Hello everyone,

My name is Salima Enloe, coming to you from Cape Girardeau, MO. I have been a nurse for twelve years. I have worked in many different states and many different organizations. I have been providing care at bedside in various settings including critical care, medical-surgical, emergency department and post-anesthesia.

My husband, who has been working for Procter and Gamble for the past twenty-five years, gave us the opportunity to live in various parts of the world. The most exciting place we have ever lived in was Tianjin, China, a major port city in northeastern China. This was a wonderful opportunity that allowed our family to explore and experience Chinese culture. My first six months in China were spent learning Mandarin. I hired a retired high school teacher who came to my house three times a week and taught me Mandarin the ancient Chinese language for five to six hours a day. It was intense but it was worth it. It made our life in China much easier.

I look forward to getting to know you.

Screening Guidelines

It is through a thorough history and physical exam the clinician will be able to assess patient’s eligibility for preventive services using the Papanicolaou (Pap) test. The clinician needs to fully understand the preventive services and its limitations. The patient population to be considered for Papanicolaou (Pap) test includes all women with a cervix despite their sexual history (U.S. Preventive Service Task Force [USPSTF], 2018). However, women who are at high risk for cervical cancer will need a plan of care tailored to their unique needs and may need to be seen more frequently. The risks for these women include immune-compromised individuals, individuals who have a history of treatment for cervical cancer or precancer lesion, and women who have a history of exposure to Diethylstilbestrol in utero (Schadewald, Pritham, Youngkin, Davis, & Juve, 2020). Women with these risk factors may need to continue their screening well after the age of 65 years old (Schadewald et al., 2020). Once the clinician establishes the patient’s need, the clinician must be prepared to discuss the risks and benefits to ensure the patient is well informed regarding the preventive service. An informed decision reflecting a patient-clinician partnership will result in the implementation of evidence-based preventive service (USPSTF, 2017).

The Pap smear was developed 50 years ago, and it has contributed to the decrease of cervical cancer by 70 percent (Buttaro, Trybulski, Bailey, & Cook, 2017). There are two methods of obtaining a specimen for Pap testing. The first one collects the endocervical cells with cytobrush or cotton swab while a wooden or plastic spatula collects the ectocervical cells and then the specimens are placed on the slides (Buttaro et al., 2015). The second method uses a liquid-based medium (Buttaro et al., 2015). The cells are collected in the same way, but the specimen is placed in a liquid medium and is processed using a centrifuge. The specimen collected using the liquid-based medium allows the provider to add additional test like gonorrhea and chlamydia if needed (Buttaro et al., 2015). The choice of which test to perform is based upon the provider’s preference.

The USPSTF (2018) recommends initiating screening for cervical cancer using Pap smear regardless of their sexual history at age 21. In fact, women who are 21-29 years of age should have a Pap smear every three years. Additionally, USPSTF recommends Pap testing alone for women ages of 30-65years old be performed every 3 years or every 5 years where the patient is provided two tests which include high-risk human papillomavirus (HPV) and a cytology (USPSTF, 2018). Women older than 65 who have had a history of regular screening without negative outcomes without risk factors for cervical cancer do not need to be screened (USPSTF, 2018).

Potential deviation from routine screening frequency can occur for various reasons. One factor that may contribute to this deviation is fear of financial burden related to lack of health insurance coverage (USPSTF, 2018). In fact, 26 percent of women without coverage have not had a Pap test in the past five years (USPSTF, 2018). Also, women who are geographically isolated with minimal access to healthcare may contribute to the deviation in routine screening frequency. This type of situation is seen among the women who live in Appalachia (USPSTF, 2018). On the other hand, deviation from routine screening frequency may be the result of patient preference to opt-out of the service despite the knowledge of the risk and benefits of the service. Finally, deviation from this routine preventive screening frequency may be the result of time constraints of the primary care providers (USPSTF, 2017). Too often primary care providers are limited to the time allocated for each patient, forcing the provider to prioritize patient’s needs according to acuity which can result in deviations in routine screening frequency.

Buttaro, T., Trybulski, J., Bailey, P., & Cook, J. (2017). Primary Care: A Collaborative Practice (5^th ed.). St. Louis, MO: Elsevier.

Schadewald, D., Pritham, U., Youngkin, E., Davis, M., & Juve, C. (2020). Women’s Health: A Primary Care Clinical Guide (5^th ed.). Hoboken, NJ: Pearson Education, Inc.

U.S. Preventive Services Task Force. (2017). Shared decision making about screening and chemoprevention. Retrieved from https://www.uspreventiveservicestaskforce.org/usps…

U.S. Preventive Service Task Force (2018). Cervical cancer: Screening. Retrieved from https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/cervical-cancer-screening