NUR241 Challenge and Response to Body Integrity 2

Questions:

1. Describe pathophysiology of cervical cancer. What risk factors can you identify in Sarah’s case?

Cervical cancer or dysplasia which is medically known as cervical intraepithelial neoplasia (CIN), is commonly caused by sexually transmitted Human Papilloma Virus (HPV) infections with HPV-16 and HPV-18 being the responsible causal factor for 70% of cervical cancer cases (Craft et al., 2018). Cervical dysplasia is the abnormal and increased growth of squamous epithelial cells within the cervix (Craft et al., 2018). It is a progressive disease which consists of many stages beginning with normal cell growth within the cervix leading to premalignant dysplasia (Johnson et al., 2019). Premalignant cells can last 10-12 years before progressing to severe and invasive carcinomas such as CIN III and carcinoma in situ (Craft et al., 2018). Once the premalignant cells invade the basement membrane, it progresses to invasive cancer and is considered malignant (Craft et al., 2018). Risk factors for Cervical cancers which are evident in Sarah’s case are both her and her husband’s history with multiple sex partners (Williamson, 2017), Johnson et al. (2019) states that the risk doubles with more than two sexual partners and triples with six or more.

2. What are the latest guidelines for cervical screening in Australia? Why has screening changed from two to five years? Provide scientific rationale for the new guidelines.

On 1 December 2017, the National Cervical Screening Program introduced new guidelines to Australian women regarding the future of cervical screening. Previously it was expected for all women aged 18-69 to have 2-yearly pap smear tests (Australian Institute of Health and Welfare [AIHW], 2018), which examines squamous cells within the cervix detecting any precancerous abnormalities before progression into cervical cancer (Williams & Carter, 2017). The latest guidelines include a 5-yearly cervical screening of all women aged 25-69 regardless of being HPV vaccinated or not, and women aged 70-74 will continue with exit screening (Department of Health, 2018). All screenings still include a vaginal speculum examination and collection of cervical samples. However, the testing will use primary HPV testing with partial HPV genotyping and reflex liquid-based cytology triage (Department of health, 2018). Current screening tests for the presence of HPV rather than abnormal cells within the cervix, compared to the 2-yearly pap test the 5-yearly HPV screening decreases the lifetime risk of  cervical cancers (Velentzis et al., 2017). It is estimated to reduce cervical cancer and mortality rates by 30% even with the extended 5-year gap (Department of Health, 2020). Precancerous cells take 10–12 years to generate into cancerous tumours; this data has influenced the change of length between screens (Craft et al., 2018). It has been reported that not all cervical cancers have a precancerous stage such as neuroendocrine cancer (AIHW, 2018), thus meaning the previous pap smear test would not detect the abnormalities of these cancers. Evidence by the AIHW (2018) states 99.7% of worldwide cervical cancer cases test positive for HPV DNA; therefore the updated cervical screening has more successful chances of detecting and preventing cervical cancers by implementing the detection of HPV.