289 Nursing Care of the Postmenopausal Woman, 3rd Edition
Cervical cancer screening The American College of Physicians and the American Academy of Physicians do not recommend pelvic exams be per- formed in asymptomatic, nonpregnant women (American College of Physicians, 2014; USPSTF, 2017). In 2018, the Amer- ican College of Obstetricians and Gyne- cologists determined in their committee opinion #753 that pelvic examinations are necessary only when indicated by the woman’s history or presence of symp- toms. This opinion was reaffirmed in 2020 (ACOG Committee Opinion #754, 2020). Even though the guidelines advise against annual cervical cancer screenings for some women, an annual physical ex- amination is still encouraged so that the nurse/provider can counsel women about maintaining a healthy lifestyle, screen and counsel regarding immunizations, meet the needs for preventive care, and take a comprehensive history (ACOG Com- mittee Opinion 755, 2018). The current practice guidelines for cervical cancer screening, per the ACOG, for women ages 30–65 are to have a Pap and HPV test (called co-testing) every five years, a Pap test alone every three years, or an HPV test alone every five years (ACOG, 2021). Women over age 65 do not need screening if they have no history of abnor- mal cervical changes and have had three negative Pap tests in a row, two negative HPV tests in a row, or two negative co- tests in a row within the past 10 years. It’s important to note that women up to age 65 getting regular testing still need to be screened, even if they’ve had an HPV vac- cine, and may still need to be screened even after a hysterectomy if their cervix was not removed (ACOG, 2021).
Endometrial cancer Endometrial cancer is one of the most common gynecologic cancers. Only breast, lung, and colorectal cancers are more common. The mean age of wom- en presenting at time of diagnosis is 63 years, and 90% of women with endome- trial cancer are older than age 50. Endo- metrial cancers are related to unopposed estrogen. Conditions that put a woman at risk for having excess estrogen include unopposed estrogen therapy, early men- arche, late menopause, tamoxifen thera- py, nulliparity, infertility, failure to ovulate, and polycystic ovarian syndrome (PCOS). Despite the frequency of this cancer, there are no good screening tests. The ACS recommends that all women older than 65 years be informed of the risks of endometrial cancer. The primary symp- tom of endometrial cancer is bleeding or a change in bleeding. All perimenopaus- al and postmenopausal women should be strongly advised of the importance of contacting their provider should they have any abnormal bleeding, especially after the cessation of menopause (ACS, 2019d; CDC, 2021b). Pelvic pain, feeling a pelvic mass, or loss of weight without trying are also symptoms of endometri- al cancer but are more common in later stages (ACS, 2019d; CDC, 2021b). Wom- en with Lynch syndrome (nonpolyposis colorectal cancer) should be tested with an endometrial biopsy annually (CDC, 2021b).
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