Assignment: Prophylactic Hysterectomy Essay
Assignment: Prophylactic Hysterectomy Essay
The lifetime risk of developing ovarian cancer is approximated at 1-2%. Family history is a major risk for the development of ovarian cancer. In most cases, the family links are associated with genetic inheritance; therefore, increasing the genetic composition to the diseases resulted in the creation of its registry. Various measures have been developed to minimize the incidences of ovarian cancer and some of them include increasing surveillance and use of pelvic ultrasound among others. The study conducted by Villella, Parmar, Donohue, Fahey, Piver, & Rodabaugh (2006) aimed at analyzing the current recommendations for the risk reduction of ovarian cancer. The use of prophylactic bilateral salpingo-oophorectomy for high-risk women is highly recommended. On the other hand, controversies have been linked to the practice with the main question being ‘‘is hysterectomy necessarily and prophylactic surgery?’’Therefore, the study aimed at determining the outcomes of the women who underwent the hysterectomy as part of their initial procedure.
According to the study findings, the major factor affecting the women at risk of developing ovarian or breast cancer is the identification of the measures to use in their reduction (Villella et al., 2006). Cancer is highly lethal with a high rate of mortality. Therefore, developing appropriate preventive and management measures would help significantly in reducing the mortality rate. The carriers of the BRCA1 and BRCA2 genes are at lifetime risk of developing the two cancers. Also, women carrying the two germline mutations may decide to undertake the prophylactic oophorectomy as a way of reducing their risk of developing ovarian and breast cancers (Villella et al., 2006).
The extent of surgery remains a major debate considering that some authors believe that the addition of the hysterectomy to the BSO will eliminate the need of having a gynecological surgery in the future. Additionally, hysterectomy has been recommended by some scholars due to its ability to reduce the risk of developing endometrial cancer (Villella et al., 2006). Also, the procedure has been associated with the reduction of risk of developing fallopian tube cancer. On the other hand, the opponents to the procedure claims that carcinoma of the fallopian tube is part of the clinical spectrum and thus there is no need of preventing future malignancies through the hysterectomy.
The study findings, in this case, indicated that while women may not require a hysterectomy for the fallopian tube and ovarian cancers, it is necessary that they are screened for benign gynecological indications that may require the procedure (Villella, et al. 2006). Therefore, in incorporating hysterectomy as part of the prophylaxis procedure, caution must be taken to distinct women with a family history of cancer.
From an ethical perspective, the issue on whether to integrate hysterectomy as a prophylactic procedure for fallopian and ovarian cancer continues to raise a lot of debates and opposing points of view. Therefore, does the procedure offer any beneficial outcomes to the patients? Various studies have shown that the procedure is necessary because it helps in the reduction of the risk of the fallopian tube and endometrial cancer in various ways (Pozgar, 2019). In exploring this ethical concern, both the pros and cons of the procedure must be considered and weighed.
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According to the findings in the current study, there is no sufficient evidence to fully support the need for hysterectomy in preventing the development of fallopian tube cancer in women. Cancer development is triggered by various factors including the genetic
composition. Promoting public health is an important ethical obligation for al healthcare providers. Therefore, before undertaking any procedure, it is important to fully explore its short-term and long-term health implications to the patient. The main question, in this case, is whether the hysterectomy adds any value to the patients at risk of ovarian and breast cancer or not. Therefore, it is important to ascertain that the procedure will truly impact the patient positively by preventing the development of fallopian tube cancer and other cancers before initiating it.
Early screening and identification of ovarian cancer result in good health outcomes to the patients. Ovarian cancer is a deadly disease; therefore, having a proper diagnosis and screening measures would help significantly in reducing its associated morbidity and mortality among women. Women without a family history of ovarian cancer are not advised to undergo the screening tests unless they are enrolled in a clinical trial. However, with a family history are at high risk and can significantly benefit from the screening tests. The screening tests include checking for the CA 125 marker in the blood.
On the other hand, it is important to note that the marker may also be increased in women with uterine fibroid, endometriosis and pelvic infections. Apart from the test, a pelvic ultrasound can also be done to help in the screening (Siwek, 2016). Vaginal ultrasound can detect about 80% to 100% of the ovarian cancer cases (Siwek, 2016). The CA 125 marker tests does not cost much and thus suitable for the patients lacking health insurance. However, the patients may also be educated on the importance of enrolling for health insurance to enhance their ability to access health services in case they are diagnosed positive for ovarian cancer (Paluch-Shimon et al., 2016). Additionally, the education plan would involve encouraging the patients to use hormonal therapies as a way of reducing the menopausal associated risks.
For this assignment, you will review and reflect on the Prophylactic Hysterectomy article. This article can be applied to healthcare providers in the primary care and specialty settings. Discussion of the article is based on the course objectives and weekly content, which emphasize the core learning objectives for an evidence-based primary care curriculum. Throughout your nurse practitioner program, discussions are used to promote the development of clinical reasoning through the use of ongoing assessments and diagnostic skills, and to develop patient care plans that are grounded in the latest clinical guidelines and evidence-based practice.
Discuss any “take-away” thoughts from the article.
What are the ethical dilemmas to consider with prophylactic surgeries?
Discuss the screenings/interventions/options/education that you would provide to a patient that has a strong family history of ovarian cancer. What if the patient has no health insurance? What resources could you offer to assist the patient?