From the Guidelines
The patient should not be screened for cervical cancer at this time, as current guidelines recommend starting cervical cancer screening at age 21, regardless of sexual activity or other risk factors. According to the US Preventive Services Task Force (USPSTF) recommendations 1, women younger than 21 years should not be screened for cervical cancer. This recommendation is based on the potential harms of screening, including unnecessary procedures and stress, outweighing the benefits in this age group.
However, it is essential to consider the patient's risk factors, including early sexual debut and multiple partners, which increase her risk of HPV exposure and cervical cancer. Despite these risk factors, the guidelines prioritize the age-based recommendation for screening.
Regarding HPV vaccination, the American Cancer Society recommends routine HPV vaccination for females aged 11 to 12 years, but also for females aged 13 to 18 years to "catch up" those who missed the opportunity to be vaccinated or who need to complete the vaccination series 1. For women aged 19 to 26 years, the decision to vaccinate should be based on an informed discussion between the woman and her healthcare provider regarding her risk of previous HPV exposure and potential benefit from vaccination. Given the patient's age and risk factors, a discussion about HPV vaccination may be warranted, but the current guidelines do not strongly recommend vaccination for women in this age group 1.
In summary, the patient should not undergo cervical cancer screening at this time, but her healthcare provider should continue to monitor her risk factors and consider discussing HPV vaccination with her. The patient's healthcare provider should also ensure that she receives adequate education on cervical cancer prevention and screening, as well as the importance of regular health check-ups.
From the Research
Recommended Course of Action
Based on the provided evidence, the following recommendations can be made for the patient:
- The patient should receive the human papillomavirus (HPV) vaccination series, as she has not received it yet 2, 3, 4, 5.
- The patient should undergo a Pap test, as she has never had one before 6.
- The patient's sexual history and HPV vaccination status should not be used to determine her eligibility for the HPV vaccine 3.
- The patient's provider should recommend the HPV vaccine and Pap testing, and the patient should be encouraged to initiate Pap testing herself 6.
Rationale
The rationale for these recommendations is as follows:
- The HPV vaccine is effective in preventing high-grade precancerous cervical lesions and is recommended for individuals who have not been infected with HPV 2, 4, 5.
- The patient's age and sexual history do not preclude her from receiving the HPV vaccine, as the vaccine is recommended for individuals up to 26 years of age 3.
- Pap testing is an important screening tool for cervical cancer, and the patient should undergo regular Pap testing 6.
- The patient's provider plays an important role in recommending the HPV vaccine and Pap testing, and the patient should be encouraged to take an active role in her health care 6.