36C24419R0074-019.pdf

DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER

Erie, Pennsylvania

Medical Center Memorandum No. 11-34 October 29, 2014

SCREENING FOR CERVICAL CANCER

I. PURPOSE: To establish policy, responsibility, and outline procedures for cervical cancer screening.

II. POLICY: Cervical cancer screening will be completed as per national VHA standards for female patients, inpatient, ambulatory, Sharing Agreement, TriCare, and CHAMPVA.

These screenings will be done by the patient’s women’s health primary care provider (WH PCP) or, if not on the panel of a designated WH PCP, by a CBOC or facility women’s health provider of the patient’s preferred gender.

III. RESPONSIBILITY:

A. Medical Center Director is responsible for all policy and the implementation of procedures concerning this program.

B. Chief of Staff is responsible for providing competent medical staff as well as guidance, education and logistical support of this program.

C. Providers/ Ambulatory Care staff/Treatment Team will ensure performance of cervical cancer screenings, and repeat screening and/or appropriate referral to Non VA Care gynecology determined by the cervical screening result per VHA/Network/facility Guidelines.

D. Women Veterans Program Manager (WVPM) is available as a resource person to both staff and patients regarding all aspects of this program.

IV. PROCEDURES:

A. All female outpatients will be assessed by their Primary Care provider and given care as appropriate. Documentation of most recent pap, if done outside this facility, should be completed using the pap clinical reminder. Justification for deferral of cervical cancer screening must be documented.

B. All female inpatients will have documentation of cervical cancer screening in the History and Physical when appropriate. Justification for deferral of this examination must be documented.

Attachment Q

MCM 11-34, Screening for Cervical Cancer

C. Maximum privacy will be provided for purposes of personal hygiene activities and examinations.

1. Privacy curtains are to be used in all areas such as an emergency/urgent care areas, examination rooms, procedure rooms, and inpatient private rooms.

2. Examination tables are to be positioned in such a way that the end of the examination table is facing away from the doorway.

3. A restroom should be located adjacent to the exam room or, if not available, in close proximity so that the patient does not have to walk through a public area to get to one.

D. Women veterans with non-routine gynecological problems may be referred via

Non VA Care GYNECOLOGY consult to a community provider of their choice.

Necessary patient medical records will be sent to the community provider for their review prior to the scheduled appointment.

E. A female chaperone must be in the examination room during examinations, procedures, or treatments involving the breast and genitalia, regardless of the gender of the provider. In addition to breast examinations and pelvic examinations, and Pap smears, this may include procedures such as Urodynamic testing or treatments such as Pelvic Floor Physical Therapy.

F. All patients whose Pap smear results are normal should receive a mailed communication within 7 working days of result being available to the provider stating their results and stressing the importance of continued cervical screening.

G. Women veterans whose Pap smear results are not normal will be assessed by their

WH PCP or referring provider who will then take proper and appropriate action to assure medical follow up.

H. A process will be in place that will track the results of this cytological screening.

I. An electronic clinical reminder will be used to assure completion.

J. Guidelines for Providers:

1. VHA recommends screening with cytology (Pap test) every 3 years for women ages 21–65 who have a cervix.

2. VHA recommends against using HPV testing alone or in combination with cytology for cervical cancer screening in women younger than 30 years. In women 21–30 years of age, there is a high incidence, approximately 27 percent, of HPV infection, which usually resolves and could lead to

MCM 11-34, Screening for Cervical Cancer unnecessary procedures. In fact, 80 percent of women in this age group with detectable HPV infection spontaneously clear it within 2 years.

3. For women ages 30–65 who wish to lengthen the screening interval, screening with a combination of cytology and human papillomavirus (HPV) testing every 5 years is acceptable. Positive screening results are more common with strategies that include HPV testing than with strategies that use cytology alone; this could lead to increased testing.

4. VHA recommends against screening for cervical cancer in women who have had a total hysterectomy for benign disease. At any age, if the patient has had a hysterectomy due to cervical or other gynecological malignancy, vaginal cytology / pap should be obtained as clinically indicated. The sample should be collected from the vaginal cuff, the area in the upper vagina where the cervix was once located.

5. VHA recommends stopping cervical cancer screening of women at age 65, unless they are at high risk* for cervical cancer or have had inadequate screening. Providers should consider whether or not to screen patients of any age that, although not terminally ill, have a life expectancy of less than 10 years. These patients are unlikely to benefit from screening.

V. REFERENCES:

A. U.S. Preventive Services Task Force Recommendation Statement: Screening for Cervical Cancer. U.S. Preventive Services Task Force 2012. Available at:

http://vaww.prevention.va.gov/Screening_for_Cervical_Cancer.asp

B. VHA Handbook 1330.01, Healthcare Services for Women Veterans

VI. FOLLOW UP RESPONSIBILITY: Women Veteran’s Program Manager, Women’s Health Case Manager, PACT Teamlets

VII. REPORTING REQUIREMENTS: The Women Veterans Program Manager will report the status of the program annually to MEC

VIII. RESCISSION: MCM 111-04, Screening for Cervical Cancer, dated July 23, 2008.

(Original Signed 10/29/14) Barbara Forsha Interim Medical Center Director