Breast Cancer and Cancer

¶ … Woman Exam With Pap Smear

Subjective

The patient is a 28-year-old white Caucasian woman who is married with no children. She is a professional insurance adjustor and travels frequently throughout the year to settle claims, as she works for the disaster division of the insurance company that is her employer.

The patient is presenting for her annual Well Woman Exam with Pap smear. The patient is a healthy female with no issues. She discusses exercise, nutrition, smoking, alcohol consumption, sexual practices and menstrual cycles with her health care provider as is the custom with a Well Woman visit. A Pap smear is performed upon request.

The patient has no precipitating/alleviating factors, as there are no issues pertaining to health wellness that the patient describes. She does not smoke, abuse alcohol, or eat an improper diet. She exercises regularly in spite of her frequent travels and her sexual activity is healthy; she stated that she does not engage in extra-marital sexual intercourse. She demonstrates no associated symptoms of illnesses, and her Pap smear indicates no sign of cervical cancer.

The patient's quality of life is reported as being very high: she enjoys outdoor activities, has a healthy social life, easily makes friends everywhere she goes (and for this reason has friends in many cities around the world, due to her frequent travels); she is interactive with members of her community and church, expresses no symptoms of depression, has a good relationship with her husband, and the two of them are now considering having children. They feel financially secure at this point in their lives, their house is paid off, and their jobs are stable. She is comfortable with where she is in life and is looking forward to the next stage.

The issue of how children might effect her job situation was discussed and she stated that she can always move back to a position that allows her to work locally and that will not require travel if she and her husband do decide to have children. Currently, she is using birth control and a discussion of returning to a natural menstrual cycle was conducted.

Because she is under the age of 50 the patient is not determined to be at risk for breast cancer and she declined a mammogram, as she had received one in the prior year and it is only recommended that a mammogram be performed every three years for women over the age of 20. Once she is at 40 years of age, she was informed that the mammogram should be performed every year.

Patient discussed with the health care provider the subject of pubic hair grooming because she wanted to know what was "normal" for women her age and whether the provider had any advice on common practices. The provider told her that is now "more common than not for women to have groomed their pubic hair" (Demaria, Berenson, 2013).

Patient did express some concern over the usefulness of gynecologic exams -- the Pap smear -- as she had come into contact with misconceptions about cancers. The provider discussed the patient's beliefs and values regarding performing pelvic examinations and why it is important for the Pap smear (Stormo, Cooper, Hawkins et al., 2012).

Objective

Pap smear results were normal indicating no sign of cervical cancer. HPV test was also conducted and results were negative. Discussion was had about when to conduct next Pap smear and HPV test and whether her tests would be covered by her husband's insurance, should she choose to leave her job upon having a child and starting a family. The patient was instructed to check into this as most insurance providers cover preventive medicine procedures such as this (Bitler, Carpenter, 2016).

The woman's sexual activity was discussed and assessed as healthy as she did not engage in risky sexual behavior; her grooming habits were also assessed as normal and common.

The patient did not require or request a psychological examination and did not indicate any signs of having depression or any other psychological or emotional or behavioral disorders. Her mood was upbeat and positive and her only concerns were with starting a family and moving to the next step in life. The well woman examination was concluded upon the providing of further recommendations about stopping birth control in order to facilitate conception and steps she could take in inquiring about discussing with a provider the type of care she would like going forward in the process of starting a family.

A check into family history of the patient revealed a history of breast cancer in the family and so it is important to monitor the breasts in this case, and this was expressed to the patient.

Assessment

The patient is a healthy woman and her Pap smear indicated no signs of cervical cancer. Her emotional state is healthy and strong and her well woman exam proceeded with typical calmness.

The patient was instructed to have another well woman exam in a year and that a Pap smear should be conducted in another 3 years. A mammogram would be scheduled in a year so as to maintain a watch over the possibility of breast cancer.

Health risks assessment conducted for the patient indicated that her family history poses a risk for breast cancer, which means that she should be monitored carefully in the coming years. A preventive plan based on reducing the risk for developing cancer in both the breasts and in the cervix was discussed and that plan is outlined below for the patient.