Family nurse practitioners (FNPs) are able to perform many of the same health care duties as physicians, from diagnosing illnesses to prescribing medications. Furthermore, FNPs tend to emphasize preventative medicine, working with patients to ensure they live the healthiest lives possible, in a bid to curtail incidence of chronic conditions such as heart disease and diabetes.
Screening for certain cancers, including breast and cervical cancer, falls under the preventative health care umbrella. FNPs can help in spreading awareness and understanding among patient populations about the importance of screening measures.
With breast and cervical cancer in particular, FNPs can implement a number of strategies to encourage more frequent screening, which can lead to more widespread early detection of the diseases, helping to improve patient outcomes.
A closer look at cervical and breast cancer
Researcher N.S. Leslie wrote in an abstract published by the U.S. National Library of Medicine that breast and cervical cancer have the highest mortality rates for women compared with other cancers that can develop in the reproductive system.
I. Cervical cancer
Cervical cancer is a term that refers to any malignancy that forms in the cervix. An article published by the Prevent Cancer Foundation pointed out that roughly 4,200 women die annually from the disease, and upward of 12,820 women receive a cervical cancer diagnosis each year.
As explained in a U.S. Centers for Disease Control and Prevention (CDC) educational guide, the human papillomavirus (HPV), in a vast majority of cases, is what causes the development of cervical cancer. HPV is a ubiquitous virus that is contracted sexually. Given how common HPV is — 80 percent of sexually active adults will contract it at some point — it is important to note that a majority of women who become infected with the virus may not develop cervical cancer. If they do develop cervical cancer they often do not show symptoms until the disease is significantly advanced. The disease is often asymptomatic and the body may eradicate the virus without individuals being aware they have it. Cervical cancer is a threat when certain dangerous strains of HPV are contracted, such as types 16 and 18.
Given the link with HPV, cervical cancer poses a threat to any woman who is, or who has been, sexually active. The CDC guide noted, however, that women over the age of 30 are at the highest risk.
II. Breast cancer
A fact sheet circulated by the CDC noted that breast cancer is a term that denotes the development and proliferation of cancerous cells in breast tissue. It is by far one of the most common cancers to affect women, although men also have a small risk of developing the condition.
Unlike cervical cancer, which almost invariably is caused by HPV, a number of factors can increase an individual’s risk of developing breast cancer. Information from the CDC cited age and gender as the major reasons why breast cancer develops in patients —women over the age of 50 are statistically at the most risk. Other potential risk factors include being overweight or obese, having a family history of the disease, carrying a genetic mutation, not exercising enough and taking certain forms of birth control. For a comprehensive list of risk factors, review the CDC fact sheet.
Screening methods
Both cervical and breast cancer easily can be screened for, allowing for earlier detection that can help save lives. For example, information published by the Prevent Cancer Foundation reported that screening for cervical cancer has slashed considerably the mortality rate among women with the disease in the half century since it was introduced. Furthermore, according to findings from the International Agency for Research on Cancer, women who undergo breast cancer screening are at a much lower risk of death from the condition — by some 40 percent — than those who opt out of proactive screening.
Cervical cancer screening
Cervical cancer is screened through a method known as a pap smear. As stated in a CDC fact sheet, a pap smear is a process wherein a gynecologist removes a small tissue sample from the patient’s cervical area. This sampled then is assessed under a microscope for signs of cancerous or precancerous cells. The HPV test is another cervical cancer screening method, which typically is used in conjunction with the pap smear.
Breast cancer screening
Breast cancer is screened for with a mammogram. Information published by the CDC pointed out that a mammogram is essentially where the breast tissue undergoes an X-ray to look for any abnormalities that could signify the presence of cancer.
FNPs can encourage screening
FNPs should actively encourage women to receive both breast and cervical cancer screenings, with some studies indicating that FNPs can be more effective at boosting screening rates among patient populations than reminders from physicians.
For example, according to a literature review from researchers Alexandria A. Smith, Deanna Kepka and K. Robin Yabroff, one study that looked into the efficacy of breast cancer screening found that when patients received screening reminders from an NP, rates of adherence were dramatically higher when compared with those who received reminders via a provider orientated system. The disparity was 18.3 percent to 40 percent.
The same method also was used to assess the effectiveness of provider reminder systems when compared to NPs offering screening reminders for cervical cancer. The results again favored the NP-oriented method.
Strategies for FNPs to encourage screening
Some of the most effective ways that FNPs can encourage screening include:
1. Understanding barriers to screening
As detailed in a white paper from the CDC, there are certain demographics of women who are statistically less likely to utilize screening services, particularly for breast cancer. Examples include, women from low income backgrounds, women with lower levels of education, women in rural areas with less physical access to health care and women of color. The organization therefore recommended that providers be cognizant of these barriers and alter their screening awareness strategies accordingly. For example, in the case of patient groups with low health literacy levels, FNPs are encouraged to deliver information about the importance of routine screening in a way that is comprehensive yet easily understandable. This may be achieved with the help of written materials, videos or other kinds of media.
In any case, all FNPs should deliver information to all female patients about the importance of cancer screening, covering in some detail why screening is important and when and how it will be conducted.
2. Sending reminders
Taking steps not just to educate patient populations about the importance of screening but to send reminders about upcoming appointments is also key. As proposed in a guide published by the U.S. Health Resources and Services Administration (HRSA), an example of a reminder system that FNPs can implement is sending hard-copy letters directly to clients. Another useful method for sending reminders is via digital technology. A literature review from researchers Hani Eskandar, Mary-Anne Land et al, published by Cancer Control, reported on two studies concerning cancer screening and mobile phones. One study found that, in an unspecified high-income nation, screening increased by some 23 percent when patients were enrolled in a text message information and reminder program.
FNPs also can take steps to connect patients with educational online resources that outline the significance of routine cancer screening.
3. Establishing community connections
Another practical way to spread cancer screening awareness among populations is through programs that involve the local community. For example, HRSA guidelines noted that it can be helpful for providers to put patients, particularly those from low-income backgrounds, in contact with screening centers that offer free screening on a routine or occasional basis. This kind of community-led approach to screening intervention also may involve developing awareness events in conjunction with organizations such as the local church and passing out free literature concerning breast and cervical screening in public spaces.
Further reading:
https://www.ncbi.nlm.nih.gov/pubmed/7664252