Recommended Screening Test: Papanicolaou Smear
This woman of reproductive age planning pregnancy within 2 years should undergo Papanicolaou (Pap) smear screening, making option B the correct answer. Her breast tenderness is a normal physiologic finding that does not warrant imaging in the absence of abnormal clinical examination findings.
Cervical Cancer Screening Rationale
Pap smear screening is indicated for this patient based on standard cervical cancer screening guidelines:
- Women should begin Pap testing approximately 3 years after becoming sexually active, but no later than age 21 1
- For women using conventional Pap tests, screening should occur annually 1
- For women using liquid-based Pap tests, screening intervals can be every 2 years 1
- Pregnancy provides an excellent opportunity to screen women who may not otherwise seek routine gynecologic care 2
- Pap testing during pregnancy is safe, necessary, and acceptable as a routine prenatal test 3
Why Breast Imaging Is NOT Indicated
The breast tenderness described is physiologic cyclical mastopathy, not a pathologic finding requiring imaging:
- Cyclical breast tenderness beginning 3 days before menses is a normal premenstrual symptom, not an indication for screening 4, 5
- Clinical breast examination showed bilateral symmetry with no palpable abnormalities 1
- Breast ultrasound (Option A) is not indicated for normal cyclical breast tenderness without a palpable mass or other concerning findings 6
- Mammographic screening begins at age 40 for average-risk women 1
- Between ages 20-39, clinical breast examination every 3 years is sufficient for average-risk women 1
Why Other Options Are Incorrect
HPV testing (Option C) is not the primary screening modality:
- HPV testing may be used in conjunction with Pap testing beginning at age 30, but Pap smear remains the primary screening test 1
- For women under 30, Pap testing alone is the standard approach 1
Group B Streptococcus screening (Option D) is premature:
- GBS screening is performed at 35-37 weeks gestation in pregnant women, not during preconception planning 1
- This patient is not yet pregnant and plans pregnancy within 2 years 1
Clinical Pearls
- Normal cyclical breast tenderness affects many reproductive-age women and peaks premenstrually 5
- The absence of family history of cancer and normal breast examination findings further support that breast imaging is unnecessary 1
- Routine prenatal care provides an opportunity to address cervical cancer screening in women who may have delayed preventive care 2, 3