Returning Relevance to the Women’s Health Visit

Abstract

Denise G. Link, PhD, WHNP-BC In the 1940s, when the Pap smear was first introduced, cervical cancer was the number one killer of women. Over the years, the annual Pap test became the cornerstone for women’s health care. The campaign became a model for successful cancer prevention, and the result was a dramatic decrease in mortality from cervical cancer in the United States. The guidelines for cervical cancer screening have been revised several times as a result of improved understanding of the role of human papillomavirus in the development of cervical changes that lead to cancer and the unintended consequences of aggressive management of early cervical dysplasia that would likely resolve without intervention, particularly in late adolescent and young adult women. In a survey jointly conducted by the National Association of Nurse Practitioners in Women’s Health and HealthyWomen in 2014, responses from both patients and providers indicated a belief that the Pap test is important to their overall health and wellbeing. The extension of the interval between Pap testing has created concern among patients. There is also a belief among providers that lengthening the Pap testing interval may adversely affect women’s health in that if they are no longer in need of an annual Pap test, patients will forego routine visits that provide opportunities for screening for other types of health problems, health promotion/disease prevention services, and assistance with adopting and maintaining healthy lifestyle behaviors. When the new Pap testing guidelines were applied at our clinic, we witnessed a dramatic decrease in the number of appointments for well woman care. When I would end an office visit with a “see you in a year” message, patients frequently asked “What for? Why do I need to return in a year if you are not going to do a Pap?” Informal discussions with colleagues