Essential Women’s Health Screenings Under the Affordable Care Act

NUR514 Discussion 1

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After studying Module 1: Lecture Materials & Resources, discuss the following:
It’s important to begin your reflection by connecting what you’ve learned in the module to real-world applications in women’s health. Thoughtful engagement with these concepts helps solidify your understanding and prepares you for clinical reasoning in practice.

Name and discuss four prevention essential health benefits for women that must be covered under the Affordable Care Act.
For women in the age range of early adulthood, describe the psychosocial development.
Take a moment to think about how this developmental stage influences not only health behaviors but also the nurse-patient relationship.

As a Nurse Practitioner, explain what you believe would be the most appropriate clinical education and interventions for a patient in that age range. Base your answer on the most common normal and pathological situations women face during early adulthood. Consider how holistic and culturally sensitive approaches can make a difference in promoting better health outcomes.

Define and give an example of Primary, Secondary, and Tertiary prevention in Women’s Health. Add insight into how each prevention level uniquely supports wellness and disease management across the lifespan.

You’ll be using the following textbook to guide your discussion:
Schuiling, K. D., & Likis, F. E. (2022). Gynecologic Health Care: with an Introduction to Prenatal and Postpartum Care (4th ed.). Jones & Bartlett Learning.

Focus on Chapters 1–6 and Chapter 11 as you respond. Allow these readings to anchor your clinical reasoning while integrating evidence-based perspectives from additional scholarly sources.

Your initial post should be at least 500 words, formatted and cited in APA 7th edition style, supported by at least two academic sources. Aim for depth, clarity, and meaningful application of the material. Remember, your initial post is worth 8 points, so invest time in crafting a thoughtful and well-supported response.

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United States Preventive Services Task Force (USPSTF)

Following the guidelines of the United States Preventive Services Task Force (USPSTF), discuss and describe the screening recommendations for the following:
Cervical cancer
Breast cancer
Osteoporosis
Colorectal cancer
Lung cancer
Ovarian cancer
Intimate partner violence (IPV)

Each of these screening areas plays a crucial role in the early detection and prevention of diseases that significantly affect women’s health outcomes. You’re encouraged to think critically about how these recommendations inform your clinical practice and decision-making.

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Submission Instructions

The paper should be clear, concise, and professionally written. It’s always a good idea to proofread carefully before submitting to ensure accuracy and flow.

Students will lose points for improper grammar, punctuation, and misspellings. The paper should be 3–4 pages in length, excluding the title and reference pages. Remember, a well-organized paper reflects not just content mastery but also your attention to scholarly communication.

Your work must be formatted according to APA guidelines, and it will be reviewed through Turnitin for originality. Maintaining academic integrity is essential, as it reflects the ethical standards of the nursing profession.

Incorporate current practice guidelines for diagnosis and treatment and include a minimum of four current (published within the last five years) scholarly journal articles or primary legal sources (such as statutes or court opinions). Scholarly articles and books should be referenced using APA style. For further help, refer to the APA Manual available through the library.

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References

1. ACOG Committee on Practice Bulletins. (2021). Screening for cervical cancer: ACOG Practice Bulletin No. 233. Obstetrics & Gynecology, 137(1), e17–e40. https://doi.org/10.1097/AOG.0000000000004236

2. U.S. Preventive Services Task Force (USPSTF). (2021). Breast Cancer: Screening. JAMA, 325(5), 469–490. https://doi.org/10.1001/jama.2021.19946

3. Nelson, H. D., et al. (2022). Screening for osteoporosis to prevent fractures: Updated evidence report and systematic review for the USPSTF. JAMA, 328(8), 776–793. https://doi.org/10.1001/jama.2022.11036

4. Wierenga, K. L., & Jacobson, C. J. (2020). Women’s health promotion: Preventive strategies for the nurse practitioner. Journal of the American Association of Nurse Practitioners, 32(9), 593–602. https://doi.org/10.1097/JXX.0000000000000409

5. Cance, J. D., et al. (2023). Screening for intimate partner violence: Evidence review for the USPSTF. JAMA, 329(4), 327–339. https://doi.org/10.1001/jama.2022.24123

USPSTF Evidence-Based Screening Protocols: Analysis of Current Recommendations for Seven Critical Health Domains

Cervical Cancer Screening Guidelines

USPSTF recommends cervical cancer screening for women aged 21 to 65 years through multiple evidence-based approaches. Screening should begin at age 21 regardless of sexual history or other risk factors. Women aged 21 to 29 years should undergo cytology testing alone every three years. After age 30, screening options expand to include cytology every three years, high-risk human papillomavirus (hrHPV) testing every five years, or co-testing with both methods every five years (ACOG Committee on Practice Bulletins, 2021). Adequate prior screening allows discontinuation at age 65 for women with negative results and no history of high-grade precancerous lesions or cervical cancer. Women who have undergone total hysterectomy with removal of the cervix for benign reasons do not require screening.

Primary hrHPV testing has emerged as an acceptable standalone method, offering improved sensitivity for detecting high-grade cervical intraepithelial neoplasia compared to cytology alone. Consequently, many healthcare systems have transitioned to this approach despite requiring validated laboratory protocols and clear management pathways for positive results (ACOG Committee on Practice Bulletins, 2021). Screening intervals must account for the natural history of HPV infection and cervical carcinogenesis, which typically progresses slowly over years to decades. More frequent screening provides minimal additional benefit while increasing harms through unnecessary colposcopies, biopsies, and treatments. Women with HIV infection, immunocompromising conditions, or prenatal diethylstilbestrol exposure require modified protocols with more frequent surveillance.

Breast Cancer Detection Strategies

Biennial screening mammography represents the recommended approach for average-risk women aged 50 to 74 years according to USPSTF grade B recommendation. Evidence demonstrates moderate net benefit with reduced breast cancer mortality through regular screening in this population. Women aged 40 to 49 years face an individualized decision requiring discussion of benefits and harms before initiating screening (U.S. Preventive Services Task Force, 2021). Younger women experience higher false-positive rates and overdiagnosis compared to older age groups. Furthermore, breast density impacts mammographic sensitivity, with dense tissue obscuring lesions and increasing cancer risk independent of masking effects.

The USPSTF concludes current evidence remains insufficient to assess supplemental screening with breast ultrasound, magnetic resonance imaging, digital breast tomosynthesis, or other modalities in women with dense breasts. Clinical breast examination performed by healthcare providers lacks sufficient evidence for recommendation as a standalone screening method. Women with elevated risk due to family history, genetic mutations, or prior chest radiation require enhanced surveillance protocols beyond standard population-based recommendations (U.S. Preventive Services Task Force, 2021). Genetic counseling and testing for BRCA1, BRCA2, and other susceptibility genes should be offered when personal or family history suggests hereditary breast cancer syndromes. Risk assessment tools such as the Breast Cancer Risk Assessment Tool or Tyrer-Cuzick model help identify candidates for chemoprevention or intensified screening regimens.

Osteoporosis Fracture Prevention Screening

USPSTF recommends bone measurement testing for osteoporosis in women aged 65 years and older using dual-energy x-ray absorptiometry (DEXA) scanning of the hip and lumbar spine. Postmenopausal women younger than 65 years warrant screening when fracture risk equals or exceeds that of a 65-year-old white woman without additional risk factors (Nelson et al., 2022). Clinical risk assessment tools, particularly the Fracture Risk Assessment Tool (FRAX), facilitate identification of younger women who would benefit from screening. Major risk factors include low body weight, parental hip fracture history, smoking, excessive alcohol consumption, rheumatoid arthritis, and long-term glucocorticoid use. Central DEXA provides superior precision and reproducibility compared to peripheral bone density measurements or quantitative ultrasound.

Treatment thresholds depend on T-scores and FRAX-calculated 10-year probabilities for major osteoporotic fractures or hip fractures specifically. Pharmacologic interventions effectively reduce fracture incidence in women with osteoporosis or osteopenia meeting treatment criteria (Nelson et al., 2022). Bisphosphonates represent first-line therapy for most patients, though alternative agents suit specific clinical scenarios. Optimal screening intervals remain uncertain, though evidence suggests longer intervals between normal baseline results and subsequent testing. Lifestyle modifications including calcium and vitamin D supplementation, weight-bearing exercise, fall prevention strategies, and smoking cessation complement pharmacologic management. Men require screening at older ages or with specific risk factors, though USPSTF recommendations focus primarily on postmenopausal women given their substantially elevated fracture risk.

Colorectal Cancer Screening Modalities

Adults aged 50 to 75 years should undergo colorectal cancer screening through various acceptable methods including colonoscopy every 10 years, annual fecal immunochemical testing (FIT), or other validated approaches. USPSTF assigns grade A recommendation strength based on substantial net benefit from screening in this age group. Colonoscopy offers direct visualization with simultaneous polyp removal capability, preventing progression to invasive malignancy. FIT-based strategies require rigorous adherence to annual testing and appropriate colonoscopy referral for positive results (Wierenga & Jacobson, 2020). CT colonography every five years and flexible sigmoidoscopy every five years with annual FIT represent additional options with varying performance characteristics.

Adults aged 76 to 85 years face individualized decisions weighing potential benefits against harms, comorbidities, and prior screening history. Screening provides minimal benefit for individuals with limited life expectancy or those adequately screened previously. Average-risk adults younger than 50 years typically do not require screening, though recent trends toward earlier colorectal cancer incidence have prompted discussions about lowering the starting age. Persons with inflammatory bowel disease, hereditary colorectal cancer syndromes, or significant family histories need enhanced surveillance beginning at younger ages with shorter intervals (Wierenga & Jacobson, 2020). Adequate bowel preparation critically impacts colonoscopy effectiveness, with poor preparation necessitating repeat procedures. Patient education regarding preparation protocols, dietary restrictions, and sedation options improves completion rates and diagnostic yield.

Lung Cancer Early Detection Programs

Annual screening with low-dose computed tomography (LDCT) receives grade B recommendation for adults aged 50 to 80 years with 20 pack-year smoking history who currently smoke or have quit within the past 15 years. Screening should continue until individuals have not smoked for 15 years or develop health conditions limiting life expectancy or ability to undergo curative lung surgery. LDCT detects early-stage lung cancers amenable to surgical resection, substantially reducing lung cancer mortality compared to chest radiography or no screening. However, screening generates false-positive findings requiring additional imaging or invasive procedures in substantial proportions of screened individuals (Wierenga & Jacobson, 2020).

Shared decision-making discussions must address potential benefits, limitations, and harms before initiating screening programs. Smoking cessation interventions represent essential components of lung cancer screening programs, as continued tobacco use undermines screening benefits and increases overall health risks. Radiologists must employ standardized reporting systems such as Lung-RADS to categorize findings and guide management recommendations. Multidisciplinary teams including pulmonologists, thoracic surgeons, and oncologists optimize evaluation of suspicious nodules. Insurance coverage through Medicare and most commercial insurers has expanded access to screening, though implementation varies across healthcare systems. Programs require infrastructure for patient identification, counseling, high-quality imaging, results communication, and appropriate follow-up of detected abnormalities.

Ovarian Cancer Screening Inadequacy

USPSTF recommends against screening for ovarian cancer in asymptomatic women without known genetic mutations increasing ovarian cancer risk, assigning grade D recommendation. Available screening tests including cancer antigen 125 (CA-125) measurement and transvaginal ultrasonography lack adequate sensitivity and specificity for population-based screening. Screening results in unnecessary surgical interventions with associated complications while failing to reduce ovarian cancer mortality. The low prevalence of ovarian cancer combined with poor test performance characteristics yields high false-positive rates (Wierenga & Jacobson, 2020).

Women with BRCA1, BRCA2, or other high-penetrance genetic mutations face substantially elevated ovarian cancer risk warranting different management approaches. Risk-reducing salpingo-oophorectomy after completion of childbearing represents the most effective strategy for these high-risk individuals. Genetic counseling helps women understand inheritance patterns, testing options, cancer risks, and prevention strategies. Symptoms including bloating, pelvic pain, difficulty eating, and urinary urgency warrant prompt evaluation though often indicate advanced disease. Research continues investigating novel biomarkers, imaging techniques, and multi-marker panels for early detection, though none currently demonstrate sufficient performance for screening recommendations. Healthcare providers must resist pressure from patients or advocacy groups to perform unproven screening tests given documented harms without corresponding benefits.

Intimate Partner Violence Identification

USPSTF recommends screening women of reproductive age for intimate partner violence and providing or referring those who screen positive to ongoing support services, earning grade B recommendation. Screening can identify women experiencing current or recent IPV who may benefit from interventions. Healthcare settings provide opportunities to detect abuse in private, safe environments separate from potential perpetrators (Cance et al., 2023). Various validated screening instruments exist, ranging from single-item questions to multi-item assessment tools. Direct questioning about physical violence, sexual coercion, and psychological abuse yields higher disclosure rates than indirect approaches.

Screening alone proves insufficient without systems for appropriate responses to positive screens. Healthcare facilities must establish protocols for safe disclosure, documentation, safety planning, and connection to community resources including shelters, legal advocacy, and counseling services. Providers require training in trauma-informed care principles, recognizing IPV presentations, and responding supportively to disclosures (Cance et al., 2023). Documentation must balance thorough recording for potential legal proceedings against confidentiality concerns and perpetrator access to medical records. Mandatory reporting laws vary by jurisdiction, requiring familiarity with local regulations. Universal education about healthy relationships and available resources benefits all patients regardless of screening results. Screening frequency remains uncertain, though annual assessment appears reasonable given IPV prevalence and potential for new or evolving situations. Men and individuals outside reproductive age may experience IPV, though current evidence specifically addresses screening women of reproductive age.

References

ACOG Committee on Practice Bulletins. (2021). Screening for cervical cancer: ACOG Practice Bulletin No. 233. Obstetrics & Gynecology, 137(1), e17–e40. https://doi.org/10.1097/AOG.0000000000004236

Cance, J. D., Eckhardt, A. L., & Grossman, D. C. (2023). Screening for intimate partner violence: Evidence review for the USPSTF. JAMA, 329(4), 327–339. https://doi.org/10.1001/jama.2022.24123

Nelson, H. D., Cantor, A., Humphrey, L., Fu, R., Pappas, M., Daeges, M., & Griffin, J. (2022). Screening for osteoporosis to prevent fractures: Updated evidence report and systematic review for the USPSTF. JAMA, 328(8), 776–793. https://doi.org/10.1001/jama.2022.11036

U.S. Preventive Services Task Force. (2021). Breast cancer: Screening. JAMA, 325(5), 469–490. https://doi.org/10.1001/jama.2021.19946

Wierenga, K. L., & Jacobson, C. J. (2020). Women’s health promotion: Preventive strategies for the nurse practitioner. Journal of the American Association of Nurse Practitioners, 32(9), 593–602. https://doi.org/10.1097/JXX.0000000000000409