See Van, a 35-year-old married Hmong-American woman recently underwent an annual Papanicolaou test (Pap smear) at her Certified Nurse Midwife’s practice, and the results were abnormal. Her provider diagnosed her with low-grade cervical dysplasia. What alterations at the cellular level would you expect to see with this diagnosis? Provide and discuss with your colleagues S. V.’s prognosis. Support your discussion with citations from the textbook, external credible literature and/or reliable electronic sources N512- Advanced Pathophysiology – Low-grade Cervical Dysplasia discussion 1.
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According to the American Cancer Society (ACS), sexually active women are encouraged to have a Papanicolaou (Pap) smear test which removes tissue from the cervix for microscopic inspection to find pre-cancerous or cancerous cells (2020.). Cells that appear mildly abnormal is called low-grade squamous intraepithelial lesions (LSIL) (ACS, 2020). The abnormal cell growth provides an environment for the human papillomavirus (HPV) which is responsible for causing over 90% of cervical cancer, the most common type being HPV 16 which causes 50% of all cervical cancer (Cooper & McCathran, 2020). HPV is transmitted sexually with multiple partners increasing the risk of exposure and usually clears within eight to 24 months, but persistent infection leads to dysplasia and can subsequently start a slow progression to cervical cancer over several years (Cooper & McCathran, 2020).
35 year old See Van is Hmong-American, an Asian American community. “The cervical cancer incidence rate among Hmong American women is three times higher than other Asian/Pacific Islanders and more than four times higher than Non-Hispanic Whites” and due to this healthcare disparity, there is an ongoing HPV vaccination initiative in this population (Beltran, et al., 2016). Her diagnosis of low-grade cervical dysplasia would warrant an HPV test and a repeat pap smear in one year. All sexually active women and women between the age of 21-65 should have a routine pap smear at least every three years. In the United States of America HPV has a prevalence of 1 in 4 people within the population (Vaccines.org, 2020). The HPV vaccine has been proven to be effective in preventing cervical cancer and other conditions associated with HPV and recommended from age 9 to 26 and even up to 45 years of age under certain circumstances (Vaccines.org, 2020) N512- Advanced Pathophysiology – Low-grade Cervical Dysplasia discussion 1.
American Cancer Society. (2020). The pap (papanicolaou) test. Retrieved from https://www.cancer.org/cancer/cervical-cancer/detection-diagnosis-staging/screening-tests/pap-test.html
Beltran, R., Simms, T., Lee H.Y., Kwon, M. (2016). HPV literacy and associated factors among hmong american immigrants: Implications for reducing cervical cancer disparity. J Community Health. 2016;41(3):603-611. doi:10.1007/s10900-015-0135-9 Retrieved from https://pubmed.ncbi.nlm.nih.gov/26696118/
Cooper DB, McCathran CE. (Updated 2020 July 17). Cervical dysplasia. StatPearls. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK430859/
Vaccines.org. (2020). (HPV) human papillomavirus. Retrieved from https://www.vaccines.gov/diseases/hpv
Dysplasia is considered abnormal cells. N512- Advanced Pathophysiology – Low-grade Cervical Dysplasia discussion 1 With cervical dysplasia, the cervix’s abnormal cells are identified through a pap smear of women age 21 and older. (Heinzler et al., 2018). Pap smears are considered the standard of care for detecting cervical cancer, although testing remains inaccurate, allowing misdiagnosis and false negatives (Wasswa, Ware, Habinka-Basaza-Ejiri, & Johnes, 2019).
For the case study of S.V., the cellular level changes would be that the pap smear showed atypical or abnormal low-grade squamous cells or low grade squamous intraepithelial lesion (LSIL), which could lead to cervical cancer (Barron, Li, Austin, & Zhao, 2014). These cellular changes can result from being exposed to human papillomavirus (HPV) (Barron et al., 2014). The concern for this patient would be that education regarding the test results, future and further testing, and safe sex practices.
Providing education regarding continued to follow up for cervical cancer with pap smear following the guidelines which would be every three to five years depending on HPV. Possible colposcopy with future testing. Review with this patient if she has or has not had the HPV vaccine. Suppose they did not to consider it. Consider safe sex practices using condoms to help avoid sexually transmitted diseases such as HPV.
Barron, S., Li, Z., Austin, R., & Zhao, C. (2014). Low-grade squamous intraepithelial lesion/can not exclude high-grade squamous intraepithelial lesion (LSIL-H) is a unique category of cytologic abnormality associated with distinctive HPV and histopathological CIN2+ detection rates. American Journal of Clincial Pathology, 141(2), 239-46.
Heinzler, J., Brucker, J., Bruckner, T., Dinkic, C., Hoffmann, J., Dornhofer, N., … Schott, S. (2018, August 3, 1018). Impact of cervical dysplasia and its treatment on quality of life and sexual function. General Gynecology, 298, 737-45.
Wasswa, W., Ware, A., Habinka-Basaza-Ejiri, A., & Johnes, O. (2019). A pap smear analysis tool (PAT) for detection of cervical cancer from pap smear images. Biomedical Engineering Online, 18. N512- Advanced Pathophysiology – Low-grade Cervical Dysplasia discussion 1
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