FNP perspective supporting an alternate opinion

Science

Please respond to your peer’s posts, from an FNP perspective. To ensure that your responses are substantive, use at least two of these prompts:

  • Do you agree with your peers’ assessment?
  • Take an opposing view to a peer and present a logical argument supporting an alternate opinion.
  • Share your thoughts on how you support their opinion and explain why.
  • Present new references that support your opinions.

Please be sure to validate your opinions and ideas with in text-citations and references in APA format. Substantive means that you add something new to the discussion, you aren’t just agreeing. Be respectful and thoughtful.This is also a time to ask questions or offer information surrounding the topic addressed by your peers. Personal experience is appropriate for a substantive discussion and should be correlated to the literature.Minimum of 100 words.

Tracie’s response:

When is the ideal time to complete a clinical breast exam? What steps would you follow for concerning findings on the clinical breast exam? What age or risk factors indicate the need for a mammogram?

According to the American College of Obstetricians and Gynecologists (ACOG), the American Cancer Society (ACS), and the National Comprehensive Cancer Network, clinical breast exams (BE) should be performed annually in women ages 40 and older (Fuller, Lee & Elmore, 2016). For those who are low risk and women 20-39 years old, unclear recommendations state that these women should have a breast exam every one to three years (Fuller, Lee & Elmore, 2016). Breast exams do not replace routine mammograms for women of indicated age and those that are high risk. A breast exam helps screen for abnormalities such as tumors and cysts. The best time to do a monthly breast exam is while you are off of your period. A woman’s breasts are lumpier when she is on her menstrual cycle making it hard to perform an accurate breast exam (Sullivan, 2016).

When something abnormal is found on a BE, the next step is to make sure you do a good history and physical on the patient and try to determine her risks. If it’s appropriate, a mammogram, breast ultrasound, or a biopsy can be ordered for further diagnostic testing (Fuller, Lee & Elmore, 2016). A biopsy can identify abnormal cancer cells.

The age and risk factors that indicate the need for a mammogram start at age 40. Most of these women have this done annually. Every national society has different recommendations on when women should start mammograms.

For women who are at high risk of breast cancer, screening may begin at an earlier age. This includes women with a familial history of breast cancer. There is a genetic screening tool done in many offices that screen at risk women for cancer. It’s a series of questions asking about familial cancer history and if the women meets criteria, they will go and have their blood drawn and sent off to a lab.

References

Fuller, M., Lee, C., & Elmore, J. (2016, October). Breast Cancer Screening: An Evidence-Based Update. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5064844/ (Links to an external site.)Links to an external site.

Sullivan, D. (2016). Breast Self-Exam. Healthline. Retrieved from https://www.healthline.com/health/breast-lump-self…

Jodie’s response:

Detail the routine health periodicity for the gynecologic and clinical breast exam. What health factors are utilized to determine the need for a Pap test? When is the Pap test no longer necessary?

Routine gynecological and breast exams for women begin at the age of twenty-one. A clinical breast exam is done by a trained doctor or nurse who uses his or her hands to feel for lumps or other changes in the breast (CDC, 2018). This is different from a mammogram that the female patient will need to complete later in life. The patient can perform a self-breast exam; however, it is not encouraged as many women were coming in with false alarms. A woman at average risk for breast cancer should get a mammogram when she is age 50-74 every two years. If she is at an increased risk due to a first degree relative having breast cancer then she should seek screening at age 40 (CDC, 2018). Doing self-exams or clinical breast exams do not lower the risk of breast cancer but can lead to early detection and better outcomes (Clinical Breast Exam, 2016).

Pap examination begins at the age of 21 unless otherwise warranted. The Pap smear looks for precancer cells or changes on the cervix that might become cervical cancer if they are not treated properly. The Pap smear also looks for human papillomavirus (HPV) that can cause these cell changes (CDC, 2019). Between the ages of 21-29 if the Pap is normal the test does not have to be repeated until every three years. Between the ages of 30-65 it is recommended that a woman takes one of three options that are agreed upon with her prescriber. If it has a Pap test only this should be continued every three years. If she desires HPV testing and has normal results this test should be completed every five years. It is most commonly done that a woman will have an HPV test along with a Pap test and if she has normal results than the test only needs to be repeated every five years. Once the woman is 65 or older she does not have to have a Pap test if she has had normal results for several years or had her cervix removed as part of a total hysterectomy for non-cancerous conditions (CDC, 2019). If a woman has a hysterectomy because of abnormal cervical cells or cervical cancer she should continue to get a Pap and HPV test (U.S. Department of Health & Human Services, 2019).

References

CDC. (2018, September 11). What Is Breast Cancer Screening? Retrieved from Centers for Disease Controml and Prevention: https://www.cdc.gov/cancer/breast/basic_info/scree…

CDC. (2019). What Should I Know About Screening? Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/cancer/cervical/basic_info/scr…

Clinical Breast Exam. (2016). Retrieved from National Breast Cancer Foundations, INC.: https://www.nationalbreastcancer.org/clinical-brea…

U.S. Department of Health & Human Services. (2019, January 31). Pap and HPV tests. Retrieved from Office on Women’s Heath : https://www.womenshealth.gov/a-z-topics/pap-hpv-te…

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