrs old (Younger if they have chronic diseases
- Covid — Given to pregnant and breast feeding women
- Varicella and MMR are Contraindicated in pregnancy because they are LIVE vaccines
5
Q
Self Breast Exams
A
- NO requirement for clinicians to teach women how to perform BSE. (Risk for false positive test results
6
Q
Clinical Breast Exam
A
- Every 1-3 years starting at age 20
- Every year starting at age 40
- Recommended more frequently with a strong family hx
7
Q
Mammograms
A
- USFSTF recommends biennial screening mammography for women aged 50-74.
- For women 40-49, the decision to start screening should be made through shared-decision making
8
Q
Cervical Cancer
A
- Begin screening at age 21
- Screening Tests include
- PAP test every 3 years
- 30-65 yrs = PAP + HPV DNA “co-test” every 5 years - End screening age 65 or after hysterectomy for benign indications
- Any patient w/ a cervix should undergo routine cervical cancer screening
9
Q
Chlamydia and Gonorrhea Infection
A
- ALL sexually active patients aged 24 yrs or younger AND individuals 24+ who are at risk for STIs
- Test: Nucleic Acid Amplification Tests (NAATs)
- Risk factors: Age, hx of STIs, new or multiple sexual partners, exchanging sex for money or drugs, no monogamous relationships who do not use condoms consistently, and specific communities
10
Q
HIV Infection Screening
A
- All adults aged 15-65 yrs old
- Screen all pregnant women
- Screen younger adolescents and older adults who are at increased risk for infection
- One-time screen for all patients aged 15-65 to ID existing disease w/ follow up testing based on risk factors
- Pregnancy: Screen at New OB visit and consider repeat screening in 3rd trimester (Risk factors vs. state mandated screenings)
11
Q
Sexual Health Hx
A
- Partners — How many Partners and are they men, women, or both
- Practices — What type of sex do they have — be descriptive
- Past Hx of STDs
- Protection from STDs
- Pregnancy Plans
12
Q
General Physical Exam
A
- Patient is in control of the Exam — TRAUMA informed care — Treat each patient as if they have trauma
13
Q
GYN Exam Ages 19-39
A
- FOCUS on reproductive life plan, contraception, pre-conception plan, and exercise
- HPV and Influenza Vaccination
- Screen for STI, and Cervical Cancer
- Physical Exam:
- Initiate speculum exam w/ PAP at 21
- 30-39 co-test PAP + HPV q5 years
- Clinical breast exam (q1-2 years)
14
Q
GYN Exam Ages 40-65
A
- FOCUS on perimenopause Sx’s, age-related metabolic changes, physical changes and Exercise
- Immunizations:
- Shingles Vaccine Ages >50 yrs and compromised immune system
- Pneumococcal for those w/ asthma and COPD ; COVID and annual influenza offered as well - Screening for — STIs, cervical cancer, mammograms offered w/ shared decision making
- Physical Exam
- 40-65 yrs Co-test PAP + HPV q5 years
- Clinical breast exam (q1-2)
15
Q
NEXT SLIDES ON GYN CANCERS
A
NEXT SLIDES ON GYN CANCERS
16
Q
Cervical Cancer
A
- 4th most common cancer in women worldwide — Caused by HPV
- Risk Factors — Multiple sex partners, immunosuppression, cigarette smoking, HPV or STI infection, inadequate screening/Gyn care
- Sx’s include — Abnormal DC, watery DC, abnormal vaginal bleeding, post-coital bleeding
- Many women w/ early cervical CA are asymptomatic
17
Q
Updated Cervical Cancer Screening 2018
A
1. Cervical cytology alone q3 years OR 2. hrHPV testing alone q5 years. OR 3. Co-testing (hrHPV testing and cervical cytology every 5 years)
Guidelines are changing as the evidence is updated
18
Q
ASCCP RISK-Based MGMT for Cervical Cancer
A
- Risk based rather than results based
- More individualized
- Estimates patients immediate risk of pre-cancer based on type and duration of HPV infection
19
Q
Breast Cancer
A
- 1/8 women will be diagnosed with breast cancer in their lifetime
- High Risk Women (Fam hx or familial cancer hx) OFFER genetic counseling and genetic testing
- Sx’s
- Breast mass, swelling, skin changes (dimpling, thickening), pain, nipple retraction or discharge - Screening — Clinical breast exams (q1-3 years), mammography, breast self awareness — ALL should be SHARED-DECISION MAKING
- Begin 40-50 yrs
- Frequency - 1-2 years
- DC at age 75 or life expectancy <10 yrs
20
Q
Endometrial Cancer
A
- Cancer of the lining of the Uterus
- Most Common in POST-MENOPAUSAL Women — Uncommon <45 yrs of age
- Sx’s —Persistent abnormal Vaginal Bleeding **
- Risk Factors — Obesity, PCOS, estrogen replacement therapy, pelvic radiation
- NO recommendation to screen low risk women
- Ask ALL post-menopausal women about abnormal bleeding
- Refer to GYN for endometrial biopsy
21
Q
Ovarian Cancer
A
- Responsible for MORE deaths than any other GYN cancer
- Risk Factors
- Age, BRCA 1/2, Fam hx (familial cancer syndromes), infertility treatment, Nulliparity, breast cancer - Sx’s — Vague, bloating, pelvic pain, urinary urgency/frequency, abdominal pain or mass in later disease
- REFERRAL when Adnexa mass is palpated on bimanual exam
22
Q
Vulvar Cancer
A
- 4% of all GYN cancers.
- Risks include: Post-menopausal, HPV infection
- Sx’s — Mass or lump on vulva, prolonged/persistent vulvar pruritus
- Screening — Careful exam of the vulva, vagina, perineum, inguinal lymph node assessment
- Treatment/Referral: Lesions or persistent Sx’s should be biopsies, refer to Gyn for colposcopy, imaging and treatment
23
Q
NEXT SLIDES: CERVICAL CA SCREENING
A
NEXT SLIDES: CERVICAL CA SCREENING
24
Q
HPV
A
- Spread through sexual contact
- Associated w/ anogenital cancer (Including vaginal, anal, vulvar
- 150 HPV subtypes —13 known to cause cervical cancer
- HPV 16/18 are MOST frequent and account for 80% of cervical cancers
- 90% of Genital warts are caused by HPV subtypes 6 & 11
25
Q
HPV Vaccination
A
- Ideally given ages 11-12
- Ages <15 — 2 doses 6-12 months apart
- Ages >15 — 3 dose series given over 6 months
26
Q
HPV Prevention Through Vaccination
A
- Risk factors
- Male partner w/ HR HPV
- Parter who is a sex worker
- Cigarette smoking
- HIV Co-infection
- STI co-infection - Decreased Risk
- HPV vaccination
- Evidence based screening
- Monogamy
- Healthy diet
27
Q
Cervical CA is the 4th most common cancer in women worldwide
A
- Peak incidence - 45-55 years old
- Increasing incidence in young women
- Cervical Intraepitherlial Neoplasia (CIN)
- Cervical pre-cancers
- rates of CIN are more common than invasive cervical cancer
- Incidence rates — #1 latina, #2 African Americans, #3 Caucasian
28
Q
PAP Sample Collection
-Patient Education
A
- Avoid intercourse x 48 hrs prior
- Do not use vaginal meds/lubricant, creams, douches x 48 hrs prior
- Avoid collection during menstruation
- Use lubricant sparingly
29
Q
What does Screening Identify?
A
- Cervical cell changes (Precancerous or cancerous)
- High Risk HPV infection
- Abnormal growth on the surface of the cervix or endocervical canal
- Cervical intraepitherial neoplasia (CIN) aka displasia
30
Q
Cervical Intraepithelial Neoplasia (CIN)
A
- CIN 1 = Low-grade lesion — typically regresses back to normal
- CIN 2 = equivocal — often regress like CIN 1
- CIN 3 = High grade lesion — Immediate cancer precursor — 10 -20% progress to cancer WITHOUT TREATMENT
- CIN 3 TO Cancer time averages 8.1 -12 years
31
Q
Updated Cervical Cancer Screening TEST and QUIZ
A
- Women age <21 yrs — NO Screening
- Women age 21- 29 years — Cervical cytology along every 3 years
3. Women aged 30-65 years —Cervical Cytology alone every 3 years OR —hr HPV testing along every 5 years OR —Co-testing (hrHPV testing and cervical cytology every 5 years
- Women aged >65 years w/ adequate prior screening — NO screening
32
Q
Screening Options
A
- Cytology alone — High specificity but lower sensitivity and lower predictive value than hrHPV testing
- PREFERRED Method for women age 30-65 years (Co-testing w/ Cytology + HPV DNA)
- Primary HPV Testing
- Tests for 14 types of high risk HPV and Specifically test for types 14 & 18 - Start screening at age 21**
- Age 21-29 — Cytology alone every 3 years
- Age 30-65
- Cytology alone every 3 years
- FDA approved Primary HR HPV testing every 5 yrs
- Co-testing (Cytology +hrHPV) every 5 yrs
- Cytology alone acceptable every 3 yrs only if co-testing or primary HPV screening are NOT AVAILABLE
33
Q
Immunocompromised Individuals
A
- HIV Positive <30 y/o
- Begin screening w/in 1 year of sexual activity or age 21
- 3 annual, negative tests followed by q3 year screening
- HPV not recommended
- Cytology only with +HIV, then annually - HIV positive >30 y/o
- Co-test q3 years for life**
34
Q
Strategies for Mgmt of Abnormal PAP results (ASCCCP 2019)
A
- RISK-based mgmt vs result based mgmt
- Algorithms are no longer useful
- Use the PAP APP***
- Follow up is based on the individual probability of having CIN 3 or greater based on current results and past hx
- Tx options include — Colposcopy, treatment, or surveillance
