Goals - Community Health Center Association of Mississippi



LogoFQHCEffective DateRevision DateReview DateApproved byPROTOCOL TITLECervical Cancer ScreeningApproval DatePage1 of 2l. Definition: The Papanicolaou (Pap) smear is a screening test for cervical cellular pathology. A pap smear involves collecting cells from the cervix. The abnormal pap can range from benign cellular changes to suggestion of invasive cancer. Early detection of cervical cancer is the first step in halting possible development of cancer and provides a better chance for cure.GoalsTo provide comprehensive women’s health care for early detection of cervical cancer in accordance with the current guidelines, including the American Congress of Obstetricians and Gynecologists (ACOG), United States Preventive Service Task Force (USPSTF), American Cancer Society (ACS), American Society got Colonoscopy and Cervical Pathology (ASCCP), and the American Society for Cervical Pathology (ASCP).Diagnostic Criteria: N/ABaseline Assessment: Screening criteriaCervical cancer screening should begin at age 21. Liquid-base cytology is recommended every 3 years for patients 21 – 29 years of age.Women age 30 and older with 3 consecutive cytology test results that are negative for intraepithelial lesions and malignancy may be screened once every 5 years.Women with HIV should have cervical cytology screening twice in the first year of diagnosis and annually thereafter if screening remains within normal limits.Women treated for cervical intraepithelial neoplasia (CIN) 2, CIN 3 or cancer remain at risk for at least 20 years after treatment, and should continue annual screening for at least 20 years.Upper age limit for discontinuation of screening: it is reasonable to stop cervical cancer screening at age 65 or 70 among women who have 3 or more consecutive negative cytology results and no abnormal test results in the past 10 years.For women with hysterectomy:Screening should be discontinued for those with total hysterectomy for benign indications and have no prior history of high-grade CIN routine cytology.Annual screening is recommended for women who have had high grade squamous intraepithelial lesion (HSIL) before hysterectomy, as recurrent intraepithelial neoplasia or cancer at the vaginal cuff can occur (vaginal Pap smear).Screening should be continued for women who have had hysterectomy with removal of the cervix and history of CIN 2 or CIN 3, or in whom a negative history is not documented.Cervical TestingLiquid-base cytologyGeneral physical examination, including breast examinationContinuing Assessment:Based on cervical cytology resultsReferral as indicated following 2001 Bethesda System Classification (Appendix)Plan:Patient Education:Patient education, including disease process, management and treatment based on 2001 Bethesda System Classification (Appendix).Document self-management goal setting with the patient in accordance with the baseline assessment screening recommendations.Management:As indicated by 2001 Bethesda system classification (Appendix)Notify the patient of pap results within 30 days of test completion. Patient notification must be documented.If pap is done elsewhere, verbal or written report is documented noting date, place and results.Medications: for possible bacterial or fungal infection on cytology reportMetronidazole (Flagyl?)Metronidazole gel (MetroGel?)Miconazole (Monistat?)Fluconazole (Diflucan?)Conjugated Estrogen (Premarin?) vaginal creamOther medications for management of cervical cytology atrophic, bacterial or fungal findingsReferral:Gynecologists for management of abnormal cytologyCompletion of additional evaluation and/or treatment must be documented within 90 days of diagnosis.Codes:ICD-9ICD-10Routine gynecological examV72.31Z01.411 or Z01.419PAP Smear CervixV76.2Z12.4HPV screeningV73.81Z11.51Vaginal Pap Smear s/p hysterectomy non-malignantV76.47Z12.72Vaginal Pap Smear s/p hysterectomy for malignantcondition (Follow up)V67.01Z08Screening Exam for Venereal DiseaseV74.5Z11.3Reference:American College of Obstetricians and Gynecologists Cancer screening guidelines 2012.Solomon Davey et al. 2001 Bethesda System: terminology for reporting results of cervical cytology. JAMA. 2002; 287:2114-9.HRSA Health Disparities Cancer Collaborative: Phase 2 measures 2006.Clinical Consideration Algorithms reprinted from the Journal of Lower Genital Tract Disease Vol. 11 Issue 4, with permission of ASCCP American Society for Colposcopy and Cervical Pathology 2012. No copies of algorithms may be made without the prior consent of ASCCP.Links:, 2015, Cervical Cancer Screening Recommendations from United States Professional Organizations. ................
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