ORIGINAL QUESTION:

Shelby is a 32-year-old mother of two, who has smoked 1 pack-per-day for the last 15 years, and who comes to see you today for her yearly well-woman exam in your family practice clinic.  She has a family history, in a single paternal grandmother of breast cancer at age 52.  She also has a history of an abnormal cervical cancer screening three years ago requiring colposcopy. 

Given her history please consider the following:

Choose one screening test that might be considered either now or in the next few years of Shelby’s care.  Define the test, its positive predictive value, reliability and validity. 

ANSWER BY COURSE HERO:

              Cervical conization involves the removal of the entire transformation zone and endocervical canal. This procedure can be used to diagnose abnormal pap smear/test. Therefore it is referred as cone biopsy, and a screening test I would consider for Shelby.

              Diagnostic cervical biopsy leads to an accurate diagnosis and decreases the incidence of inappropriate therapy like cytology is highly suggestive of dysplasia; micro invasive carcinoma is found on directed biopsy. A dilute solution of acetic acid in water was found to be outstandingly effective in clearing of the cervical mucus, although the positive predictive values substantially increased the probability of infection to around 80% (Tabor & Berget, 1990).

             Cone biopsy have proven to be of high accuracy in revealing the maximal severity of histological findings, hence found to be reliable method of predicting residual carcinoma within the walls of the uterus. There are two diagnostic alternatives to the less cervix-conserving conization. The colposcopically directed biopsy plus endocervical curettage have proven to be a diagnostic method of accuracy and reliability in the histological evaluation of pathological cytology. It is therefore preferred in the very young female population, since it is a non-mutilating procedure. 

References

Tabor, A., & Berget, A. (1990). Cold-knife and laser conization for cervical intraepithelial neoplasia. Obstetrics & Gynecology, 76(4), 633-635.Villasanta, U., & Durkan, J. P. (1966). Indications and Complications of Cold Conization of the Cervix: Observations on 200 Consecutive Cases. Obstetrics & Gynecology, 27(5), 717-723.

Tabor, A., & Berget, A. (1990). Cold-knife and laser conization for cervical intraepithelial neoplasia. Obstetrics & Gynecology, 76(4), 633-635.

 

QUESTION TO ANSWER BASED ON INFORMATION ABOVE:

Upon the course of your history you find out that Shelby has a great aunt on her mother’s side who died of ‘some woman cancer in her stomach’ and an uncle on her father’s side who died of pancreatic cancer.  Her mother and older sisters are all in good health. Does this information change your recommendations for screening?  Why or why not?